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Success, Sustainability, Strategies, and the Future of our EHR ONIG AGM and Education Day March 6, 2015 Donna Simpson Janet DeCloet Emily O’Sullivan.

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Presentation on theme: "Success, Sustainability, Strategies, and the Future of our EHR ONIG AGM and Education Day March 6, 2015 Donna Simpson Janet DeCloet Emily O’Sullivan."— Presentation transcript:

1 Success, Sustainability, Strategies, and the Future of our EHR ONIG AGM and Education Day March 6, 2015 Donna Simpson Janet DeCloet Emily O’Sullivan

2 Donna Simpson RN, BScN, Clinical Informatics Specialist

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4 The Renal EMR

5 Renal EMR Training and Preparation

6 Transition to Hugo

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10 Post Hugo Need to continue to be able to raise issues and problem solve formed Nephrology IT user group drawing from subject matter expert group –initial meeting occurred July 22 –terms of reference –multidisciplinary –monthly meetings –issue log (identifying issue, action, and responsibility) –Renal program website to be “hub” for communications Need to continue to be able to raise issues and problem solve formed Nephrology IT user group drawing from subject matter expert group –initial meeting occurred July 22 –terms of reference –multidisciplinary –monthly meetings –issue log (identifying issue, action, and responsibility) –Renal program website to be “hub” for communications

11 Nephrology IT User Group The Nephrology IT User Group leads, sponsors and co-ordinates the development, implementation, and on-going support and evaluation of PowerChart functionality in the Electronic Patient Record (EPR). In addition, they will communicate all PowerChart functionality changes/revisions/updates, in order to support appropriate, safe, and high quality of care for patients of the Nephrology program at all sites using the instance of PowerChart hosted by London The Nephrology IT User Group leads, sponsors and co-ordinates the development, implementation, and on-going support and evaluation of PowerChart functionality in the Electronic Patient Record (EPR). In addition, they will communicate all PowerChart functionality changes/revisions/updates, in order to support appropriate, safe, and high quality of care for patients of the Nephrology program at all sites using the instance of PowerChart hosted by London

12 Nephrology IT User Group

13 Ongoing Success…. e-practice group engaged program –frontline staff, leadership and MDs dedicated resource-subject matter expert e-practice group engaged program –frontline staff, leadership and MDs dedicated resource-subject matter expert

14 Janet DeCloet, Informatics LMS eLearning Spec

15 Emily O’Sullivan, RN, MBA Director Clinical Transformation

16 Background HUGO is formally closing as a project, yet there is a need to make improvements on what exists today The Optimization project is the term used to describe the projects that will be implemented over the next 12-18 months that increases usability and adoption related to existing Cerner functionality The objective of this meeting is to share information on the processes used to select projects for Optimization and the refreshed governance structure to support it

17 Optimization Project Goals Increase usability and adoption of the Electronic Health Record across the hospitals Promote an understanding of the impacts of having quality data related to usability and adoption and standardization Through increased adoption, create an environment of safer and higher quality

18 The project goals were used to create prioritization criteria to drive the selection of projects to be considered in Optimization 1.Reduces risk of harm to patients and/or improves quality a)Promotes Clinical Decision Support to ensure quality metrics and quality outcomes b)Keeps Ministry priorities in mind 2.Positively affects usability and adoption a)for providers and all clinicians to promote clinical adoption b)results in time neutral processes and c)offloads unnecessary steps for overall efficiency 3.Positive Organizational Impact a)“Readies” the organization for the clinical documentation project b)Promotes foundational improvements

19 Extensive stakeholder consultation took place using various means to understand the biggest challenges facing end users today Jun 2014July 2014Aug 2014Sep 2014Oct 2014Nov 2014Dec 2014Jan 2015Feb 2015 Engagement timeline per Activity Deloitte Interviews Cerner Interviews UPMC Interviews Workshop Regional Site Visits Consultation with PAC/CAC Consultation with CIOC Optimization project engagement Total 30 240 17 14 27 56 24 198

20 Hundreds of front line Providers & Clinicians were engaged in order to identify the greatest patient safety issues and workflow challenges across all hospitals Providers Nursing Educators ITS Leaders Clinical Leaders Medical Affairs Professional Practice Allied Health HIM Lab Medical Imaging Pharmacy Privacy & Risk Clinical Informatics Cerner/Vendors Exec Practice Committee London ePractice Committee Integrated Care Committee Lab Working Group Medication Working Group Regional Total Engagement by Resource Group Deloitte Interviews 10 161 112 53 30 Cerner Interviews 341640 26 41718210317 61239 UPMC Interviews 101 1 12 Workshop 9 5 317 Regional Site Visits 27 Consultation with PAC/CAC 184262 511 2 12 1256 Consultation with CIOC 1 12724 11 21 224 Optimization project engagement 235724213439198 Total 7321442336213292031452962357242134144 603

21 These inputs where then used to shape 113 potential projects that could be included in Optimization Consultations with regional sites Cerner 170-Page Report UPMC Report 113 potential projects Workshop conducted with CIs and NETs Stakeholder Interviews Letters from various stakeholders and services e.g. Ortho, Schulich

