use of clinical simulation for assessment in ehr- procurement; design of method sanne jensen, stine...
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Use of clinical simulation for assessment in EHR-
procurement; design of method
Sanne Jensen, Stine Loft Rasmussen, Karen Marie Lyng
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Clinical simulation
• Clinical simulation: clinicians using it-systems in realistic environments
• Clinical simulation may be used for various purposes and in all stages of the lifecycle of clinical information systems
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IT Experimentarium (ITX)
•20+ clinical simulation during 6 years
•Clinical simulation is used for • analyzing and assessing existing & future work practice
• analyzing and assessing user requirements and usability
• user involvement
• design and evaluation of clinical information systems
• identification of potential issues in new technology
• Mandatory before implementation of clinical IT-systems
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Background
• Procurement of new EHR-platform 2012 – 2013
• 2 Danish regions
• 14 hospitals covering half the Danish population
• Approx 40.000 healthcare professionals
• Broad functionality to support clinical and administrative core processes
• Strategic demand of simulation assessment:• shall cover usability & human factor issues
• must cover demands from various different end-users, specialties and cultures
• shall meet transparency demands of procurement in a public tender according to EU rules
• .
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Purpose of new EHR-platform
Main topic is increased effectiveness in quality of care
1.continuity of care and patient safety
2.streamlining of clinical processes and workflow
3.patient and employee satisfaction
Furthermore
• Support cross-functional work processes
• Support hand-over of responsibility
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Procurement plan
6
Preliminary procurement Dialogue phase Assessment of 3 offers
Procurement
December 2012 Ultimo Dec. 20-13
Signing of purchase agreement
August 2012 26/8 201321/6 2013
Final requirement specification
ITX assessment
5 3 vendors
May 2013 6/9 2013
Milestones
8 5 vendors
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Assessment: full scale clinical simulation
Part of the assessment: clinical simulation
Part of user involvement
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Challenges
• Conditions for procurement
• Vendors
• Qualitative data must be made quantitative
• Time schedule
• Resources
• Organization
• Perspectives of various stakeholders such as risk managers, quality managers and clinical manager must be taken into account
• New method had to be developed
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Elements and relations in assessment
Evaluation
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Scenarios - work practice
• First visit in outpatient clinic
• Dispensation and administration of drugs
• Assignment to hospital (physician and nurse)
• Ward round
• Patient care and nursing treatment
• Hand over
• Consult
• Interruption and shift between different patients
• Discharge of patient (physician, nurse)
• Children’s outpatient clinic
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Patient cases
Patient cases:
• Hip fracture
• COPD
• Appendicitis
• Depression
• Breast cancer
• Child with failure to thrive
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Clinicians- future users
• 9 physicians• Surgery (3)
• Internal medicine (3)
• Psychiatry (2)
• Pediatrics (1)
• 7 nurses • Surgery (3)
• Internal medicine (3)
• Psychiatry (1)
• 2 medical secretaries
• Divided into 3 teams (red, blue, green)
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Metrics of assessment
Overall metrics for assessment
1.ability to support key areas of clinical work practice
2.clinicians experience of the use of the systems
3.patient safety
Data collection
• Observations
• Questionnaires
• Paper version after each scenario to support memory
• Electronic versions after each vendor
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Detailed plan
Clinical simulation
Clinical simulation
Evaluation
Clinical simulation
Evaluation
Clinical simulation
Clinical simulation
Evaluation
Clinical simulation
Qestionnaires
Clinical simulation
Training Hands-onDay 1
Day 3
Day 2
AfternoonMorning
Evaluation Evaluation
Evaluation Evaluation
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Overall plan of assessment
Fidelity dimensions and levels of fidelity used in the clinical simulation
Monday 26 August
Tuesday27 August
Wednesday28 August
Thursday29 August
Friday 30 August
Vendor A Red team Blue team
Vendor B Green team Red team
Vendor C Blue team Green team
Monday2 September
Tuesday3 September
Wednesday4 September
Thursday5 September
Friday6 September
Vendor A Blue team Green team
Overall assessment of the 3 solutions
Vendor B Red team Blue team
Vendor C Green team Red team
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Conclusion
• Thoroughness in scenarios
• Simulations must be performed uniform
• Metrics of assessments must be very specific
• Context sensitive patient safety issues