Starting out with a 'bang'

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This is a review of Joseph Conn's 2007 article, Starting Out with a 'Bang'. [1]


The article cites a single-payer Canadian hospital system and an academic medical center in the United States as successful recent examples of hospital systems that chose to rollout new clinical information systems (CIS) in very short (hours to days) time frames (i.e., "Big Bang").


Prior examples of quick deployment of clinical information systems, some having been successful (Evanston Northwestern Healthcare in 2004) and some unsuccessful (Cedars-Sinai in 2002), are briefly described.

Lessons learned from prior unsuccessful implementations

making sure to involve users at all levels in the planning process and involving them from the beginning, analyzing workflows and making adjustments to those workflows after implementation, and recognizing the “complexity of human change”.

Additional lessons learned from the two successful implementations (Calgary Health and New York University Medical Center)

development of “superusers”; extensive, systematic and continuous training (including web-based); immediate access to ubiquitous trouble-shooters and superusers before and after “Go-Live”.


The author states anecdotally (no references) that after an initial setback, the “Big Bang” implementation strategy for implementing CISs is “making a comeback”.


The author lists “broad participation, systematic and continuous training and clear, open lines of responsibility” as “keys to success” in Big Bang implementations. While these factors are no doubt key, in addition to the “lessons learned” above, other factors mentioned in the article may have contributed greatly to the success of these abbreviated implementations

  1. long-term familiarity with the hospital’s clinical information system by the clinical users, 2) increasingly savvy clinical users (e.g., over half the Canadian users already had an electronic medical record systems (EMR) in their practice) due to the increasing use office-based EMRs and 3) a trend away from “home grown” CISs to “vendor” CISs has shortened the implementation phase considerably as product development is already completed when the CIS is selected.

The author lists a 10.5 hour conversion for Calgary Health and a 36 hour conversion for NYU; however, in both cases it appears that many months of training and planning preceded “Go-Live” and prior familiarity with the hospital’s clinical information system was present in each case--although it's hard to tell to what degree. Consequently, these examples may not be that different from what is occurring at many “Go-Lives” in today’s hospital systems on a regular basis.


  1. Conn, Joseph (2007). Starting Out with a 'Bang'. Modern Healthcare, 37. 32-33.