22 These potential project were then grouped into similar applications or work streams, with a consolidated list of 32 potential projects as a result 1 Ambulatory Optimization 18 Order Entry Workflow Optimization 2 Clinical Alerts Optimization 19 Radiology Workflow Improvement 3 Device Assessment 20 Cardiology 4 MPage Improvement Project 21 Blood Product Administration 5 ED Workflow Optimization 22 Downtime 6 Foundations Improvement Project for Core 23 Care Compass 7 Med Project 24 X-R Charting 8 Encounter Strategy 25 Clairvia (or other workload measurement tool) 9 HIM Clean Up 26 Oncology 10 Discharge Process Optimization 27 Anesthesia 11 Improve Patient Scheduling and Access Management 28 Training 12 Improve User Management 29 Perioperative Functional Improvements 13 Misc. Laboratory Improvement Project 30 Benefits 14 Nursing Workflow Optimization 31 Governance and Resources 15 Med Rec Workflow Optimization 32 Message Centre 16 Order Set Design 17 Order Entry Clean-up

23 On December 18 2014, the Integrated Care Committee approved the following projects moving forward as the Optimization Projects 23 Month123456789101112 Wave 1: 9-12 months (may vary depending on resource availability) A.Medication Project B.Med Reconciliation Optimization C.Order Entry & Order Sentences clean-up D.Alerts clean- up Wave 2: 12 months A. Electronic tools to support Leaner integration and support Wave 3: 9-12 months (may vary depending on resource availability) A. Encounter Strategy B. Discharge Process Optimization C. XR-Charting A.Improvements to formulary to reflect ordering practices, improvements to the medication catalogue, fixes to prescription functionality that aligns with workflow B.Clarified guidelines for which roles should be doing BPMH in various scenarios, conduct value stream mapping session to identify improvements, update policies to reflect best practice C.Updates to order entry formats for various fixes like consistent stop dates, adding more defaulted values to reduce clicks for order entry D.Create alert strategy that provides guidance on when alerts should be created, asses current alerts that are active and reduce alerting to critical alerts Wave 1 Outcomes A.Improved patient flow and access to information by implementing a single encounter strategy. Updated reports and interfaces to support the technical changes. Improved workflow for transitions in care and less missed orders B.Improved discharge process and discharge summaries C.Foundational requirement to prep for Clinical Documentation build Wave 2 Outcomes A. Increased provider satisfaction by improving upon how efficiently they use the system B. Easier access to information for in the moment educational needs C. Improved transition for providers who rotate between departments D. Established mechanism for informing providers on enhancements to the system and strategies for using the system more efficiently E. Process created for measuring competency in the use of the Electronic Health Record Wave 3 Outcomes

24 The sub-projects within Optimization have a strong focus on medication management, medication reconciliation, transfers in care, improved provider workflow, and improvements to the needs of our learners. Practice will drive technology changes and overall direction of the E.H.R Where proposed changes have impacts to other hospitals, services, and/or to the workflow of other end-users, proposed decisions will be brought forward through our revised governance structure The impacts of decisions must be clearly articulated and understood from an interdisciplinary perspective so that informed decisions are being made Many other workflow challenges and issue raised that would have been addressed with the projects that are not being proposed will be improved when Clinical Documentation is rolled out because there will be an integrated E.H.R as opposed to the hybrid chart that exists today

25  Clear accountability and authority  Nimble decision making  Strong project management  Scope transparency  Adaptability to changing project needs as required A modified governance structure is required in order to manage the volume and complexity of issues post-HUGO to support Optimization and also Clinical Documentation which must support:

26 Post-HUGO e-Governance Structure Integrated Care Committee Represents all hospitals Executive Council Represents al hospitals 1) System Level 2) System Level - All Sites MHA ePractice Group (Four Counties and Strathroy) LWHA ePractice Group (Listowel and Wingham) AH/TDMH ePractice Group (Alexandra & Tillsonburg) STEGH ePractice Group WH ePractice Group Exeter ePractice Group Regional Executive e-Practice Committee (HIS Navigations) London Executive e-Practice Committee Clinical Transformation Coordinating Committee (sub-committee of ICC) Regional Clinical User Group London ePractice Sub-Committee TBD 3) Mid and Local Level

27 Integrated Care Committee (monthly): Represents all hospitals Due to the volume and complexity of issues there will be a sub-group meets weekly in order to facilitate nimble decision making (This is the Clinical Transformation Coordinating Committee) Executive Council (quarterly as mediating body): Represents all hospitals Local Executive e-Practice Committee Local ePractice Working Group Post-HUGO Governance Structure with role details Consulted when the Integrated Committee cannot reach consensus System level focus representing all hospitals Includes one Executive level representative for each hospital Understanding of Standards of Practice, Legislation, resource constraints and technology limitations. Interdisciplinary Practice group at each hospital Non-consensus items go to Executive ePractice (or for London, to the ePractice sub-committee) London SLT’s Executive-level Interdisciplinary Practice group London’s has been established, Regions are discussing a Regional Executive Committee Decision making body as it relates to Practice issues Receives Practice direction from MAC, and/or SLT Where technology changes are required to support best Practice, provides recommendations to Integrated Committee via the Clinical Transformation Coordination Committee Note: London will have a combined London focused ePractice sub-committee due to the combined size of their hospitals in one area, in addition to local ePractice groups at the local level as per previous slide HIS Steering Committee

