What should you centralize after an acquisition?
Start with common definitions, who owns each decision, and the steps sites already perform the same way. Keep an explicit list of differences by program, brand, and billing entity. Choose one common workflow and one local exception to test before approving the shared configuration.
Clinical documentation
Shared: Define the fields, signing steps, and escalation path every program can use.
Site or entity: Keep approved differences in assessments and treatment plans by program. Ask a clinician at each site to complete a new note and retrieve a historical one.
Intake and scheduling
Shared: Standardize referral status and the handoff from intake to the clinical team.
Site or entity: Keep routing, appointment types, and program availability local where they differ. Reconcile future appointments and test a referral at each brand.
Access
Shared: Assign owners for access approval and define common job roles.
Site or entity: Scope access to the sites and records each role needs. In a test environment, verify an allowed action and a denied action across brands.
Billing and reporting
Shared: Use common definitions for service date, posting date, and outstanding balance.
Site or entity: Keep the billing entity and payer configuration explicit for each site. Reconcile open balances by entity and service period, and test claim routing before moving that entity.
The matrix is a planning example. For guidance on testing configuration, patient identification, and downtime procedures, see the ASTP/ONC SAFER Guides.
How do you decide which sites go live together?
- Map the rollout. List every site and billing entity that will change. If a site uses multiple entities, keep their claim tests and owners separate. Allocate support time once across its rows.
- Review the evidence. Have owners confirm chart and schedule reconciliation, billing tie-out, role access, downtime recovery, and local shift coverage. A site with an open check holds its proposed wave until the check is resolved or the wave is reassigned.
- Check staffing by role. Compare estimated support hours with qualified hours available for the same go-live window, after normal duties and protected coverage. Calculate clinical and billing shortfalls separately.
- Make the go-live decision. When shared setup, site checks, and coverage are ready, the release owner can approve the wave and record the fallback plan. Recheck the evidence if scope or timing changes.
See the ONC Health IT Playbook for implementation planning and training guidance. The staffing calculation and wave rules are part of the Ease workbook.
A worked example across two brands
In this fictional example, Pine and Cedar share a configuration. Each of the five sites has its own evidence to review. All estimates below use the same support window within each wave.
Wave 1 · Pine North and East
- Clinical hours
- 42 needed / 36 available
- Billing hours
- 21 needed / 24 available
Add 6 clinical support hours.
Wave 2 · Cedar Lake and West
- Clinical hours
- 28 needed / 32 available
- Billing hours
- 22 needed / 24 available
Hold for the Lake billing tie-out.
Wave 3 · Pine South
- Clinical hours
- 14 needed / 20 available
- Billing hours
- 8 needed / 12 available
Ready for release-owner sign-off.
Wave 1 has 3 spare billing hours and a 6-hour clinical shortfall. Wave 2 has enough staffing on paper, but the revenue cycle lead still needs to reconcile Lake’s open balances. Wave 3 has the evidence and coverage to go to the release owner.
Use the planner for your next rollout meeting
Bring the clinical, billing, and implementation leads together to fill in the site rows. Assign an owner and evidence reference for each decision. Keep patient records and claim details in your approved systems.
Download the workbook or read the guide to switching behavioral health EHRs.