1. Faculty/Presenter Disclosure Faculty: Sally Remus & Diane Salois-Swallow Relationships with commercial interests: –Nothing to disclose. Slide 1

2. Building capacity, operational readiness & sustainability to realize a ‘SMART’ hospital design & build eHealth 2013 Ottawa, ON May 29 th, 2013 Sally Remus, RN, BScN, MScN Director, Health Informatics & Practice Diane Salois-Swallow RN, BScN, M. Ed., Chief Information Officer

3. Agenda Who is Mackenzie Health (MH) ? MOHLTC mandate –Design a ‘smart’ hospital New structures & nursing informatics roles/skill sets Current Issues and Challenges Next steps – –Good old days vs New reality –Create a climate of operational readiness –Future possibilities through innovative NI roles Questions/Discussion

4. Who is Mackenzie Health (MH)? Large community hospital serving Richmond Hill, Vaughan and other parts of York Region Expanding to a two-site model: new hospital in Vaughan in planning stages Mackenzie Vaughan Hospital Proposed Concept Existing Mackenzie Richmond Hill Hospital

5. MH Quick Facts Current State: Opened in 1963, Mackenzie Health serves 500,000+ residents in Southwest York Region Mackenzie Richmond Hill Hospital (formerly known as York Central Hospital) - 488 Beds Second largest employer in Southwest York Region Annual budget of $250 million Future State: Mackenzie Health will include two hospitals, the future “Mackenzie Vaughan Hospital” and the existing Mackenzie Richmond Hill Hospital - ~ 600 beds –construction expected to begin in 2015/16 –new hospital (second site) scheduled to be fully operational by 2018/19 Southwest York Region is known as one of the fastest growing and most diverse communities in Canada. –1 st new hospital to be built in the Southwest York Region in 50 years.

6. MOHLTC Mandate: Design & Build a ‘Smart’ Hospital MH’s ‘Smart’ Hospital vision : ‘Paperless’ environment where all information is digital Systems are automated & interoperable Communications are multi-modal & digital People are equipped for mobility All technologies are IP addressable and Interoperable To do this requires a ‘state of the art’ IT infrastructure - ICAT 6

7. 28th March 2012 Copyright - Vantage Business Management Services, 2013 7

8. ICAT components that maximize automation include: Electronic Patient Record & Other ‘Enabling Clinical Technologies’ Automated Patient Bedside Terminals & Bedside Infrastructure Fully Automated Pharmacy, Laboratory, Materials Management & Building Systems Integrated Tube Transport System & Infrastructure Unified Communications –Integrates voice, data & image into digital/electronic format Auto Guided Vehicles (AGVs) Enterprise Service Bus (ESB) 8

9. Operationalizing ICAT & its components requires answers to the following questions: What do the logistics and material’s management distribution systems/processes look like? What do the drug delivery/distribution & drug administration systems/processes look like? What does bedside care look like? (e.g., bedside terminals, etc.) What does ‘unified communications’ look like? What does specimen collection/analysis and results processing/reporting look like from bedside to laboratory? What does environmental cleaning look like in clinical vs. non- clinical areas ? For example – ‘terminal room cleaning’, etc… Nursing informatics roles are essential in ‘brokering’ and ‘translating’ in partnership with key clinical stakeholders, the answers… 9

10. Mackenzie Health Organizational Structure

11. Embracing Enabling Technologies & Innovation in Patient Care through Informatics Adapted from: Englebart, S, Nelson, R. (2002). Health Care Informatics – An Interdisciplinary Approach, p. xviii; Eysenbach, G. (2001). What is eHealth. J Med Internet Res 3(2):e20. Medical Informatics Clinical Informatics Health Care Informatics Health Information Management Nursing Informatics eHealth through informatics & practice @ MH

12. Nursing Informatics - New Roles and Skills Sets Director, Health Informatics & Practice will : facilitate the corporate mandate & realization of the new ‘Smart’ hospital build (MVH) and MH’s eHealth agenda. position MH to be an industry leader in launching a transformative practice leadership model and governance structure that will enable the delivery of a ‘world class health experience that is patient focused, results driven, integrated, and sustainable, critically dependent upon information and communication technologies’ essential informatics skills & knowledge. position MH to realize the benefits of patient safety, quality care delivery models and knowledge driven care by the application of informatics’ skills & knowledge to execute ‘state of the art’ enabling information & communication technologies.

13. Role alignment with industry trends: Informatics competencies & certification –ANA (2001, 2008); HIMSS, COACH-HIMSS Employment trends - new informatics’ roles –Obama Care & Accountable Care Organization (ACO) Act influencing the emergence of CNIO roles to compliment CMIO roles Academic preparation of nurses –TIGER, CASN, RNAO Industry Reports – 2003 IOM, Amara 2000

14. Current Issues and Challenges Creating & sustaining a climate of operational readiness to meet the build/design characteristics of the new ‘Smart’ hospital (MVH) supported by a robust ‘state of the art’ ICT infrastructure: Introduce and nurture a ‘new way of thinking’, understanding and endorsement of the MVH ‘smart’ hospital vision Introduce transitional clinical system building blocks to meet HIMSS – EMRAM Stage 6 –CPOE with full closed loop medication administration checking & Physician documentation Introduce transitional ‘state of the art’ technologies that further the ‘smart’ hospital vision: –‘Smart’ beds; Nurse Call Bell System that aligns with a unified communication’s infrastructure

15. Current Issues and Challenges cont. Design and introduce new work flow practices/processes & policy/procedures that are scalable/flexible to support successful transition to MVH ‘smart’ hospital. Build internal resource capacity to transition successfully –Workforce preparation –  Develop all hospital staff (e.g.., nursing /allied health/physicians) with the requisite informatics skills & knowledge to leverage the state of the art ICT infrastructure  Recruit/prepare clinical informatics team to design clinical/business systems that meet the ‘smart’ hospital vision & eHealth agenda/mandates –Consumer preparation –  Educate MVH & MRHH communities to understand & leverage new ‘smart’ hospital services & offerings that will create MH providing a ‘world class health experience’. o E.g.., consumer friendly access to self services - patient scheduling/registration ; chronic disease management

16. 16 The Good Old Days……

17. Create an ‘operational readiness’ climate via a User Engagement Strategy # 1 # 2 # 3 # 4 Reference: Remus & dela Cruz. (2007). CNIA Conference Proceedings, Toronto, ON

18. 18 The New Reality!

19. A glimpse into our future possibilities with innovative nursing informatics leadership roles … http://www.youtube.com/watch?v=gxz9ZVvdu Gc

20. Thank You!