Paragon^® and the Big Bang
By Janice MacDonald

Paragon^® system implementation is a big project no matter how many or how few modules are included in the contract. Typical contracting for a McKesson Paragon system adopts a Big Bang strategy for implementation; install all modules all at once. As Paragon continues to add new modules and increase system functionality, the Big Bang strategy has become less appealing. Hospitals need to carefully consider their implementation strategy. How big will the project be and do any parts of the implementation lend themselves to a phased roll out? Ideally this planning would be part of the pre-contract and contracting stages of the project, but it is never too late to re-assess and re-negotiate a project already in motion.

The Big Bang approach has traditionally made sense for many reasons with Paragon. Paragon provides a team of implementation consultants in support of this model of implementation. If you can leverage the combined strength of the team you have the opportunity to get the best outcome for the organization as a whole, rather than just the sum of the parts that a module by module approach might bring. The integrated nature of Paragon application modules also lends itself well to this approach. At the core of Paragon are the Common Reference Masters, tables that are shared across multiple functional modules. To build them well, there should be agreement among all users, clinical and financial, about converted data and future data sources and definitions in order to build a system that meets the needs of the entire organization. This requires that all departments of the hospital be equally engaged in the process and understand the impact of the decisions. This type of teamwork is often facilitated by the Big Bang approach where resources are engaged throughout the hospital. Hospitals have few resources to spare. It can be helpful to keep everyone focused by keeping the intensity high the project moving forward quickly. Clinical and financial data have become tightly linked in the hospital revenue cycle. Having the entire organization engaged in an HIT system implementation does provide the opportunity to review and enhance workflow across the board.

From the IT departments standpoint, there are also advantages to this approach. The cut over date is usually clear to everyone and support and training can be focused on a single system. The development of temporary interfaces is not needed when you cut over all systems at once. User documentation does not need to be updated during the implementation process, because it happens in such a short period. In addition, a Big Bang may be absolutely necessary if legacy systems are failing or simply too expensive to maintain.

There are disadvantages to this approach as well, and the risks need to be carefully considered. The Big Bang strategy can be very expensive and resource intensive. There is typically no time for additions or customizations that would enhance system use for hospital staff. Even if testing is aggressive, the readiness and validity of converted data is not completely proven in the whole system prior to system cut over, presenting risks for data integrity. Back up plans can be very difficult to develop and become almost impossible once the Big Bang has taken place; manual processing is the only fall back alternative if things go wrong. Finally, there is a lot of pressure to meet the deadline for system activation, and this can result in rushed decisions and poor outcomes.

The Paragon General Financial and Patient Management modules are the foundation of the hospital revenue cycle and need to be implemented together. On the Business side, modules that might be considered for a phased implementation (following an initial Big Bang of core modules) include: Payroll/HR, Fixed Assets, Patient Supply Charging, Referrals and Authorizations, and Webstation for Executives.

Clinical Foundation modules, typically included in a Big Bang include: Paragon Order Management, Clinical Care Station, Pharmacy, Laboratory, and Radiology. On the clinical side, any service that is presently paper based or on a completely stand alone system can be considered for a phased implementation. Clinical Care station can be rolled out over time on a unit by unit basis. The Operating Room Manager, Emergency Department, Medication Administration, and Physician Webstation modules also lend themselves to a phased approach.

In any Paragon installation, some level of Big Bang will be necessary, given the integrated nature of the application. However, as the bang starts to get bigger and bigger some level of phasing may be necessary to ensure that the project vision and goals are maintained. Understanding the risks and benefits of the implementation strategy in the context of your organization’s culture and resource availability will help you minimize the risks and leverage the strengths of the integrated Paragon system.

For more information about Paragon implementations and how VCS can help you prepare call us at 610.444.1233 or email us at vcs@getvitalized.com. For more about VCS and our services and solutions visit our website at www.getvitalized.com.