CPIA Module 16, Section 3: Command Center Operations and Issue Tracking
MODULE 16: IMPLEMENTATION & GO-LIVE STRATEGIES

Section 3: Command Center Operations and Issue Tracking

Mastering the art of managing launch day. This section details how to set up and run a go-live command center, implement a rapid-response issue tracking system, and triage problems effectively under pressure.

SECTION 16.3

Command Center Operations and Issue Tracking

The Art and Science of Crisis Management on Launch Day.

16.3.1 The “Why”: The Central Nervous System of Go-Live

In your daily pharmacy practice, you operate within a highly structured environment designed to manage chaos. You have designated queues for new orders, refills, and clarifications. You have a triage process for STAT orders versus routine fills. You have a clear chain of command for escalating clinical problems from technician to pharmacist to manager. This structure is the only thing that prevents a busy pharmacy from descending into chaos. A go-live event is the equivalent of your pharmacy’s busiest day, multiplied by a thousand, with the added complexity that nobody is fully sure how the new equipment works. Without an equally robust structure, chaos is not a risk; it is a certainty.

The Go-Live Command Center is that structure. It is the dedicated, centralized hub that serves as the brain and central nervous system for the entire implementation. It is not simply a room with phones; it is the single source of truth, the nexus of communication, the engine of triage, and the seat of rapid, authoritative decision-making. Every problem, from a single malfunctioning printer to a system-wide patient safety crisis, flows into this room to be logged, assessed, prioritized, assigned, and tracked to resolution.

An organization that attempts a go-live without a formal command center invites disaster. Issues are reported to random IT staff in the hallways. Rumors spread faster than facts. Multiple people work on the same problem, while critical issues are dropped entirely. The result is a reactive, inefficient, and dangerous launch that erodes user confidence and jeopardizes patient care. In this section, we will deconstruct the art and science of command center operations. You will learn how to build, staff, and run this critical function, translating your innate skills in workflow management and clinical triage into the high-stakes environment of a system launch.

Retail Pharmacist Analogy: The City-Wide Health Crisis

Imagine a natural disaster strikes your town, knocking out power and cell service. Your pharmacy, equipped with a generator, becomes an impromptu hub for the community. Suddenly, you are not just a pharmacist; you are the manager of an emergency command center. How do you respond?

You don’t just stand behind the counter and wait for the chaos. You create structure:

  • The Physical Setup: You designate your consultation room as the “Command Center.” You grab a whiteboard to serve as your Issue Tracker. You set up a dedicated phone landline for incoming calls (the Hotline). You gather flashlights, batteries, and first-aid kits (your Go-Live Supplies).
  • Roles & Responsibilities: You are the Incident Commander; you make the final decisions. Your most organized technician becomes the Scribe, responsible for writing every reported issue on the whiteboard. Another technician mans the hotline, logging the calls. Your staff pharmacists become “Runners” or “At-the-Elbow Support,” delivering emergency medications to a nearby shelter and helping triage patients in the front of the store.
  • Issue Tracking & Triage: A frantic parent runs in—their child is having a severe asthma attack and their nebulizer has no power. This is a Severity 1 (P1) – Critical Issue. Your pharmacist-runner immediately grabs a new albuterol inhaler with a spacer and provides it. Meanwhile, someone calls the hotline because they are worried about getting their routine blood pressure medication refill tomorrow. The hotline tech logs this on the whiteboard as a Severity 3 (P3) – Medium Issue. You will address it, but only after all life-threatening issues are handled.
  • Communication Cadence: Every hour, on the hour, you call for a “War Room Huddle.” The whole team gathers for 60 seconds. You review the whiteboard, announce which P1 issues have been resolved, and set the priorities for the next hour. This keeps everyone informed and focused.

This structured, methodical response to a crisis is precisely how a go-live command center functions. It is the application of emergency management principles to the controlled chaos of a system implementation.

16.3.2 Building the Command Center: The Physical and Digital Infrastructure

An effective command center is a carefully engineered environment designed for high-pressure collaboration and rapid information processing. It requires a thoughtful combination of physical space and digital tools to function as the mission control for the go-live. Success is not accidental; it is a direct result of meticulous logistical planning weeks and months in advance.

