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“…that it will ever come into general use, notwithstanding its value, is extremely doubtful; because its beneficial application requires much time and gives a good bit of trouble to both the patient and the practitioner; and because its hue and character are foreign and opposed to all our habits and associations. It is just not going to get used.”

-The Times (London), 1834; regarding the stethoscope, invented by René-Théophile-Hyacinthe Laënnec in 1816


  • Describe the maintenance phase in relation to the system life cycle.

  • Discuss the importance of robust change management, downtime, and business continuity processes and tools.

  • Examine optimization in the context of the system life cycle, user adoption, and resource allocation.


After the implementation phase is complete and the “switch is flipped” on a clinical information system, many think that the most difficult work is behind them. However, this next phase of a system's life cycle can be just as challenging as the preceding phases. The system life cycle definition of post-implementation activities comprises support, maintenance, and project evaluation (Dennis, Wixom, & Roth, 2012; Saba & McCormick, 2011). Phrases used to describe this phase include “winding down,” “turning over to support staff,” “moving on to the next project,” and other terms that denote significant reduction in the quality and quantity of dedicated resources.

Traditionally, this approach is well established, particularly from a fiscal perspective. Accounting principles distinguish capital versus operating expenses. New information system implementations are capital projects that have budgetary and temporal limits. Funding for a capital project ends when the project is deemed closed, typically soon after go-live. In the world of the Chief Financial Officer (CFO), a completed system installation signals the end of the capital project and a subsequent dramatic decrease in the human and monetary resources dedicated to that information system.

Ongoing system maintenance and support is resourced from the operations budget. Operations budgets in hospitals and other healthcare provider organizations undergo perpetual scrutiny for opportunities to reduce costs. Because information technology (IT) and informatics experts are expensive resources and are not revenue generators, naturally, budget trimming after a system installation will include proposals for reduction in staff. The net effect is that experts who are essential to optimize—not simply maintain—the electronic health record (EHR) are at-risk resources in operating budgets. Why is this important to explore?

In the former IT world of financial and departmental management systems, the philosophy of “install, stabilize, and redeploy resources” was appropriate for new information systems. End users of these systems were accustomed to using information technology; and typically, a new system meant enhanced departmental workflows and functionality for a relatively small user population.

EHRs created a new and unexpected level of complexity to system implementations in terms of the integration of multiple upstream and downstream systems, medical devices, and clinical analytics, as well as factors such as ...

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