1. Piecing Together a Soft Upgrade (4.0 line)
The Whole Puzzle : Overview of the upgrade process with lessons learned along the way
By:
Emily Grimm
Sonal Pandey
- Intro
Emily’s first Upgrade
Both SW/HW upgrade
Not live yet… go live experiences, go live on the 20th

2. Amish/ Lancaster County
600 beds soon to be 700 beds
New Frederick tower, Private patient rooms, 3 different floors
Lancaster Behavioral Health Hospital

3. Soft Client since 2009 LGH current Soft versions:
SoftLab
SoftBank
SoftID
SoftMIC
SoftPath
SoftDonor
New versions May 20, 2018
SoftLab
SoftBank
SoftID
SoftMIC
SoftPath
SoftDonor

4. Pieces in the Upgrade Puzzle
Overview of the project
- Develop project plan
- Receive Release notes
- New environment creation
- Review of release notes/choose enhancements
- Workflow gap analysis
- Build
- Testing
- Freeze/ Go live prep
- Go live
Project Partners
- Project manager
- Subject matter experts (SMEs)
- Lab managers
Overview the steps. Team effort, SCC, facility, vendors……decide on versions, e.g: BB coming out with the version in Jan. Develop project plan. Receive release notes, review, choose enhancements. Workflows, gap analysis. Build. Testing. Build freeze. Go Live. Also upgraded hardware at the same time.

5. Release Notes (RN) review
Review of release notes is very important!
Have Soft Product Specialist review the notes as well, and ask questions!
Be mindful of versions when reviewing RN
- Bullet 1: Take your time and BE THOROUGH. This will save you time later.
- Bullet 2: You may think you understand what the PCC is referring to, but by not clarifying before testing, you could quickly end up behind on your timeline. EXAMPLE OF MIS-READ Release note
- Bullet 3: If a PCC lists a specific version, it is best to verify whether it does/does not apply to your version. This may take some back and forth with Soft, but you will be glad to know the answer before testing.

6. Enhancements overview
Review closely with your subject matter experts
Prioritize the enhancements High, Medium, Low.
Time flies when you’re having fun!
Time to build enhancements!
Bullet 1: SMEs know what enhancements will best suit their workflows.
Bullet 2: There is only so much time to build and test. You will also be testing anomalies and automatic enhancements, and have to keep up the daily maintenance of your department.
Bullet 3: Make sure there are set timelines to complete these reviews and stick to your timelines.

7. Workflows and Gap Analysis
Working this process will
help you get to your end
result efficiently.
Use the tools the
software offers.
Work smarter, not
harder!
Current, future state and gap. Discuss subject matter experts and their role in the process. This will help with the development of training materials for the end user.

8. Testing Overview Application-testing of workflows
Direct- testing of specific scenarios
Enhancement – testing new workflows
Functional- testing of flagging and HIS
Mapped Record – unit testing
Integrated- complete test from HIS and back to HIS, including billing
Documentation is key!
So many items get discovered during testing. Also mapped record testing, digitrax labels and ref lab. Spending time using the system, you keep finding things you didn’t realize were there. (examples)

9. A little humor always helps!
Keeping calm and staying positive are key. Everything will get done.

10. Blood Bank and Donor Updates (Bank 25.1.0.5.11 to 25.3.3, Donor 4.5.2.2.6 to 4.5.3.3.18)
Larger upgrade for our Blood Bank and Donor systems than other modules
Used an outside vendor for validation.
LIS and SME still spent over 900 hours on build and validation processes.
Start with blood bank and donor, since the largest part of the upgrade. To give you an idea…also, direct test scripts, almost 60.
Application testing done by vendor. Very happy with vendor, very thorough. Good to use vendor because of all of the regulations associated with bank/donor. Definitely a fresh set of eyes. Found very few issues, but a few key ones. (able to issue an IgA unit to the wrong patient)

11. Our Own Blood Donor Center
Before we get into Bank enhancements, LGH has its own donor center that provides us with a large percentage of our patients’ red cell, plasma, and platelet needs. Not going into it a lot in the presentation since many facilities don’t offer this, but we are proud of it and thought it deserved a mention.
List of some donor enhancement..