The Physical Space: Your Mission Control

The location and layout of your command center, or “War Room,” are critical. It must be a dedicated, secure space that can comfortably house a large, interdisciplinary team for long hours, 24/7, for at least the first one to two weeks of the go-live.

Visualizing the Command Center Layout

Phone Bank / Triage
The “Front Door” for All Issues
Food & Supplies
Coffee, Water, Snacks
LEADERSHIP POD
Go-Live Commander, PM, Scribe
APPLICATION & TECHNICAL PODS
CPOE, Pharmacy, Interfaces, etc.
CLINICAL PODS
Pharmacy, Nursing, Provider Leads
QUIET ZONE
For focused problem-solving
BIG BOARDS / WALL MONITORS
Live Dashboards: System Status, Issue Queue, Key Metrics
Masterclass Table: Command Center Logistics Checklist
Category Item Pharmacist’s Perspective & Rationale
Location Secure & Dedicated Space The room must have controlled access. You cannot have random staff wandering in. It needs to be a protected space for focused work.
Proximity & Accessibility Ideally, it’s centrally located or near the highest-impact areas. If it’s too far from the pharmacy or ICU, it slows down response times for runners.
Sufficient Size It needs to be large enough to hold 20-50+ people without being cramped. Pods or table groups should be arranged by function (Pharmacy, CPOE, etc.) to facilitate collaboration.
Equipment Connectivity Hard-wired network ports and Wi-Fi are non-negotiable. There must be enough ports and bandwidth for everyone. Have dedicated phone lines for the hotline and leadership.
Visual Displays (“Big Boards”) Multiple large monitors or projectors are essential. They display the single source of truth: the live issue tracker, system performance dashboards, and key announcements. This maintains situational awareness for the entire room.
Workstations & Printers Every person in the room needs a dedicated computer, monitors, and phone. A dedicated, high-volume printer is needed for printing tip sheets, reports, and downtime forms.
Whiteboards Physical whiteboards are invaluable for diagramming complex issues, tracking P1 tickets, and listing key contacts.
Supplies Human Factors Go-lives run on caffeine and sugar. Having readily available coffee, water, and healthy snacks is not a luxury; it’s a necessity to keep the team functional during long, stressful shifts.
Office Supplies A full stock of notebooks, pens, markers (multiple colors for whiteboards), sticky notes, and tape.
Go-Live “Armor” Color-coded vests or shirts to identify roles (e.g., Red for Pharmacy Lead, Blue for At-the-Elbow Support). Also, have pre-printed binders with key documents: contact lists, escalation paths, downtime procedures, and cutover plans.

The Digital Infrastructure: Your Arsenal of Tools

While the physical room is the body, the digital tools are the nervous system of the command center. These tools ensure that information is captured accurately, disseminated quickly, and acted upon appropriately.

  • The Issue Tracking System (Ticketing System): This is the most important tool. It is the definitive, legally-discoverable record of every problem reported during the go-live. It cannot be optional; every single issue, no matter how small, must be logged as a ticket. This prevents issues from being forgotten and provides invaluable data for post-go-live analysis. Common platforms include ServiceNow, Jira, or even a well-designed SharePoint list. The key is that it’s centralized, accessible to all, and has fields for severity, owner, status, and resolution.
  • Mass Communication Tools: You need a way to send urgent messages to large groups of people. This could be a system like Everbridge for mass SMS/paging, or simply well-maintained email distribution lists (“All Nurses,” “All Pharmacists”). This is used for announcing downtimes, system-wide issues, or the resolution of a major problem.
  • Collaboration Platform (Conference Bridge & Chat): A dedicated, 24/7 “War Bridge” (a conference call that never ends) is critical for verbal communication. Leaders can jump on to discuss a P1 issue in real-time. A dedicated group chat (like Microsoft Teams or Slack) is essential for rapid-fire text communication, sharing screenshots, and coordinating between the command center and at-the-elbow support staff on the floors.

