CHANGE MANAGEMENT FOR CERNER CSP'S
By Eric Dierkens, VCS Project Manager
Change management is a vital process used to control changes that could affect timelines, budgets, risks,
and scope of a project. Change management provides a formal approach to documenting, approving, and testing
production changes prior to implementation. After a Cerner® system has gone live, there are many risks
associated with introducing code changes. These code updates known as CSPs, Cumulative Support Packages,
must be carefully analyzed to determine what level of risk could be introduced to a production
environment.
Let’s first examine the background of Cerner code releases. Cerner distributes CSPs on a weekly basis.
As the name implies, these are cumulative updates. When taking an update, the most recent update must be
applied. There are 13 major functional areas and each has its own CSP. This means the more time has passed
between code updates, the larger the task of certifying the applications. Each CSP also comes with a set of
certification guidelines and special instructions. The certification guidelines describe how to test a
certain fix, and the special instructions are additional steps that my need to be implemented after the
downtime process has completed. As a common practice, there are two functional areas that must be taken.
These are Core and Install Tools. There can also be inter-dependencies between CSP functional areas.
There will be occasions where a code fix must be taken to resolve a patient safety, compliance, or
financial issue. These can usually be taken without much interruption to the production domain. Testing is
focused around these fixes along with a standard regression test plan for non-effected areas. It is also
important to remember that because code fixes are cumulative, testing will need to occur for all
functionality that the site has deployed for the CSP’s taken.
To minimize the risk of introducing unknown behavior, it is important to follow a three domain strategy
when validating CSP’s. This includes a Build, Certification, and Production domain architecture. The CSP’s
are first loaded in the Build domain. The code is tested and configured. Build is a test domain and my not
match production exactly. Once testing is complete and any errors corrected, the code is then loaded in
Certification. The Certification domain should mimic Prod. The code is tested and all areas should perform
regression testing. If any errors are found, a root cause analysis should be conducted to determine where
and how the errors occurred. Once all issues are resolved and all areas are satisfied, the CSP’s can be
loaded in Production. No testing will occur in Production.
Having an update strategy in place can minimize risk and allow time for planning. There are several
different approaches that can be followed. One thought is to update code on an annual or bi-annual basis to
minimize the effort required to regression test the functionality. This process can take several weeks of
dedicated testing. Another approach is not to take any CSP’s and wait until the next major revision has
been released. The path that any hospital will take depends upon the applications installed, size of staff
and resources available. Experience plays a large role in determining the approach that is selected. The
key to a good Cerner CSP change management process is to first define the process so there is no confusion
in roles and responsibilities. Some of the important aspects and to keep in mind include:
- Determine an update schedule
- Define roles and responsibilities
- Assign a Change Management Coordinator. It is the role of the Change Management Coordinator to:
- Communicate upcoming CSP loads to staff (downtime)
- Schedule CSP loads with the system engineer loading the CSPs
- Plan the testing of the CSPs
- Communicate the results of the CSP loads to staff (uptime)
- Ensure each team completes the certification guidelines and special instructions.
- Plan for the future.
If you would like to discuss Change Management, Cerner or Project Management tips and tricks, please
contact us at vcs@getvitalized.com or call us at 610-444-1233.