As luck would have it, just about everything that could go wrong did when the Mercy Surgery Center in suburban Philadelphia went live with its new facility management software. On that day in May 2001, it was one minor travesty after another. On the one hand, the surgical schedule was the busiest it had ever been and the employee in charge of registering patients had resigned. And on the other, the server that ran the ASC's DOS-based program (Temple) was not compatible with the Windows-based suite (AdvantX) the center was switching to - adding $9,000 in unbudgeted capital expense to the conversion.

"It was a nightmare," business office manager Lisa Rickards says, "but we made it with relatively little aggravation." But not without learning a few important lessons on how to get a new system running with minimal downtime.

For one, think three steps ahead, says Ms. Rickards. Know how the new software will affect every aspect of your daily operations. Know how you're going to handle those staff members who've never before clicked a mouse. For another, keep your old system up and running as a backup while you break in the new one. Print hard copies of your case schedule during your go-live period so that surgery doesn't grind to a halt in the event of a computer emergency. Experiment with the new software on a dummy copy of your database before your go-live date.

Six practical tips
Management software is touted as a cure for all that ails the paper record: illegibility, inaccuracy, inaccessibility and incompleteness. But even the most helpful practice software doesn't do your facility a lot of good if your computers can't run it and your staff can't use it. Outpatient Surgery asked facility administrators and product managers for ways to break in new software with fewer unpleasant surprises.

Seek help from IT experts
While most hospitals have information technology (IT) departments that can oversee software-installation projects, very few independent ASCs or office surgery centers have this advantage. It is the rare facility manager or staff member who is sufficiently tech-savvy to know how to manage a software-installation project alone. "This isn't like running Microsoft Office. These are very complicated systems," warns Tom Pliura, MD, the founder and CEO of electronic medical records software manufacturer zCHART.

"I strongly suggest spending the extra money up front to hire an IT consultant because it can solve a lot of problems before they snowball," says Sarah Wainscott, RN, the director of several surgery centers affiliated with LeBonheur Ambulatory Services in Memphis, Tenn. Additionally, the software manufacturer's technical staff should be actively involved throughout the process. For example, a Source Medical representative spent three days on site during Surgery Center of Pennsylvania's conversion. You should expect that all manufacturers will spend a couple days on site before the go-live date to work with users, answer questions and make sure everyone is comfortable with the system. Many will also stay on a few days after the official launch to evaluate the comfort level of the users and provide the administrator with a report outlining any lingering concerns. ProVation Medical, Inc., which manufacturers medical procedure documentation and coding compliance software, has a project implementation tech staff that works with you to set rough timelines for installation, discuss technical issues and facility layout issues, plan training and a target a go-live date.

Learn the key pre-requisites for installation
Even if an IT rep will be the one doing most of the talking with the vendors, you still can help expedite the process by doing some homework. You should be able to provide the software vendor with the hardware you use, your network setup and remote access capabilities. Brandon Hoheisel, the director of technical sales for Minneapolis, Minn.-based ProVation Medical, Inc., says you should be able to answer these questions:

• What support platform do you use (such as Windows ME)?
• How many gigabytes is your hard drive? What is the precise amount of hard-drive space presently available?
• What protocols does your system speak?
• Do you have a high-speed Internet remote access network? Can you run Cat5 network cabling?
• Are you HL7 compliant?
• Will new source codes have to be written to run the program?

Additionally, the installation team will need to know the way information flows around the facility during the workday. You should provide the installation rep with the number of people who'll be using the system frequently and the layout of the facility, including the location of the ORs and building-related wiring and connection "trouble spots" (such as lead walls) within the facility.

If you can, provide a facility blueprint to the tech reps so you can point out the places where you anticipate having terminals to use the software, suggests Priscilla Kirby, director of sales at Camberley Systems of Needham, Mass., which manufacturers the scheduling, case costing and billing SurgeOn software. For example, some facilities plan to have a computer between two ORs for the nursing staff to share (to record supply usage, for instance), while some want a terminal in each OR.

Identify "power users"
Meet with your power users (the people at the facility who'll be using the software the most) and tell them why the software was purchased, how it should be used and what benefits you hope to realize. You should also ask them what they'll need from the software (and the physical setup of the computers) to do their jobs better. This will affect the number and location of workstations.

For example, the power users at your facility may decide that you want the software to do "patient tracking." This is an efficiency-measurement tool that tracks where the patient is at any given moment in the ASC and records the number of minutes a patient spends in a given area (such as prep and PACU). To use this feature, however, you'll need more workstations and slightly higher hard-drive memory capabilities.

"Often times, a client over-projects the number of computers they'll need and the number of system features they'll actually use. We can assist them to get only what they truly need," says Ms. Kirby.

Upgrade your system, if necessary
After purchasing an expensive software system, the last thing you want to hear is that you need to spend several thousand dollars more before the system will install and run the way you want. Be aware that this may happen, however. Dr. Pliura says that many pre-installation visits reveal that the facility may need to buy more computers than it initially thought, add more hard drive space to its existing computers, and/or upgrade network capabilities. This is especially true if you have customized add-ons to your software, such a program to "communicate" with endoscopy case-recording equipment, which may require additional programs to be written and require more hardware.

Ms. Wainscott says that if your IT rep and the company recommend upgrading your hard drives and your network capacity, you should heed their advice - even if they say you can still run the system without upgrading.

"This is simply issue of efficiency. If doing the simplest task takes forever because the system is running too slowly, whatever money you save up front, you'll lose in reduced productivity," she says.

Consider buying the hardware you need through the software vendor, says Ron Pelletier, the vice president of product development for Birmingham, Ala.-based Source Medical, the manufacturer of such practice management programs as AdvantX and SurgiSource. This way, you can ensure that the hardware is tested and compatible with the application. More importantly, the vendor will often load and configure the software application before shipping the hardware to you.

Create a well-organized training schedule
Arrange training around the surgical schedule without pulling away so many people that you can't meet your core staffing requirements, says Ms. Wainscott. A cross-trained staff is particularly useful at times like these, she says.

Even before the go-live date, some software companies perform all the training on-site, starting with the designated power users, while others have the power users travel to attend more intensive off-site training sessions and then return to the client site to train the other users. The rationale is that getting people away from their centers encourages more active participation from the users. During this facet of training, the power users can help the project team determine system and workflow preferences.

Invest in follow-up training
Consider advanced training about 90 days after you've been using your new software, suggests Mr. Pelletier of Source Medical. Many facilities forgo this service to save money, but it does have benefits. First, facilities with cross-trained employees who are occasional system users can brush up on the basics. Secondly, the regular users will have the basics down pat by now and can learn advanced functions.

Plan the work, work the plan
The more upfront work you do, the more you'll benefit from your software's ability to manage your clinical, financial and administrative processes. You'll soon find it indispensable.

"Our software manages all of the operational aspects of outpatient surgery - billing, collections, tracking inventory, and registering and scheduling patients, says Ms. Rickards. "It is absolutely critical to everything we do."