The pilot strategy

The correct answer: D. Pilot

✅ Why this answer

Take the description apart along its two axes: “complete new EHR” (all functions, not parts) + “at its smallest hospital first... evaluates... then rolls out” (one site first, then the rest) = pilot: the fully functional trial site you learn from before deployment.

Its philosophy: buy the learning with one site; build, training and workflow errors are discovered and fixed within a limited scope instead of being paid for at every site.

❌ Why the other options are wrong

The matrix of strategies along its two axes (functions × sites):

• Big bang (A): all functions × all sites at once; fastest and riskiest (a related question in the full bank).
• Phased by functionality (B): one function after another (pharmacy, then lab, then orders) across the organization; the opposite axis to the question’s.
• Parallel (C): outside the two axes: running the old and new systems together and comparing outputs (a related question in the full bank); not what the scenario describes.

💡 Key concept

The strategy by goal: speed and standardization → big bang. Maximum safety → parallel. Learning before rolling out → pilot. Gradual rollout, by function or by site → phased.

In the exam: take the description apart along two axes: functions and sites. “The complete system” with “one site first, then an evaluation, then the other sites” is a pilot. The evaluation stop after the first site is its distinguishing mark.

🔗 Related facts and questions

• The strategies on the two axes: big bang: all functions at all sites together, the fastest and the riskiest (a related question in the full bank). Phased: in stages, either one function after another across the whole organization (phased by functionality) or one site or unit after another (phased by location). Pilot: all functions at one site first, with an evaluation before the other sites follow. Parallel is not on these two axes: it runs the old and new systems together for a time and compares their outputs (a related question in the full bank).
  Practice question: the pharmacy system goes live in all hospitals first, then the laboratory two months later, then order entry. Which strategy is this? → Phased by functionality.
• Parallel operation: the safest strategy, but it doubles the users’ work for as long as it lasts.
  Practice question: nursing staff document medication administration in both the paper record and the new system for two weeks, and the two results are compared daily. Which strategy is this? → Parallel.
• Choosing the pilot site: choose a site that represents the others in the nature of its work, whose leadership is keen, and whose size allows intensive support. A site unlike the others gives lessons that do not apply to them.
• The purpose of a pilot is its lessons: problems, what worked and what did not are recorded, then the plan is adjusted before the next site.
  Practice question: after the pilot, nursing staff’s most common complaint was that training came long before go-live and was forgotten. What changes at the next sites? → Training is moved closer to the go-live date.
• A computerized provider order entry (CPOE) system that succeeds at one site and whose results are then made known at the other sites (a related question in the full bank) is a familiar fruit of this strategy.