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MODULE 9: THE SOFTWARE DEVELOPMENT LIFE CYCLE (SDLC)
Section 6: Deployment & Maintenance
Go-live and beyond. Understand the strategies for deploying new software (big bang vs. phased rollout), the importance of post-launch support, and how to manage the ongoing cycle of bug fixes and enhancements.
SECTION 9.6
Go-Live and Beyond: From Project to Product
This phase marks the transition from building the system to living with it. Your role evolves from a creator to a steward and frontline clinical leader.
9.6.1 The “Why”: The Project is Over, The Product is Born
There is a palpable sense of finality associated with “go-live.” For months, or even years, the entire team has been driving towards this single, monumental event. The launch of the new software feels like the finish line. In reality, it is the starting line. The moment the software is deployed to the production environment, it ceases to be a theoretical project and becomes a living, breathing product—an integral part of the clinical ecosystem that directly affects patient care and clinician workflows every second of every day.
The deployment and maintenance phase is arguably where the true work of an informatics pharmacist begins. All the preceding phases—requirements, design, build, testing—were a prelude to this moment. This is where the theoretical value of the new system collides with the messy, unpredictable reality of clinical practice. No amount of testing can perfectly simulate the chaos of a busy emergency department or the unique complexities of a real patient. Unexpected issues will arise. Users will get confused. Workflows you thought were perfectly designed will reveal unforeseen bottlenecks. The success or failure of the entire endeavor now rests on the organization’s ability to support the users, rapidly resolve issues, and manage the ongoing evolution of the product.
Your role undergoes a dramatic transformation. You morph from a behind-the-scenes analyst and tester into a highly visible, frontline leader. You become the clinical face of the project, the primary point of contact for frustrated users, the lead investigator for production issues, and the strategic guide for future enhancements. Your deep knowledge of both the software and the clinical workflows makes you the single most valuable resource in the post-live environment. Mastering this phase is the difference between a project that is simply “installed” and one that is truly “adopted” and ultimately succeeds in improving patient care.
Retail Pharmacist Analogy: The Grand Opening of a New Pharmacy
After a year of construction, planning, and stocking, the day has finally come to open your brand-new, state-of-the-art pharmacy. The “go-live” is scheduled for Monday morning at 9 AM.
The Deployment Strategy: How do you open?
- The Big Bang: On Friday at 5 PM, you close your old, cramped pharmacy forever. Over the weekend, a massive team moves the final items, and at 9 AM on Monday, you open the doors to the huge, new facility. Every service—prescriptions, OTCs, immunizations, compounding—is available from the first minute. It’s a high-risk, high-reward strategy. If the computer system doesn’t work or the shelves are stocked incorrectly, it will be immediate chaos.
- The Phased Rollout: Alternatively, you decide to open in phases. On Monday, you only open the drive-thru for prescription pickup. This is your “pilot.” You work out the kinks in the workflow with a limited number of patients. The next week, you open the main pharmacy for drop-off and pickup. The week after that, you begin offering immunizations. It’s slower, but each step is more controlled, and problems are easier to manage without overwhelming the staff.
The Go-Live Event: The first week is “hypercare.” You don’t just have your regular staff. You have corporate trainers in bright vests (“at-the-elbow support”) standing next to your technicians, showing them how the new register works. You have the IT support team on speed dial, and a regional manager is on-site in the back office, running the “command center” to deal with any major issues that arise, like the automated pill counter malfunctioning.
Maintenance and Enhancements: The grand opening is just day one. Now the real work begins.
- Break/Fix: The printer for the prescription labels keeps jamming (a bug report). You call the support vendor to get it fixed (a patch release).
- Enhancements: Patients keep asking if you offer medication synchronization (an enhancement request). You realize this is a major need. You present a business case to your corporate leadership, and six months later, you launch a new med-sync program (a new feature release).
9.6.2 Crossing the Chasm: Deployment Strategies
The deployment strategy is one of the most critical decisions in the project lifecycle. It determines how the new software is introduced to the end-users and has massive implications for risk, training, and support. There is no single “best” strategy; the right choice depends on the nature of the software, the size of the organization, and its tolerance for risk.
