When Did This Change?

System users frequently ask this question when the documentation and communication of EHR changes are not handled effectively. Organizations sometimes overlook the importance of a good change management process as it pertains to their EHR application, which in turn affects the success of new EHR configurations. Change management in the context of an EHR build refers to “a project management process wherein changes to the scope of a project are formally introduced and approved [1]”. A good change management process involves many aspects that an organization should consider when implementing build changes in their EHR system:

1. Know the Process

The first key part of an effective change management structure is to outline and define the process. Knowing how changes will be tracked and communicated will benefit all parties involved, including key leadership personnel who may not be part of the day-to-day build discussions. Things to consider:

  • How will end-user requests be accepted?
  • In what forum will these changes be discussed and solidified?
  • What system/software will be used to document and communicate changes?
  • Who gives final approval for changes in the LIVE system, and how will those approvals be obtained?
  • If necessary, what is the rollback plan and how will it be accomplished?

2. Know the Resources

The next part of designing an effective change process is knowing who will be involved during the stages of the build. Without a method for assigning build items to specific resources, organizations risk delays in getting changes approved through the TEST/QA and ultimately into the LIVE environment. It is also important to involve the user(s) who requested the enhancement to provide additional details when needed and test the changes as well. People that should be involved:

  • Build team managers and at least one analyst
  • Support team managers and at least one end user support specialist
  • End user requesting the change
  • Leadership involved in approving changes

3. Know the Details

Another key aspect of the change process is understanding the details of the change and informing the affected parties when that change will take effect. Documenting and maintaining a well-organized change management form will help track key elements. Details to include in a change management document:

  • Who is making the request
  • What change is being requested
  • What specific build or configuration work is required to accomplish the request
  • When is it scheduled to be implemented in the TEST/QA system
  • How the change will be validated
  • When is it scheduled to be implemented in the LIVE system
  • The rollback plan, if applicable

4. Know What Happened

Lastly, establishing a process to track changes will provide a detailed log of who made what change when and why. It is beneficial to document the following in a change process tracking system:

  • When the change was implemented in the TEST/QA and LIVE systems
  • Details from the build analyst, complete with before and after screenshots if applicable
  • Who completed the testing and when it was completed
  • When end-users were notified
  • How the change affects the system’s users a month or so after the change is implemented

These are just a few of the many considerations when implementing a change management process. Every organization is unique and what works for one may not work for another and even the most efficient organizations can benefit from ongoing reassessments of how their process is functioning for their staff and most importantly, their end users.

1. Filicetti, John (August 20, 2007). “Project Management Dictionary“. PM Hut. Retrieved 08/05/2014

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