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"Big Bang" deployments of EHR technology are not for the faint-hearted. The rapid roll-out of multiple modules in a clinical information system requires equal measures of organizational commitment and in-depth preparation. That was one message delivered by two speakers at Health Data Management's Health IT Stimulus Summit in Boston. Both Susan Heichert and Bill McQuaid orchestrated rapid rollouts at their hospitals. And both lived to tell about it.

Heichert, CIO at Allina Hospitals and Clinics, Minneapolis, pulled off a system standardization across 10 hospitals (a newly built facility is about to go live this fall). Allina converted its hospitals to an enterprise system from Epic Systems Corp. on a rolling basis, taking about nine months to convert each hospital. And McQuaid, CIO at Parkview Adventist Medical Central, Brunswick, Maine, led a best-of-breed replacement project. Parkview deployed 23 modules from Meditech in about six months--and that was just the first phase.

Allina plowed $250 million into its new system in a project that was driven by operations, not the IT department, Heichert said. Allina also modified its physician staff bylaws to compel the doctors to place orders electronically. She described the mandate as "supported by a value proposition," namely that CPOE would improve patient safety. "After we converted the third hospital, we had no more complaints," she said.

Likewise, Parkview included order entry as part of its IT implementation, although it has not mandated use of the system. McQuaid noted that such features as remote access helped gain physician acceptance of the system. By forgoing its best-of-breed approach for a suite of Meditech modules, the 55-bed community hospital is saving some $150,000 in annual operating costs, primarily from the reduced expense of maintaining multiple interfaces.

The two Big Bang survivors both cited clinician involvement in order set development as critical to the success of CPOE. "We had hours of conversations" with specialists, Heichert said. "You need to fight the battles ahead of time."

--Gary Baldwin