Masterclass Table: Comparing Deployment Models
| Criteria | Big Bang Deployment | Phased Deployment |
|---|---|---|
| Description | All users transition to the new system at a single point in time. The old system is shut off. | The new system is rolled out incrementally to different user groups, locations, or by module. |
| Analogy | Flipping a switch. | Opening a faucet. |
| Risk Profile | Extremely High. A significant failure at go-live impacts the entire organization simultaneously. There is no fallback option. | Low to Moderate. Issues are contained to the pilot group, allowing the team to fix them before a wider rollout. |
| Speed of Value | Fast. The entire organization realizes the benefits of the new system at once. | Slow. The full value of the project isn’t realized until the final phase of the rollout is complete, which could be months or years later. |
| Training Burden | Massive and concentrated. The entire organization must be trained just before the go-live date. | Spread out over time. Training is delivered to specific groups as their go-live date approaches. |
| Support Complexity | Extremely high but for a short duration (the “hypercare” period). Requires a large, centralized command center. | Lower intensity but over a much longer period. Support resources are focused on the current pilot group. |
| Technical Complexity | Simpler in the long run. After go-live, there is only one system to maintain. | More complex. Often requires building and maintaining temporary interfaces between the old and new systems so they can coexist during the rollout. |
| Pharmacist’s Role | Key member of the central command center, making rapid-fire decisions for the entire enterprise. Intense, high-stress role. | Deeply embedded with the pilot group, providing high-touch support, gathering feedback, and becoming the organization’s foremost expert on the system before the next phase. |
| When to Use It | When the old and new systems cannot coexist (e.g., a full EHR replacement). For smaller, less complex applications. | For large, complex organizations. When the new system can be broken down by module (CPOE, Pharmacy, etc.). When risk tolerance is low. |
Deep Dive: Types of Phased Rollouts
The “phased” approach is not a single strategy, but a category of strategies. As an informatics pharmacist, you will be instrumental in helping leadership decide which model is most clinically appropriate.
- Pilot Rollout (By Location/Group): This is the most common approach in large health systems. The team selects a single nursing unit, clinic, or an entire pilot hospital to go live first. This group becomes the testbed. The project team can provide intensive, high-touch support to this smaller group, identify unforeseen issues in a controlled environment, and refine the training and support plan based on lessons learned. Once the system is stable and the pilot group is successful, the rollout can proceed more rapidly to other areas. Your role is to be on the ground with that pilot group 24/7, gathering feedback and becoming the organization’s first true expert on the live system.
- Modular Rollout (By Functionality): This strategy is used when a large system is being replaced piece by piece. For example, a hospital might first deploy the new system’s registration and scheduling modules. Six months later, they deploy the CPOE and clinical documentation modules. Six months after that, they deploy the pharmacy and MAR modules. This breaks a massive project into more manageable chunks but creates significant technical challenges in maintaining interfaces between the legacy systems and the new modules. Your role is to ensure that these interim-state workflows are safe and that the handoffs between the old and new systems do not introduce new risks for medication errors.
9.6.3 The Go-Live Event: Orchestrating Success in the Hypercare Period
The period immediately following deployment—typically ranging from 48 hours to two weeks—is known as the “hypercare” period. It is a time of all-hands-on-deck, intensive support designed to ensure a smooth transition and rapid user adoption. The success of the entire project often hinges on a well-executed hypercare strategy. This strategy is built on two pillars: a centralized Command Center and decentralized At-the-Elbow support.
The Command Center: The Central Nervous System
The Command Center is the physical or virtual hub for all go-live activities. It is staffed 24/7 during the initial hypercare period with key decision-makers from all areas of the project.
Who’s in the Room?
- Project Leadership
- Application Team Leads (for Epic, Cerner, etc.)
- Technical Leads (Interfaces, Servers)
- Training Lead
- Lead Informatics Pharmacist(s)
- Nursing and Physician Informatics Leads
What Are They Doing?
- Monitoring system performance dashboards.
- Triaging all incoming support tickets.
- Making rapid-fire policy and build decisions.
- Coordinating and dispatching ATE support.
- Communicating status updates to hospital leadership.
Your role in the Command Center is to be the ultimate clinical authority for pharmacy and medication management issues. When a high-severity ticket comes in, you are the one who analyzes the potential patient safety impact and recommends the immediate course of action.
At-the-Elbow (ATE) Support: The Frontline Responders
While the Command Center is the brain, the ATE support staff are the hands. These are the highly visible resources—often called “super-users,” trainers, or analysts—who are physically present on the patient care units and in the pharmacy. Their job is to provide immediate, shoulder-to-shoulder help to end-users.
The Golden Rule of ATE Support: Don’t Touch the Keyboard!
This is the most important and most difficult rule for ATE support staff to follow. When a user is struggling, the natural instinct is to take over the mouse and say, “Here, let me show you.” This is a mistake. Taking over robs the user of the opportunity to build muscle memory and learn the system. Instead, a good ATE resource acts as a coach. They point to the screen and say, “Okay, now look for the ‘Reconcile’ button in the top right corner. Go ahead and click that.” This empowers the user and makes them more self-sufficient. Your job is to coach your ATE staff on this principle before go-live.
