PREPARING FOR AN EHR SYSTEM Carol Sainsbery Project Director Leanne Cox Medical Records Manager

Southern “One small step for man; one giant leap for mankind” (Neil Armstrong, ).

Southern Health Vital Signs Acute, Sub-acute, Mental Health, Aged & Community Service area of 2800 square kms and 750,000 people 12,000 staff Annual turnover of $700 million

Southern Health Vital Signs 110,000 inpatient attendances 700,000 outpatient attendances 1.8 Million PMI entries 2.4 million MR location moves annually

Southern

From this….. Typical paper based medical records department ;

To this….. Casey Hospital medical records department following the removal of shelving and installation of scanning workstations

Preparing for an EHR System How does a Health Service start? An EHR is a journey, not a destination

WHAT?

Activity One Group Activity Key Stakeholder Groups Brainstorming EHR

WHAT do you want to achieve? Paperless Medical Record Electronic diagnostics Direct entry forms Wireless tablets Integration between different systems

WHAT do you want to achieve? E-Prescribing Direct Pathology and Radiology order entry Remote access Document Management / Archiving

WHAT do you want to achieve? If you don’t know where you are going, you surely won’t get there!

WHY?

WHY do you want to do this? Which would you prefer?

WHY do you want to do this? Clinical Care / Continuum of Care Timeliness and Accessibility Access by multiple users Reduces physical storage space Reduces the clerical EFT in HIS

WHY do you want to do this? Record Transportation – Network record issues Decreased record consumables HIS Information Systems ‘get smart’ Quality Management / Auditing

HOW?

HOW will you achieve this? Think BIG …. Start Small

HOW will you achieve this? What is available? Scanning Direct entry Voice recognition Archiving systems e-Pens In house or Out house How will these support your WHAT & WHY?

HOW will you achieve this? How will you get your chosen product to work? Working party & steering committee of stakeholders: - IT - HIMS - Clinicians - Project Team – Ownership and direction - Vendor What are the expectations of your stakeholders? Are they aligned, realistic and achievable?

HOW will you achieve this? Process Redesign Challenge everything you know about medical records management Implementing into an existing site Managing the dual world between paper and scanned records Individual sites – transition “hump” but it is manageable Networked records – messy and resource intensive

HOW will you achieve this? How do we do it? Ensure chosen solution reflects the look of the paper record - Minimise the impact in the hospital - Consider containing the change to HIS for a short time - Scan on discharge - Decrease reliance on past paper history - Centralised and decentralised scanning areas

HOW will you achieve this? Forms – Top Priority Forms inventory – Which stay and which go? Forms register – Standardise across your service Barcode all forms – Document mapping file Control forms in one central location

Activity Two Medical Record Sample Analysis of Content Comparison with Scanned Record

Activity Two

Backscanning is a dirty word! Consider the pros and cons All or nothing or segmented approach? Pick a start date – “old” records then become static Consider impact on throughput of current records What is to be gained – what are current recall rates?

WHO?

WHO should be involved? Organisations Executives / Board Clinicians / NUMS / Key Clinical Stakeholders Steering Committee HIMS Project Team Working Party IT / Computer Services Forms Co-ordinator / Materials Management / Printer HIS Clerks / Scanners

WHO should be involved? Clinicians Vendor Project Team H.I.S Computer Service s EHR Project Steering Committee Executive

WHEN?

When do you want it? When can you do it? What are the known barriers? Hardware / software IT Infrastructure Impact on organisation whilst doing it? Who will be affected Staffing required to provide ongoing services Staged or Big Bang? Department based or whole of organisation

It’s not going away! Moving to an EHR is not an alternative. It is not an IF, it is a WHEN! Don’t get left behind, the planning starts NOW!

HOW MUCH?

HOW MUCH and who pays? Funded by the Health Service Government / Department funding Consortium or partnership arrangement Hub & Spoke What is the projected return on investment?