16.3.3 Staffing the Command Center: Your Go-Live Dream Team

A command center is only as effective as the people in it. The team must be a carefully selected group of empowered, knowledgeable, and calm-under-pressure individuals from all key clinical and technical domains. Each person has a clearly defined role and responsibility, operating within a strict chain of command to ensure efficient decision-making.

As a pharmacy informaticist, you will likely serve as the Pharmacy Clinical Lead, the highest authority on medication management workflows within the command center.

Masterclass Table: Command Center Roles & Responsibilities

Role Primary Responsibilities A Pharmacist’s Interaction Guide
Go-Live Commander The single point of ultimate authority. Makes the final call on major strategic decisions (e.g., initiating a major downtime, rollback decisions). Sets the tone for the entire operation. You report critical, unresolvable patient safety risks to this person. They are your final escalation point when a P1 medication issue cannot be solved by the teams.
Project Manager (PM) Manages the logistics and operations of the command center. Ensures the processes are being followed, facilitates the huddles, manages communication, and removes roadblocks for the team. The PM is your partner in operations. You go to them for logistical needs (e.g., “We need two more at-the-elbow pharmacists on the night shift”) or process problems.
Scribe Maintains the official go-live log. Documents every major decision, P1 issue timeline, and action item discussed in the command center. This creates the official record of the event. Ensure your critical medication-related decisions and their rationale are clearly communicated to the Scribe. (“Scribe, please log that at 03:15, the Pharmacy Lead made the decision to revert to paper MARs for the ICU due to issue #1234.”)
Pharmacy Clinical Lead (This is likely you). The ultimate authority on pharmacy workflow and medication safety. Triages all incoming pharmacy-related tickets, assigns them to resolvers, validates proposed solutions, and makes the final call on workarounds and downtime procedures for the pharmacy. You are the hub for all things medication-related. All pharmacy issues flow through you. You must be decisive, knowledgeable, and an excellent communicator.
Other Clinical Leads (Nursing, Provider) Serve the same function as the Pharmacy Lead but for their respective domains. They are your peers and most important collaborators. You will work with them constantly. A CPOE issue is also a pharmacy issue. An eMAR issue is also a pharmacy issue. You must form a tight-knit team to solve cross-functional problems.
Application & Technical Analysts The “resolvers.” These are the builders and technical experts who investigate and fix the system. They are assigned tickets by the leads and do the hands-on work. These are your problem-solvers. You will assign tickets to your pharmacy application analysts. You must provide them with clear, concise information and shield them from distractions so they can focus on fixing the issue.
At-the-Elbow Support (“Runners”) Super-users and project team members deployed on the clinical units. They provide immediate, hands-on support to end-users and are the eyes and ears of the command center. You will deploy your best pharmacists and technicians in this role. They will be your first line of defense, solving issues on the spot and providing rich, detailed information back to you in the command center for issues they can’t solve.

16.3.4 The Go-Live Rhythm: Issue Flow & Communication Cadence

A command center cannot be a free-for-all. It must operate with a disciplined, predictable rhythm. This structure ensures that information flows efficiently, priorities are clear to everyone, and progress is constantly being made and communicated. This rhythm is defined by two key components: a standardized issue management process and a regular communication cadence.

The Life of an Issue: A Standardized Flow

Every single issue must follow the same path. This ensures nothing is lost and provides a clear audit trail.

Visualizing the Issue Management Workflow
1. Report
User calls hotline or flags a runner.
2. Log
Hotline creates a ticket with all details.
3. Triage
Lead reviews ticket, assigns Severity, assigns to a resolver.
4. Work
Analyst investigates and develops a fix or workaround.
7. Close
Ticket is formally closed.
6. Communicate
Resolution is communicated to reporter/stakeholders.
5. Resolve
Fix is implemented and validated. Resolution documented in ticket.

The Communication Cadence: Keeping Everyone in Sync

In the absence of clear, official communication, rumor and fear will fill the void. A disciplined communication plan is essential to maintaining order and confidence across the organization.

