In late January, ECG’s Healthcare IT team completed its first NextGen KBM version 8.3 client upgrade project, supporting a midsized physician group through the transition. The organization was the tenth on record in the country to have upgraded to KBM 8.3, having completed its NextGen application version 5.8 upgrade in early December 2013 (also with ECG’s support). All NextGen clients must upgrade to these versions this year in order to meet both ICD-10 and meaningful use Stage 2 requirements.
Our experience culminated in 10 key recommendations that we will adhere to while working with our current and future upgrade clients:
1. Ensure all previous template customizations are fully documented and vetted as part of the gap analysis process. If current and complete documentation is not available, manually review the system (in addition to using NextGen’s gap analysis utility) to identify changes that have been made in the current version. Focus on the most commonly used templates first.
2. Avoid customizing the foundation templates (Intake, SOAP, Histories, Checkout, and Finalize) in order to reduce future maintenance efforts and enable NextGen to more efficiently address questions and issues that may arise. Alternatively, consider work flow modifications and less complex custom pop-up templates.
3. Identify the ICD-9 codes that cannot be automatically mapped to SNOMED codes and determine the frequency with which those codes are present in the database. Based on this analysis, determine whether unmatched codes will be addressed in advance of the upgrade or reconciled in the Problems module as part of the provider work flow. If addressed in advance, a clinical work group will need to review and associate the codes.
4. Carefully consider your plan for the new clinical guidelines. Historical health maintenance and disease management as well as recommended care information can flow up to and populate the new functionality. Decide whether you will start clean and set up the clinical guidelines from scratch or bring forward the previous information and update/reset it instead.
5. Conduct full application and KBM testing before and after the upgrade (but prior to go-live), including documents, all PM system functionality, and the accuracy and completeness of converted data. As a final step in data conversion testing, print several completed encounter documents for each specialty prior to the upgrade and use these as a reference point to validate data integrity once the upgrade is applied.
6. Provide superusers with early and comprehensive training so that they can support end-user training as well as effectively participate in all system testing efforts. Neither of these things – advanced training or involvement in testing – should be optional for superusers.
7. Do not underestimate the impact of the immunization functionality and work flow changes. Ensure providers and nurses understand the impact and are effectively trained if they order and administer immunizations.
8. Think through your approach to order sets well in advance so you can effectively set expectations for the time required to build them and convince physicians that this time is well spent. Allow physicians to complete this setup in a non-production environment prior to the upgrade so that the order sets are available upon go-live. Defaults and MyPhrases can be built in a similar manner for immediate benefit.
9. Develop a strategy to ensure providers are fully caught up with documentation prior to the upgrade to avoid potential errors of beginning to chart an encounter in one version and finishing it in another.
10. Keep a full copy of your pre-upgrade production database staged in a non-production environment for up to a month after the upgrade.
BONUS TIP: We recommend each organization establish an approach to implementing the ongoing KBM 8.3 updates (UDs) prior to go-live. The UDs are published monthly with cumulative content from previous releases, and your organization will need to balance the urgency of applying fixes against the timeline for proper review and testing by the application team to determine the frequency with which you will implement the UDs. Start by ensuring your organization is on the most current KBM 8.3 content available prior to beginning pre-upgrade testing; this includes the following: (1) KBM 8.3 release package, (2) most recent KBM 8.3 UD, and (3) KBM 8.3 release addendum (if applicable). With an established KBM 8.3 UD schedule, your organization will be able to manage expectations for issues identified and fixed in a future UD as well as set some internal accountability for the application team.
As with any significant system upgrade, end-user training and support are of paramount importance and should not stop upon go-live. The key to smooth adoption and long-term success is a carefully designed, ongoing education and optimization program that is created prior to the upgrade and initiated immediately afterward.
Our Healthcare IT team would be happy to discuss any plans or questions as you prepare for your NextGen upgrades this year.