28 The Local ePractice groups that are being formed will be key in having front-line Clinicians and Providers drive change to ensure that Practice is guiding technology DRAFT Accountabilities of Local ePractice Groups Be accountable to the London ePractice Sub-Committee (in London), and HIS Navs (Regional hospitals) Bring key messages and information back to their representative areas. Provide input to the issues and changes Ensure that new process, policy, practice or system changes are effectively implemented and communicated within their area of responsibility Monitor and improve key system performance indicators in their area (e.g. percentage compliance of medication / patient scans) Ensure that the represented area has effective training and education systems in place to ensure ongoing competency of system users Accountabilities and Activities of Local ePractice groups are being drafted to provide guidance to hospitals and have been circulated. Existing groups should be leveraged where possible.

29 As of March 6 th 2015, the local e-Practice groups are still forming MHA ePractice Group (Four Counties and Strathroy) LWHA ePractice Group (Listowel and Wingham) AH/TDMH ePractice Group (Alexandra & Tillsonburg) STEGH ePractice Group WH ePractice Group Exeter ePractice Group Regional Clinical User Group London ePractice Sub-Committee LHSC Clinical Practice Team VH LHSC Clinical Practice Team UH St. Joseph's Hospital Pathology and Laboratory Medicine Working Group Parkwood Institute SWC FMH* LHSC Emergency ePractice LHSC Medicine Leadership Team Additional LHSC Local ePractice Groups TBD *Southwest Centre for Forensic Mental Health Care LHSC Surgical Care ePractice LHSC Periop Site Committee (VH) LHSC Perinatal Collaborative Practice Council Medication Working Group Regional Oncology Working Group LHSC Mental Health St. Joseph’s Mental Health

30 Local ePractice Groups The following groups have been identified or formed to-date to take on the role of the Local ePractice Group : –Within the Region: 1.MHA ePractice Group (Four Counties and Strathroy) 2.LWHA ePractice Group (Listowel and Wingham) 3.AH/TDMH ePractice Group (Alexandra & Tillsonburg) 4.STEGH ePractice Group 5.WH ePractice Group 6.Exeter ePractice Group 7.Regional Oncology Working Group –Within London: 1.St. Joseph's Hospital 2.St. Joseph’s Mental Health 3.Parkwood Institute 4.Southwest Centre for Forensic Mental Health Care 5.LHSC Clinical Practice Team UH 6.LHSC Emergency ePractice 7.LHSC Medicine Leadership Team 8.LHSC Mental Health 9.LHSC Surgical Care ePractice 10.LHSC Periop Site Committee (VH) 11.LHSC Perinatal Collaborative Practice Council *Additional LHSC Local ePractice Groups TBD

31 There is a need to compare the Regional User Groups (RUG’s) membership and TOR to the Local ePractice groups to look for alignment opportunities and eliminate redundancies Current RUG’s 1.Diagnostic Imaging/RadNet/PACs 2.Registration/Scheduling/HIM 3.PathNet –TVLIS (Thames Valley Lab Info Systems), SWRHLA (SouthWest Regional Hospital Lab Alliance) 4.PharmNet User Group 5.Infection Control User Group 6.FirstNet User Group 7.SurgiNet User Group 8.Information Technical Team (ITT) 9.Clinical Regional User Group 10.Privacy Offers Regional User Group We will bring recommendations for consideration to an upcoming Integrated Care Committee once the rest of the Local ePractice groups are known

32 What is the status of Optimization as of March 6th, 2015 Optimization has been socialized and endorsed across 11 hospitals Dollars should be approved in the March/April timeframe in order to kick the projects off

33 What about Clinical Documentation? It is important to note that many of the issues that clinicians are facing today are a result of a hybrid chart. To gain the full benefits of an E.H.R, Clinical Documentation is needed. There is a greater pressing need however to improve what exists today as expressed by all hospitals, thus the Optimization project is kicking off with a focus on meds, med rec, alerts, discharge and transitions in care (encounter strategy). The risk that must be mitigated by careful planning is to make sure we don’t remain in the Optimization phase for too long so we can actually achieve the benefits of an integrated E.H.R by rolling out Clin Doc. The other risk that must be managed is the ongoing request for clinical documentation tools to be implemented now. The way in which we document will fundamentally change in ways that have yet not been discussed/explored. In the absence of a Clinical Documentation strategy (e.g. what tools to use, how to standardize, how data is used/shared etc.) caution must be used in terms of what Clin Doc tools/workflow we want to design and build now, and the work that our scarce resources focus on.

34 Thank You and Questions Contacts Donna.Simpson@lhsc.on.ca 519.685.8500 Ext 75329 Janet.DeCloet@sjhc.london.on.ca 519.646.6100 Ext 64342 Emily.OSullivan@lhsc.on.ca 519.685.8500 Ext 35223


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