1. AHRQ 2006 Annual Conference on Patient Safety and Health IT Socio-Technical Approach to Planning and Assessing Redesign Huron Hospital CPOE Implementation June 5, 2006 Greg Kall, CPHIMS Regional Vice President, Information Technology

2. Socio-Technical Approach to Planning and Assessing Redesign l June 5, 2006 l 2 Huron Hospital 211-bed, acute care, urban hospital Located in East Cleveland, Ohio 361 member voluntary medical staff  52 residents in Medicine and Surgery Level II Trauma Center, Obstetrics, Community Health Center Part of 4 hospital CCHS East Region

3. Socio-Technical Approach to Planning and Assessing Redesign l June 5, 2006 l 3 Components Live at Huron Electronic Medical Record (EMR)  Patient Lists  Clinical Results Review Clinical Documentation  Electronic Medication Administration Record (eMAR)  On-line Discharge Process Computerized Physician Order Entry (CPOE)  Clinical Decision Support (Rules and Alerts)  Order Sets  Electronic Signature  Strong Authentication Remote Access

4. Socio-Technical Approach to Planning and Assessing Redesign l June 5, 2006 l 4 Implementation Facts Go-Live in July of 2004  Phase I: Psych Unit and OB Unit  Phase II: ICU  Phase III: Remainder of hospital 1,000,000 eOrders processed to date CPOE utilization rates  Residents: 94%  Overall: 75% Two Weeks Between

5. Socio-Technical Approach to Planning and Assessing Redesign l June 5, 2006 l 5 Organization Strategy Inclusive  All 4 hospitals in CCHS East Region participated from the start Multidisciplinary  Physicians, Nurses, Ancillaries, IT  Together from the very beginning Implementation Team  Clinically Focused - More Clinicians than IT!  Pharmacists, Nurses, Laboratory Ongoing/Active Management  Multi-year project  Simultaneous phasing activities Design, Implementation, Maintenance

6. Executive Sponsors Physician Advisory Committee Regional CMO, Hospital Chiefs of Staff, Hospital Physician, Advisors, Director Medical Education CPOE Design Medical Staff Bylaws and Policies Order Sets and Other Clinical Content Physician process redesign Steering Committee Regional and Hospital Executives Monthly Status Reports Remove Barriers Executive-level Support Patient Care Advisory Committee Regional and Hospital Executives and Managers of Nursing, ED, Ancillary, Clinical Services, and Quality Departments CPOE Design Hospital and Department Policies and Procedures Project Management Office Four Hospital Physician Advisory Groups Clinical Informatics Council Regional CMO, Physician Advisors, Hospital CNOs, Project Staff Collaborative clinical decision-making Implementation Team Team Members 4 Physician Advisors 1 Pharmacist 3 Nurses 1 Medical Technologist 1 HR Trainer 1 Project Manager 1 Interface Engine Analyst 1 Report Writer 1 ADT/Charge Master Analyst Functions Planning Analysis System Design Application Build Interfaces Testing Implementation Support Task Forces Communication Develop and Execute Plan Security Develop and Execute Plan Process Redesign Standard Flows Unit Review Custom content Training Develop and Execute Plan HIS Process Nursing Process Pharmacy Process Project Organization

7. Socio-Technical Approach to Planning and Assessing Redesign l June 5, 2006 l 7 Design Strategy Patient Care Advisory Committee Learn the software Identify processes likely to be impacted  By policies and procedures  By function  By department Form workgroups, including front-line staff  Flowchart existing processes  Correlate the process to the software  Identify where changes may occur  Flowchart new and revised processes

8. Socio-Technical Approach to Planning and Assessing Redesign l June 5, 2006 l 8 Nursing Workflow Redesign Examples

9. Socio-Technical Approach to Planning and Assessing Redesign l June 5, 2006 l 9 Design Strategy Validate new workflows  Design Endorsement Sessions to demo workflows  Audience includes physicians, nurses, pharmacists, ancillary departments  Structured scenarios with written participant evaluations  Iterative process Revise policies and procedures to support new workflows Conduct unit-specific workflow review sessions to identify exceptions End-user training must include workflow changes and new Policies &Procedures

10. Socio-Technical Approach to Planning and Assessing Redesign l June 5, 2006 l 10 Design Strategy Physician Advisory Committee Establish clinical priorities Create and modify policies and by-laws Review and approve design Review workflows and process Create and manage order sets Create and manage rules and alerts Clinical Informatics Council Where everything comes together! Also provides ongoing post-live management

11. Socio-Technical Approach to Planning and Assessing Redesign l June 5, 2006 l 11 Feedback and Improvement Strategy Clinical Informatics Specialist New position dedicated to supporting clinicians One-on-one training (carries beeper) Grand Rounds Weekly resident meetings Monthly User Group meetings Local Physician Advisor Group Workflow feedback Data/performance review

12. Socio-Technical Approach to Planning and Assessing Redesign l June 5, 2006 l 12 Performance Tracking Examples

13. Survey Instrument

14. Socio-Technical Approach to Planning and Assessing Redesign l June 5, 2006 l 14 Survey Dimensions EMR Adoption & Ongoing use Technology-based perspectivesSocial Perspectives Task User Task-Technology Fit Fit with technology, User evaluation, Relative advantage IT Acceptance Model Perceived usefulness, Ease of use, Attitudes, Behavioral intention Cognitive Processes, Information quality, Bounded rationality Information overload Organizational Imperative Power and control, Information politics