The Go-Live Communication Plan
  • Command Center Huddles (“War Room Huddles”): These are mandatory, standing meetings for the entire command center team.
    • Frequency: Every 2-4 hours for the first 72 hours, then decreasing as the system stabilizes.
    • Agenda: Status of all P1 issues, review of issue trends (are we seeing a lot of tickets about one topic?), staffing updates, and key priorities for the next cycle.
  • Leadership & Stakeholder Briefings: Scheduled, concise updates for hospital executives.
    • Frequency: 2-3 times per day.
    • Content: High-level summary of system stability, major issues, and impact on hospital operations. The goal is to give them the information they need without getting bogged down in technical details.
  • End-User Communications: Proactive messages sent to the front-line staff.
    • Content: “Tip of the Day” emails, notifications of widespread issues (“We are aware of an issue with lab label printing and are working on it.”), and announcements of major resolutions. This shows them the command center is aware and responsive.

16.3.5 Mastering Triage: A Pharmacist’s Guide to Rapid Prioritization

Triage is a core competency of any pharmacist. Every day, you subconsciously triage your work: the waiting patient with a screaming child gets priority over the routine refill that isn’t due for three days; the STAT antibiotic order from the ED trumps the batch of vitamin refills. This skill of rapidly assessing a situation, understanding its potential impact, and prioritizing your response is the single most important skill for a clinical lead in the command center.

During a go-live, you will be faced with a flood of issues, all of which will seem urgent to the person reporting them. Your job is to apply a consistent, objective framework to determine the true severity and priority of each issue. This ensures that the most critical problems—those that threaten patient safety or halt major hospital operations—receive immediate attention, while less severe issues are handled in a controlled manner.

The Severity Level Matrix: Your Triage Bible

Every issue tracking system must have a clearly defined, universally understood set of severity levels. This is the common language of prioritization for the entire go-live.

Level Definition Required Response Pharmacy Masterclass Example
P1 – Critical (Showstopper) A complete system or critical component is down, causing a widespread stoppage of an essential workflow for an entire department or the whole hospital. There is a direct and immediate patient safety risk. There is no viable workaround. IMMEDIATE. “All hands on deck.” This triggers an immediate alert to all relevant leads and the go-live commander. Work continues 24/7 until resolved. A conference bridge is opened immediately. “No new medication orders placed in CPOE are appearing in any pharmacy verification queue system-wide.” This halts the entire medication ordering process for the hospital. This is a patient safety disaster.
P2 – High A major piece of functionality is unavailable, or a core workflow is broken for a significant group of users. There may be a patient safety risk. A workaround may exist, but it is difficult, unsafe, or unsustainable. URGENT (Within 1-2 hours). The issue is assigned to a dedicated resolver immediately. The lead monitors progress closely. Leadership is made aware at the next huddle. “The interface to the Automated Dispensing Cabinets on all ICU units is down. Nurses cannot pull medications that have been verified.” The workaround (pharmacist delivering meds directly) is not sustainable for long.
P3 – Medium A non-critical feature is not working as expected, or a workflow is impacted but a safe and reasonable workaround is available. This is an inconvenience that does not pose a direct threat to patient safety or core operations. NORMAL (Within the business day). The issue is placed in the regular work queue for the assigned team. Progress is tracked, but it does not require an emergency response. “The ‘Refill Requests’ report is not sorting correctly by patient name.” This is an annoyance for the pharmacy technicians, but they can still find the information they need by scrolling. The core workflow is not stopped.
P4 – Low A cosmetic defect, a user question that can be answered with training, or a request for a future enhancement. There is no impact on current workflows or patient safety. DEFERRED. The issue is logged for future consideration after the go-live stabilization period. It is not worked on by the go-live support team. “A pharmacist requests that the ‘Verified’ button in the order entry screen be changed from green to blue.” This is a user preference, not a system defect.
The Peril of “Severity Inflation”

During a stressful go-live, panicked users will report every issue as a P1. A printer not working will be described as a “total system failure.” As a lead, your job is to be empathetic but firm. You must calmly apply the objective criteria of the severity matrix. If you allow every issue to be treated as a P1, then you have no priorities at all. Protecting the integrity of the triage process is essential to focusing your resources on the problems that truly matter.