1. Roles Access control >766 000 records Basic documentation all professions Referrals Multimedia Scanning Messages and letters Linkages E-messages SOM Psyk BUP SOM Psyk BUP SOM Psyk BUP SOM Psyk BUP SOM Psyk BUP SOM Psyk BUP SOM Psyk BUP SOM Psyk BUP VO ORKR MO ÅL TR LE NA PAS PatientID, Contacts ROS/LAB Blood bank PACS/RIS Web services DocuLive TS X 50 Scanning Multimedia >13 500 users >1200 concurrent >130 000 documents a week

2. Content in today’s DocuLive Users and access control Users and access control Documentation logistics Documentation logistics Scanning Multimedia Scanning Multimedia Messages, letters Messages, letters Documentation all professions Documentation all professions Internal referrals Internal referrals Prescriptions RTV forms RTV forms Patient overview PAS Integration LAB Integration LAB Integration RTG/X-ray Integration RTG/X-ray RTG Digital discharge notes Digital discharge notes Prim. lege

3. Electronic patient records - history, status and challenges Guest lecture Health informatics 1. september 2005 project manager Rut Naversen Project introduction EPR St. Olav Hospital

4. 01.09.2005R Naversen 4 Some background MEDINA project from 1996 MEDAKIS project from 1998 –Joint development project for the 5 regional hospitals –Industrial partner: Siemens Regional EPR project from 2000 –Reorganization due to State takeover of hospitals –Wish for common EPR and solutions in Helse Midt- Norge (Central Norway Regional Health Authority) Another reorganization in 2003 HEMIT 1. juli 2003 New regional project manager HEMIT: Terje Dale New project manager St. Olav: Rut Naversen

5. 01.09.2005R Naversen 5 Project organization Project owner: Helse Midt-Norge RHF Steering committee: Regional steering committee for PACS/RIS and EPR Project manager: Terje Dale, HEMIT Scanning Prj. Mng. Reference group Project group Workflow Prj. Mng. Introduction NT: Ingunn Bjørkli Reference group Reference group Reference group Project group Project group Product development.Introduction XX: ?? Project group Reference group

6. 01.09.2005R Naversen 6 Organization St. Olav IT steering committee Stein Sundmoen (finance director/manager) Ola Bergslien (chief medical officer/system owner) Gudmund Marhaug (director Children and youth) Arild Faxvaag (senior physician Department of rheumatology/NTNU) Liv Sjøvold (divisional manager Psychiatric health care) Ragnhild Brå Vardehaug (Spec.cons./nurse) Ida Lise Salberg (General manager/Orkdal hospital) Thore Smevik (IT strategist/secretary)

7. Ajour per 1. september 2005

8. 01.09.2005R Naversen 8 Departmental EPR groups –Multidisciplinary Doctor, nurse, secretary –Plan introduction in coordination with line management Introduce new software components Routine adaptation Organizational adaptation –Work on record content quality –Requests for changes to production functionality

9. 01.09.2005R Naversen 9 Superusers – new in 2005 25 secretaries and 76 nurses –teach new employees, temps and students from own occupational group within own department Secretary superusers are also responsible for educating doctors –responsible for follow-up/guidance of new and existing EPR users –train colleagues when introducing new software modules –follow up on document flow and work lists

10. 01.09.2005R Naversen 10 Introductory activities –When new functionality is to be introduced Assess need for pilot Prepare user documentation Prepare paramount procedures and guidelines Disseminate information (meetings, “Kilden” etc.) Educate superusers Pre and post planning and follow-up on department/clinic Evaluate the delivered product and project introductory activities Provide feedback to the regional project on eventual required changes

11. 01.09.2005R Naversen 11 eLearning www.helse-midt.no/elaring Practice module Theory module Certification module (intranet) Regional project manager Jane Wik

12. 01.09.2005R Naversen 12 Progress The new university hospital –Comprehensive use of IT tools is a design prerequisite for area dimensioning An total efficiency gain of 30 % is assumed – the use of a complete EPR by all record users is presumed to be the most important efficiency improvement measure –No areas for paper archives Patient records Case files –Patient areas are not dimensioned for temporary paper storage

13. Paperless patient record within 1. Januar 2007 …although not a paperless hospital…

14. 01.09.2005R Naversen 14 Status from user database, June 2005 Today, all departments except Psychiatric healthcare are using DocuLive –Somatic: a total of ca. 5000 users Assistant nurses – ca. 590 –40 % are users - divided on 75 % authors 25 % readers Nurses – ca. 3000 –Roughly 80 % authors, 100 % with access rights Doctors – ca. 800 Other occupational groups ca. 800

15. 01.09.2005R Naversen 15 Towards the paperless hospital May 2005Nurses and other professionals – ca. 3500 – quit making printouts to the paper records Sep 2005Completion lab answers + signing via DocuLive X-ray answers available via DocuLive Oct 2005Pilot introduction Psychiatric healthcare Digital dictation Oct/Nov“Paper deficient” record for Women- children

16. 01.09.2005R Naversen 16 Towards the paperless hospital Jan 2006Basic training EPR transferred to superusers Feb 2006Referrals/letters/messages to/from primary care, other hospitals, central authorities Jun 2006Anesthesia/intensive care system Birth/maternity system Patient chart/prescriptions Medication Care plans

17. 01.09.2005R Naversen 17 Challenges Relocation determines deadline/progress rate and sequencing of training –Lab center relocates Sep/Oct 2005 –Women-children relocates Oct/Nov 2005 Scanning – paperless patient record –Dermatology department pilot spring 2004 –Lab center Medical genetics –Women-children Children and youth department Gynecological department –Access to EPR not stable – backup paper solution still required for the following months

18. 01.09.2005R Naversen 18 Challenges Training – capacity for basic training has increased over the last year –Diversified offerings E-learning Decentralized guidance for super user follow-up Phasing out of introductory project course room classes –Remaining author training Somatic: ca. 500 nurses + 200 assistant nurses Psychiatric health care ca. 800 in total –Distributed on 350 caregivers and 450 environment therapists –Maintenance training – ca. 1300 a year! Equipment –The XP project has lead to a hospital-wide renewal of machinery equipment by June 2005 –There will also be an increase of PCs in the old hospital as units relocate to the new hospital

19. 01.09.2005R Naversen 19 Minister of Health and Care Services, Ansgar Gabrielsen –S@mspill 2007 shall secureS@mspill Strengthened and efficient cooperation –between different disciplines and administrative areas –Improved user contact Quality improvements –Inquiry into investment effects… Changing work processes and routines might be the biggest challenge. Up to 90 percent of the resource allocation in the wake of a successful IT implementation will often be in skills development and organizational development