BUSI 505 Week 8 Case Study Discussion Board Forum 4 Example

Case Study Discussion Board Forum 4: Managing a Health Information System Implementation

BUSI 505 Healthcare Informatics, Case Study Discussion Board Forum 4

Thread by [Student Name]

The health system, its conversion plan and the classmates are composites; the textbooks, Scripture and the peer-reviewed sources cited are real.

Our case is a regional health system with four hospitals, 40 clinics and about 9,000 employees that has signed a contract to replace three separate electronic health records with a single new system. The board approved an 18-month timeline and a budget of several hundred million dollars, much of it for training and support. As part of the project leadership team, I was asked what we should learn from other organizations' experiences before setting our plans. Leaders are focused on the go-live date; the evidence suggests they should be equally focused on the months after it. The communications plan, the budget and the vendor contract all treat go-live as the finish line, and very little money is set aside for the optimization work that typically follows.

The first warning concerns safety. Jämsä et al. (2026) examined patient safety incidents at a large university hospital in the six months before and after an imaging module went live as part of a new electronic record. Incident reports targeting radiology rose from 161 to 296, and 100 of the non-serious reports after go-live were tied directly to the new module, most involving information flow and delayed or missing examinations or reports. Serious radiology incidents rose from one before go-live to twelve after, with eleven related to the new system and most involving prolonged delays in reporting MRI or CT results for high-risk patients. Root cause analyses pointed to information technology management and configuration problems. In other words, the harm came less from users' mistakes than from how the system was built and connected, which is something a project team can test and fix before patients are affected.

The second warning concerns usability and the workforce. Lohmann-Lafrenz et al. (2025) surveyed 1,424 health professionals at a Norwegian university hospital six months after a new record replaced the old one. The median usability score was 25 out of 100, ranging from 15 among physicians to 40 among laboratory technicians. Staff in the lowest quarter of usability scores were about three times as likely to report burnout, almost twice as likely to report insomnia and more than twice as likely to report intending to leave. For a health system already struggling to recruit, losing experienced nurses and physicians because of a frustrating system would be a costly and lasting consequence of the project.

Braunstein (2014) describes implementation as a sociotechnical change in which workflows, roles and technology must be redesigned together, and Nelson and Staggers (2014) present system implementation as a life cycle that continues well past go-live into optimization and evaluation. Applied to our case, I would recommend five safeguards. First, stage go-lives by hospital rather than converting all four at once, so lessons from the first site improve the rest and support teams are not stretched across every building on the same day. Second, run a safety command center for at least 90 days after each go-live, monitoring incident reports, delayed results, orders without results and medication alerts daily. Third, test critical workflows, especially results routing and medication administration, with frontline staff before go-live. Fourth, measure usability and burnout at three, six and twelve months and fund optimization teams to fix the worst problems. Fifth, keep elbow support and super users on units well beyond the first few weeks. Go-live is not the finish line of an EHR project; it is the start of its most dangerous months.

The Chronicler says of King Hezekiah that every work he undertook he did with all his heart, and he prospered (English Standard Version Bible, 2001/2016, 2 Chronicles 31:21). A conversion of this size requires that kind of wholehearted commitment, sustained long after the celebration of go-live day.

Reply to Leah

Leah, you argued that training is the most important factor in a successful conversion and asked what kind of training works best. Your instinct is shared by most project teams, which often spend a large share of their budgets on classroom instruction and online modules before go-live. I agree that training matters, but evidence suggests the most valuable support may come after classroom training ends. Classroom sessions happen weeks before go-live, using practice patients and simplified scenarios, and much of what is learned fades before staff face real patients on a busy unit. Brunner et al. (2026) evaluated a national peer coaching program that the Department of Veterans Affairs used during its multi-site transition to a new electronic record, in which experienced staff from earlier sites supported colleagues at later ones. Among 385 surveyed users at the most recent site, 58.4% received peer coaching and 83.6% of those found it helpful. Coaching was associated with lower burnout, 29% compared with 41% among those without it, though not with differences in confidence or system-related stress. Interviews showed that coaches filled education gaps, responded quickly and drew on interpersonal skill as well as technical knowledge. Several users described coaches as the people who made the difference between giving up and pushing through the first difficult weeks, which suggests their value lies partly in encouragement and presence, not only in answers. Lohmann-Lafrenz et al. (2025) found that poor usability months after go-live was linked to burnout and intent to leave, which suggests ongoing, personal support may help staff cope while usability problems are fixed. Nelson and Staggers (2014) describe super users and peer support as key resources in implementation, and Braunstein (2014) notes that much learning happens on the job once real work begins and real patients are waiting. For our system, this suggests budgeting for peer coaches who travel with each go-live, drawing on staff from earlier sites, and keeping them available for months rather than days. Because coaching was linked to lower burnout but not to greater confidence, it should be paired with continued fixes to the system itself; encouragement can help people cope, but it cannot make a poorly designed screen easier to use. The writer of Hebrews urges believers to lift their drooping hands and strengthen their weak knees (English Standard Version Bible, 2001/2016, Hebrews 12:12), and peer coaches do something similar for exhausted colleagues during a transition, standing beside them until the new work becomes familiar. Would your organization recruit coaches from among its own early adopters, who know both the old workflows and the new system? Their credibility with peers could make their help more effective than outside consultants, and their knowledge would remain in the organization after the vendor's team leaves.

