MMHA 6600 Week 9 Anesthesia Record Go-Live Example

Not Yet, and Not Everywhere: A Go-Live Readiness Assessment for the Electronic Anesthesia Record

Student Name

Walden University

MMHA 6600: Healthcare Informatics and Technology Management

Instructor Name

Month Day, Year

Not Yet, and Not Everywhere: A Go-Live Readiness Assessment for the Electronic Anesthesia Record

Question and Answer

Bramble Creek Hospital, the composite hospital used across this course, plans to replace paper anesthesia records with an electronic anesthesia record in all five operating rooms and the endoscopy suite on a single date six weeks from now. The steering committee asked whether the hospital is ready. This assessment answers no, not on that date and not in all six locations at once. It recommends starting in two operating rooms, with elective cases only, three weeks after the planned date, and expanding when stated conditions are met.

The answer rests on criteria agreed with the steering committee before any evidence was gathered, so that the judgment would not drift toward the date already announced. Readiness assessments are most useful when the criteria are fixed first and the evidence is then reported against them without adjustment (Cresswell et al., 2013).

Criteria

Eight criteria were agreed, grouped into technology, people, process and support. Each has a threshold that counts as ready.

Table 1

Readiness Criteria, Thresholds and Findings

Two criteria are met, three partly met and three not met. None of the three unmet criteria can be closed in six weeks across all locations.

Why the Unmet Criteria Matter

Device integration is the core of the electronic anesthesia record. Its value depends on vital signs flowing automatically from monitors, which frees the anesthesia provider from hand-charting during critical moments. In rooms where the integration is not validated, providers would have to type vitals while managing the patient, the opposite of the intended benefit. Published implementation guidance for anesthesia information systems stresses device connection and validation as a precondition for go-live rather than a follow-up task (Muravchick et al., 2008).

Training matters because errors in a new system come disproportionately from unfamiliar users under time pressure. Night-shift nurse anesthetists cover urgent cases, exactly the cases where an untrained user would be most likely to fall back on workarounds. Unrehearsed downtime procedures matter because the first weeks after a go-live are when unplanned outages are most likely, as interfaces are tuned and settings adjusted, and a downtime procedure that has never been practiced is only a document. Electronic records introduce new safety hazards alongside their benefits, and readiness to manage those hazards is part of readiness itself (Sittig & Singh, 2012).

The Narrower Start

The hospital does not need to choose between the full plan and indefinite delay. Two operating rooms already meet the device, hardware and support criteria. A phased start in those rooms reduces the training requirement to the staff who work there, can be scheduled to avoid night and urgent cases, and gives the team real use to learn from before expansion.

Table 2

Phased Start and Expansion Conditions

Every phase has an entry condition drawn from the original criteria, so expansion is earned rather than scheduled.

What the Phased Start Costs

Running paper and electronic records side by side for several weeks adds work for the anesthesia department and for health information management, which must handle two record types. The vendor's implementation team will be on site longer. These costs are real but smaller than the cost of a hospital-wide go-live in which providers hand-chart into an electronic form in rooms without device integration. The steering committee should also expect pushback from staff who prepared for the original date; explaining the criteria publicly will help. Surgeons, too, may resist a period in which some rooms chart electronically and others on paper, since case turnover depends on predictable routines. Assigning the two electronic rooms to a small group of surgeons who volunteer, and publishing the expansion criteria on the perioperative unit's board, will make the phased start visible and fair. Health information management will need a short written rule on which record is the legal record for each room during the transition, so that audits and billing queries do not stall.

Recommendation

Postpone the go-live by three weeks and begin in Operating Rooms 1 and 2 for elective weekday cases. Rehearse the downtime procedure in Room 1 within two weeks. Complete device validation in Rooms 3 to 5 and schedule training for night staff now. Review readiness against Table 2 at each phase gate, with the chief of anesthesia and the perioperative director signing off.

Conclusion

Bramble Creek is close to ready in two rooms and not ready in the rest. Saying so is not a failure of the project; it is the purpose of a readiness assessment. A narrower start lets the hospital learn on a manageable scale, expand as each condition is met, and avoid asking clinicians to manage patients and an unfinished system at the same time.

References

Cresswell, K. M., Bates, D. W., & Sheikh, A. (2013). Ten key considerations for the successful implementation and adoption of large-scale health information technology. Journal of the American Medical Informatics Association, 20(e1), e9-e13. https://doi.org/10.1136/amiajnl-2013-001684

Muravchick, S., Caldwell, J. E., Epstein, R. H., Galati, M., Levy, W. J., O'Reilly, M., Plagenhoef, J. S., & Vigoda, M. M. (2008). Anesthesia information management system implementation: A practical guide. Anesthesia and Analgesia, 107(5), 1598-1608. https://doi.org/10.1213/ane.0b013e318187bc8f

Sittig, D. F., & Singh, H. (2012). Electronic health records and national patient-safety goals. New England Journal of Medicine, 367(19), 1854-1860. https://doi.org/10.1056/NEJMsb1205420