12. Blood Bank Auto Confirmation of Instructions
Complex hosparam settings.
There were several hosparams involved in this enhancement, and it was difficult to understand what they all do and how they work together.
A lot of trial and error and many hours spent testing.
Patient safety improved because
the hosparams look at patient
requirements and unit
attributes.
Our instructions are interfaced from our HIS so they file into SoftBank if LR, CMVN, IRR, WASH, are required. The new enhancement is very nice because it will autoconfirm them if the products selected meet the requirements, without tech intervention. The appropriate warnings fire when a product not meeting the requirements is selected. Some allow this, but with warnings, some like IgA, have a hard stop so that they product may not be selected if requirements aren’t met.

13. Hosparams for Autoconfirmation
hos_POS_AutoInstr
hos_POS_irr_S
hos_POS_lrd_S
hos_POS_cntrl_S
hos_POS_irr_l
hos_POS_lrd_l
hos_POS_cntrl_l
hos_POS_Pat_irr
hos_POS_Pat_lrd
hos_POS_Pat_cntrl
hos_POS_Unit_irr
hos_POS_Unit_lrd
hos_POS_Unit_cntrl

14. Patient Caution Window Enhancement
Color enhancement for patient caution window
Set colors based
on priority, so that
important patient
messages are not
overlooked.
hos_Caution_enh
set to “Y”
This had many, many options as you can see, but we only chose to use a few, so there would be obvious breaks/changes in color between different types of patient messages. Antibodies, Antigens, and transfusion colors are preset as you can see above.

15. Setting priorities for messages

16. Example of patient caution window Hos_Caution_Blankline set to “Y”

17. Patient Antigens Display in Patient Caution Window
Now can show patient antigens in the patient caution window. Nice for Sickle patients to know they have been tested. Does not stop issue of antigen positive products.

18. Numbering of resulting worksheets
You can choose which worksheets you want to have numbered. This is a nice feature for unit retyping and unit antigen typing

19. Updates for SoftLab (4.0.7 to 4.0.8)
A little public service announcement as we move into lab enhancements..

20. Lab-Result Entry and Instrument Menu Verification Tech Hosparam change

21. Lab Enhancement to Protect Patient Demographics and Stay Information
Enhancement for lab based on combination of hosparam setting and security option settings.
Set to “Y” to only allow users with
security point access to edit patient
demographic and stay information.
No more “CBCSmith, Sally” patients.

22. Test Maintenance Multi Test Edit
Nice feature for LIS users.
Set up in Settings and Definitions to allow more than one test to be open/edited in test maintenance. Have to open additional instances of test maintenance, not tabs along the top as we had hoped.

23. Instrument Interfaces
In the event that a reference lab test result comes back without an order number, and this makes it hard to troubleshoot and find where the result belongs. This enhancement is an addition to the instrument translation table that allows the results to post with OBR3.1 (ref lab order number) when OBR2.1 is empty.

24. Security Enhancement Additional Filters
Also, users who are locked out of the system after the set period, ours is 90 days, will also be inactivated automatically. Does not have to be manually done anymore. Only applies if user has accessed the system and timer has started.

25. Microbiology Enhancements (4.0.7 to 4.0.8)

26. Microbiology Corrected Reports
Complex enhancement
Hosparam changes needed
MIC_mhl7Status
MIC_audit_trail
FMESS_param
MIC_INST_general pos
MIC_apply_supl_func
MIC_flag_supl
MIC_hl7_flags1
MIC_his_rep

27. Microbiology Corrected Reports
Corrections at Prelim and/or Final
Correction of Isolates, Drugs and Test comment
System fires a comment when correction is made and a header is added