The Informatics Pharmacist’s Go-Live Go-Bag
When you are providing ATE support, you need to be prepared. Your “go-bag” should contain:
- Comfortable Shoes: You will be walking 10-15 miles per day. This is non-negotiable.
- Communication Device: A fully charged smartphone with a backup battery, or a walkie-talkie programmed to the Command Center channel.
- Key Contacts List: A laminated card with the direct phone numbers for the Command Center, the Pharmacy IT lead, the CPOE lead, and other key personnel.
- Pocket Notebook & Pen: For quickly jotting down user feedback, bug details, and follow-up tasks.
- Tip Sheets & Quick Guides: Laminated copies of the most important workflow guides to share with users.
- Snacks and Water: Go-lives are marathons, not sprints. You won’t have time for a proper lunch break.
- Endless Patience and Empathy: Users will be stressed, frustrated, and scared. Your calm, confident, and empathetic demeanor is your most important tool.
9.6.4 Life After Go-Live: The Maintenance & Optimization Engine
The hypercare period eventually ends, the Command Center is disbanded, and the project team transitions to a long-term support model. This is the “maintenance” phase, which is composed of two parallel and continuous workstreams: fixing what’s broken and building what’s next.
The Break/Fix Cycle: Managing Production Issues
Bugs and issues will continue to be found in the production system. A formal process for managing these issues is critical.
- Ticket Submission: An end-user identifies an issue and reports it to the hospital’s IT Help Desk.
- Triage: The ticket is routed to your informatics team. Your first job is to reproduce the issue and determine its nature. Is it a true software defect, or is it a training issue where the user doesn’t understand the correct workflow?
- Prioritization: If it’s a bug, you must assign it a clinical severity. A typo on a report is a low priority. A flawed dose calculation for a heparin drip is a P1 (Priority 1) Blocker that requires an immediate, all-hands-on-deck response.
- Resolution: The ticket is assigned to a developer who fixes the code.
- Testing and Release: The fix is tested by the QA team and you in a non-production environment. Once validated, it is scheduled for release into the production environment, often as part of a weekly or bi-weekly “patch.”
The Enhancement Cycle: Driving Continuous Improvement
A clinical information system is never “done.” As clinical practice evolves and users become more sophisticated, they will generate a constant stream of ideas for improvements and new features. Managing this stream is a key strategic function.
Most mature organizations have a **Clinical Governance Committee** or an **Optimization Council** responsible for this process. This committee is composed of clinical leaders from various disciplines—pharmacy, nursing, medicine, etc. Your role as an informatics pharmacist is to be a key member and often a leader of this group.
Masterclass Table: Evaluating an Enhancement Request
| Evaluation Criteria | Guiding Questions for the Informatics Pharmacist |
|---|---|
| Patient Safety Impact | Does this request have the potential to prevent a known type of medication error? Can we quantify that risk? |
| Clinical Value / Quality Improvement | Does this enhancement help us better adhere to a national quality standard (e.g., NQF, HEDIS) or a key clinical guideline (e.g., Surviving Sepsis)? |
| Efficiency / User Satisfaction | How many clicks or seconds does this save? Which user groups are impacted? Will this reduce alert fatigue or clinician burnout? |
| Regulatory/Billing Compliance | Is this change required to meet a new legal requirement (e.g., from the DEA) or to ensure accurate billing? |
| Strategic Alignment | Does this request support a key strategic goal for the health system (e.g., expanding our oncology service line, improving population health metrics)? |
| Effort / ROI | How much development and testing effort will this take? Is the clinical benefit worth the technical cost? |
9.6.5 Conclusion: The Steward of a Living System
The deployment of a new clinical system is not the end of a journey; it is the beginning of a new one. It marks the point where your role as an informatics pharmacist achieves its full expression. You are no longer just an analyst, a designer, or a tester. You are now the clinical steward of a critical piece of hospital infrastructure.
This stewardship requires a unique blend of skills. It demands the composure of a command center leader during the high-stakes pressure of a go-live. It requires the empathy and teaching ability of an at-the-elbow coach, helping frustrated colleagues navigate a new and unfamiliar digital world. It calls for the sharp diagnostic mind of a clinical detective, triaging production bugs to separate the cosmetic flaws from the critical patient safety risks. And finally, it requires the strategic vision of a clinical leader, sitting on governance committees to ensure that the system does not stagnate but continuously evolves to become safer, more efficient, and more intelligent. This is the long-term, deeply rewarding work that defines a career in pharmacy informatics—transforming a complex software product into a true and lasting asset for patient care.