Reply to Malik

Malik, you made a point that is easy to overlook: patients experience an electronic record conversion too, especially through the portal, scheduling and call center. Project plans usually describe patients only as data to be migrated, not as people who will need to learn a new login, find their records and reach their care team through unfamiliar channels. Evidence from a federal health system's transition shows the disruption can be significant and can last for months. Ball et al. (2024) conducted 122 interviews with 30 clinicians and staff at the first Veterans Affairs site to transition to a new record, before go-live and for a year afterward, giving an unusually long view of how the disruption unfolded. Staff described patients struggling to log in to the new portal and find their way around it, failing to obtain medication refills online, facing long telephone wait times and then walking into clinics frustrated and without appointments, which increased staff workload and concern for patients. The authors therefore recommended using an emergency preparedness framework, identifying at-risk patients before the transition and preparing staff with patient-centered information. That framing is useful because it treats the conversion as a predictable disruption that can be planned for, the way a hospital plans for a storm, rather than as a technical event that patients will somehow absorb. Jämsä et al. (2026) found that delayed or missing results were among the most common safety problems after go-live, which means patients may also notice gaps in the information they receive, such as a scan result that never appears in the portal. Braunstein (2014) emphasizes that patient engagement tools must be reliable to earn trust, and Nelson and Staggers (2014) describe communication planning as part of implementation. For our system, practical steps would include notifying patients well before go-live, offering portal help lines with extra staff, proactively refilling chronic medications before the switch and identifying patients who rely heavily on secure messaging so care teams can contact them directly. Front-desk staff and call center agents should receive their own training and scripts, since they absorb much of patients' frustration and are often the last to be prepared. Isaiah describes the servant of the Lord as one who will not break a bruised reed or quench a faintly burning wick (English Standard Version Bible, 2001/2016, Isaiah 42:3), and patients confused and frustrated during a transition deserve that kind of gentleness from every staff member they meet. Would your organization add patient experience measures, such as call wait times and portal login success, to its go-live dashboard? Tracking them would keep patients visible during a project that can easily become focused only on staff and systems, and it would give leaders early warning when patients are being left behind.

References

Ball, S. L., Kim, B., Cutrona, S. L., Molloy-Paolillo, B. K., Ahlness, E., Moldestad, M., Sayre, G., & Rinne, S. T. (2024). Clinician and staff experiences with frustrated patients during an electronic health record transition: A qualitative case study. BMC Health Services Research, 24(1), 535. https://doi.org/10.1186/s12913-024-10974-5

Braunstein, M. L. (2014). Contemporary health informatics. AHIMA Press.

Brunner, J., Sterling, R., Cole, E., Weiss, J., Faas, B., Nosbush, C., Ahlness, E. A., Wong, E. S., Rinne, S. T., & Cutrona, S. L. (2026). Harnessing institutional knowledge: Mixed methods evaluation of peer coaching in a multi-site EHR transition. Journal of the American Medical Informatics Association, 33(8), 1485-1493. https://doi.org/10.1093/jamia/ocag071

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Jämsä, J., Tissari, P., Kovanen, J., & Lehtonen, L. (2026). Patient safety concerns in the go-live phase of an electronic health record implementation. International Journal of Medical Informatics, 218, 106539. https://doi.org/10.1016/j.ijmedinf.2026.106539

Lohmann-Lafrenz, S., Gismervik, S. Ø., Ose, S. O., Aasdahl, L., Lauritzen, H. B., Faxvaag, A., Bardal, E. M., & Skarpsno, E. S. (2025). Usability of an electronic health record 6 months post go-live and its association with burnout, insomnia and turnover intention: A cross-sectional study in a hospital setting. BMJ Health & Care Informatics, 32(1), e101200. https://doi.org/10.1136/bmjhci-2024-101200

Nelson, R., & Staggers, N. (2014). Health informatics: An interprofessional approach. Elsevier Mosby.