28. Microbiology Corrected Reports
System provides a warning message to show the corrections on the order

29. Microbiology Corrected Reports
Reasoning for Correction

30. Microbiology Corrected Reports

31. Microbiology Corrected Reports

32. Pathology Enhancements (4.4.0.1 to 4.4.1.2)
PDF version of Soft report available in HIS/Epic

33. Pathology PDF Enhancement

34. Pathology Enhancements

35. Pathology Enhancements
Launching Epic from SoftPath – dropped
- This was a very sought after enhancement for our pathologists but we decide not to institute it because in its current state the functionality is no different than current state workflows. Lets talk about the enhancement a little and then talk about why it didn’t work for us. To start the URL info from the HIS is updated in Ancillary System Settings in Options under the Results from external systems tab. Once this update is made an EI icon appears in Result entry. When the end user is in Result entry they can click on this icon and launch HIS/Epic. Main area for the pathologists to access was Chart and Results review in Epic. Soft developed the functionality to use MRN to make the connection and did not take into consideration that the user has to be authenticated before Epic can be launched. We could get this functionality to work with Epic Link but since the pathologists did not want to enter the user name and password, this enhancement was dropped.

36. Pathology Enhancements

37. Pathology Enhancements
Ability to add a middle initial to the Path label
Ability to “x” out of Registration
New ability to add middle initial (not name) to the Path labels. This change enhances patient identification capabilities increasing patient safety.
When in Registration screen, when the gray registration “x” is clicked the system opens a decision window asking if the data should be saved.

38. Pathology Enhancements
Locked patient warning in Result Entry
Option to add ability to type outside bookmarks
(Result Entry)
(QA)
(SignOut)
For users that reflex HPV orders from SoftPath to SoftLab, Path was enhanced to warn the user if the patient record is locked in Lab and the reflex cannot be sent to Lab.
Certain roles can have the option of typing outside bookmarks like supervisors, SMEs…. Will need to add the options to the roles that need this access. This is a workaround for the setting in options that prevents you from typing outside of bookmarks (RE -> General).

39. HL7 Interface Upgrade for Reference Lab
Reference Lab HL7 version from 2.2 to
A lot of hard work
Backed out in the end
How much to say here?? VPN tunnel build? We maybe did not realize what a large project this would be. After the testing we have done, we feel that to successfully upgrade, we would need to test one of each orderable reference lab test. Non discreet results now discreet, build involved.

40. It will take several weeks to create your new Upgrade environment.
Remember to change the security settings for any SMEs who have access while testing for upgrade.
Remember to remove any build not ready for production before the system freeze period.
Have all IP changes (within Soft and Instrument interfaces) documented and ready to go for cutover. Applicable if upgrading servers at the same time as software.
Things to consider before go live. Will not have access to test until day of Go live.

41. All testing and issue resolution should be complete before the freeze
Environment strategy with your HIS should be hashed out early in the project
Scope sign off for Software should not happen until the end of Release note review
All testing and issue resolution should be complete before the freeze
Bullet 1: Consider supporting test your current production environment, an upgrade environment. And any HIS/Epic upgrades scheduled during the Soft upgrade project can add complications. Don’t forget to factor in the servers if upgrading them as well.
Bullet 2: Not until after the release note review and determination of which enhancements you will be taking (with input from SMEs) should you get signoff on the project scope. That way lab operations and you are on the same page around the enhancements and will be coming with the Upgrade. Any changes to this scope after its signed should be documented and signoffs obtained.

42. Keep your current Test environment for comparison post go live
Ensure that Product Specialist has reviewed the Release notes before delivering
Keep your current Test environment for comparison post go live
Pick up the phone to save time. Communication! Communication! Communication!
Bullet 1: Usually clients pull their own release notes from the Soft site. However, there are could be release notes that do not apply, e.g: BB example of the back and forth of removal of release notes and then adding them back.
Bullet 3: and task communication are great, but sometimes you just need to talk to the person to get an issue resolved. A simple misunderstanding of communication can be resolved in a matter of minutes on the phone, but can take hours with the other methods.