implementing a clinical information system – strategies for success
DESCRIPTION
Implementing a Clinical Information System – Strategies for Success. Helen Edwards RN MN January 26, 2012 PMI – SOC Professional Development Day. Outline. Evolution of Computerization at SickKids Implementing a Clinical Information System Design Communication Education Go-Live - PowerPoint PPT PresentationTRANSCRIPT
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Implementing a Clinical Information System – Strategies for Success
Helen Edwards RN MN
January 26, 2012PMI – SOCProfessional Development Day
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Outline• Evolution of Computerization at SickKids• Implementing a Clinical Information
System– Design– Communication– Education– Go-Live– Post Go-Live
• Key Success Factors• Lessons Learned
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SickKids Hospital
TOTALPlanned Beds 274
Ambulatory Visits 217,707Day Surgery Visits 4,953
Inpatient Surgical Visits 6,506
Emergency Visits 57,561
Admissions 14,590
Average LOS 6.9
Patient Days 100,595
Average Daily Census 276
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Evolution of Computerization• Complex infrastructure - comprises diverse platforms,
applications, client devices
• Complex and dynamic technological environment with >200 information technology systems/applications in use
• main clinical apps
• patient management apps
• decision support apps
• interface technology apps
• scheduling and departmental systems
• personal productivity apps
• business services
• network/computing infrastructures
• communication apps
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Evolution of Computerization cont’d
• 1980s first clinical information system – home grown system (functionalities included laboratory order entry / results retrieval and diet order entry)
• 1992/1993 DOS based system (Kidcom) – ADT, CPOE, eMAR, some clinical documentation
• 1996 Telemedicine launched
• 2000 - ICUs – all clinical documentation except CPOE
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Evolution of Computerization cont’d
• Other common systems– PACS– Scanned historical paper chart– Schedule Book– Transcription and Dictation System– Ambulatory Referral Management System– eCHN – provincial paediatric EHR– Surgical Information System– Emergency Department Information
System
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Evolution of Computerization cont’d
• 2005 – KidCare Phase I (transitioning Kidcom to Windows based system)– Patient Lists– Results retrieval
• 2008 – KidCare Phase II (transitioning remaining functions)– CPOE– eMAR– Clinical Documentation (e.g. Admission
Assessment, LOA, Discharge Summary)
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Our Vision• Fully electronic patient chart across
the inpatient and ambulatory areas– Progress Notes– Flow Sheets– Consents– Diagrams/Photographs, etc.
• Universal Workstations– Single Sign-on– Multiple form factors
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Implementing a Clinical Information System
• Design
• Communication
• Education
• Go-Live– Command Centre– Support
• Post Go-Live
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Design
• Based on user input working with informatics clinicians– Reflect practices and processes– Engage clinical departments/areas – e.g.
responsible for their order sets– Testing – (unit, functional, integrated)
accomplished by users and informatics clinicians
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Communication• Hospital-wide engagement/profile• Steering Committee
– Executive Sponsor– Physician Leadership– Nursing Leadership– Professional Services Leadership
• Project Team– Diverse membership – IS, Clinical
Programs, Other programs
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Communication cont’d
• Built off of successes of KidCare Phase I• User Groups - Nursing, Professional
Services, Physicians, Others• Super Users
– Meetings– Emails
• Hospital publications– This Week (print)– Daily News (homepage)
• Website – KidCare; Countdown • Key Leadership Forums – Executive,
Directors, Managers, Educators, MDs
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Informatics Education
3500+ staff
8 Weeks
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Education and Support
Pre-educationCommunication and Advertisingfor Education
Blended Learning Approach
Go-live Post Go-live Support
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Pre - Education
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Pre – Education Open Forums
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Pre – Education Open House
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Pre – Education Open House
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Pre – Education Open House
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Education and Support
Pre-educationCommunication and Advertisingfor Education
Blended Learning Approach
Go-live Post Go-live Support
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Communication and Advertising
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Communication and Advertising
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Communication and Advertising
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Education and Support
Pre-educationCommunication and Advertisingfor Education
Blended Learning Approach
Go-live Post Go-live Support
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Blended Learning Approach• Computer-based Tutorials (CBTs)
– Mandatory pre-requisite – General/Basic information– Decreased in-classroom time– Staff themselves decided when and
where• Instructor Led Classes (ILC)
– Complex process or changes in process/ concepts
– To anchor knowledge – providehands-on training
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Super User Education• Job Description
– proficient at all functionality on legacy system and KidCare Phase I
– recognized ability to lead and support all health care colleagues
– availability to act as a SU during implementation
• Attend Super User training
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Incentives
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3500+ staff
8 Weeks
Original Goal
• Outcome:– Between Sep 4th and Nov 4th
3083 staff were trained 585 classes were held
88% of staff were trained by go-live98% within 6 weeks of go-live
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Education and Support
Pre-educationCommunication and Advertisingfor Education
Blended Learning Approach
Go-live Post Go-live Support
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Go-Live Command Centre
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Command Center Help Desk
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Immediate Assistance
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Communication tools
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External Support Staff and Super Users
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Education and Support
Pre-educationCommunication and Advertisingfor Education
Blended Learning Approach
Go-live Post Go-live Support
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Post Go-Live• Ongoing education
• Clinical Applications Resources and Education Support (CARES)
• Ongoing communication– Tips and Tricks– Website updates
• KidCare Duty Officer (KDO)
• Stabilize the system for a period of time before making any revisions
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Key Success Factors• Hospital engagement
– Hospital-wide project – ownership– Go-live day was a “marked event”
• Communication mechanisms– Countdown– Posters– Clinical Managers, Directors, VPs
• Education – Model– Daily communication– CME Credits
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Key Success Factors• Go-Live Support Model
– Command centre– Super Users– Informatics nurses– Hiring skilled activation support
resources helped the front-line users tremendously throughout the activation process.
• Post Go-Live Support Model– Continuing training session– CARES
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Sense ofHumour
Essential
Lessons Learned
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Lessons Learned• Application
– Ensure sufficient resources for both the project team and support staff
– Cross-train more of the project team members on system configuration
– Changes to a legacy system should be restricted to only those that are critical
– Printing should be tested earlier in the project
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Lessons Learned
• Training
– Ensure you have sufficient technical expertise to support training
– No grab bags
– Have an admin assistant
– An LMS would help!
– Regular debrief sessions
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Lessons Learned
• Training
– Create a mock training environment for informatics educators to practice
– Create a practice database for staff to practice after attending training
– Online Reference Material only – no paper
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Lessons Learned
• Support
– Extended activation support should be planned for and acquired (for example, contracted project team members should not be released shortly after activation)
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Questions?
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Helen Edwards RN MNDirector – Clinical Informatics and Technology Assisted ProgramsHospital for Sick Children (SickKids)[email protected]
Contact Information