Paper Vs Scanning…Some costs Paper Department EFT = $23.04 per separation Scanned Department EFT = $11.40 per separation 51% reduction Tracking in a paper dept = $1.17 per move Tracking in a scanned dept = $0.58 per move 51% reduction Paper Record Construction = $1.62 per record Scanned Record Construction = $0.00 per record 100% reduction

Casey KPIs

Activity Three Sample Business Case Group Activity Brainstorming Business Case Development

Project Management Methodology Project Start-up Directing a Project Initiating a Project Controlling a Stage Managing Delivery Closing a Project Methodology controls the flow of the Project

Project Management Methodology Clinical Record Information Scanning Project (CRiSP)

Project Vital Signs People 80% Product 20%

Project Warning Signs In Scope Application - Deployment - Interfacing - Integration Out of Scope Mapping / translating data tools Direct & order entry Process re-engineering Legal compliance Acceptance testing Archiving ……

Change Management PROJECT Define the purpose Stakeholder analysis Manage the risks Develop evaluation strategies PEOPLE Who to engage Manage HR / IR issues Consult / Communicate Develop change agent skills

Change Management WORKFORCE PLANNING Reconsider recruitment Natural attrition rather than retention Plan to reach the projected EFT in your business case TRAINING Paper MR 8 weeks = $6,271 Scanning MR 1 week = $785 Training costs significantly reduced in scanning environment

Quality Plan Project Customers quality expectations Acceptance testing Quality responsibilities Applicable standards Quality control and audit processes Scanning Solution Quality of finished product at scanning and scanned stages Record Maintenance – Before, during and after scanning Regular scanning audits – Retraining and feedback Metadata and audit trails

WHAT IF…?

WHAT IF….? The most important question a Project Manager must ask hundreds of times each day is WHAT IF…? Clinicians / stakeholders don’t buy in? The Unions get involved? The system goes down? You have poor organisational support? Also need to confirm your state’s legal position on EHR

The Project Life Cycle EHR is in reality a project portfolio that is a collection of projects that must be co-managed simultaneously

Laws of Project Management  No major project is ever installed on time, within budget and with the same staff that started it. Yours will not be the first.  When things are going well, something will go wrong. When things can’t get any worse, they will. When things appear to be going better you have overlooked something.  Project teams detest project reporting because it so vividly manifests the lack of progress.  A carelessly planned project will take three times longer to complete than expected. A carefully planned project will take only twice as long.

Key Project Features Assess the Environment Who are the key players, who has the power and impact? Identify the goals of the key players What are their professional goals or hidden agendas? Know yourself What are your own strengths and weaknesses? How are you perceived by others? Define the problems What are all the relevant facts? What is the real situation?

Key Project Features Develop solutions that work Avoid premature solutions that don’t consider the previous four points Test and refine the solutions Initial solutions are rough, they need testing and refining. Political Reality A solution that does not take political realities into account is superficial and naïve. Failing to plan is planning to fail

The Five Keys to Project Success 1.Don’t be an accidental Manager Project management is a discipline, understand the process to achieve the goal. 2.Get it right the first time Doing things right requires time and effort but it is much more expensive to do it again later. 3.Anticipate inevitable problems Conflict and problems are built into the concepts of projects, plan ahead to improve your ability to cope.

The Five Keys to Project Success 4.Dig deep to find the real solution Never accept a project at face value, you must go beneath the surface to discover the real project objective. 5.Be flexible Projects are full of surprises, an overly rigid system is bound to fail.

Advocate Clarity, Avoid Ambiguity This is what the organisation conceptualised….

This is what the engineers designed….. Advocate Clarity, Avoid Ambiguity

This is what the manufacturer built…. Advocate Clarity, Avoid Ambiguity

This is how the builder installed it…. Advocate Clarity, Avoid Ambiguity

This is what the user really wanted…. Advocate Clarity, Avoid Ambiguity

Remember…. Be brave, be determined, be resolute! What may seem impossible today, may be the norm tomorrow!