Listening to the Human Side A collaborative approach to building an electronic health record

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1 Listening to the Human Side A collaborative approach to building an electronic health record Keith Adamson, PhD, RSW Senior Director, Collaborative Practice

2 Towards an Electronic Health Record An amazing journey! The biggest challenge in EHR implementation is not only technical, but behavioral Many crucial conversations were key to our success 2

3 Objectives of Today s Session Collective conversations in: 1) Board and senior management support 2) Establishing a governance and operational structure 3) Engaging clients and families 4) Review of current state 5) Initiation and execution of a full documentation redesign 6) Conversation with external stakeholders- regulatory 7) Implementation of a training and education strategy 8) Evaluation and continuous improvement 3

4 This should not be how we organize client information in

5 Board and Senior Management Support Information Resources Strategy Mission Promote secure and timely access to meaningful and reliable information Increasing organizational efficiency and effectiveness Financial support Annual Capital expenditure of $1.4M-$1.5M Consistently over 5% of total budget is allocated to IS operating and capital

6 Highlights of our IS Journey Finance and Health Records modules Pharmacy Management Data Repository echn Instrument Interface Ventilator Monitoring Lab, Scanning & Archiving, inpatient documentation all disciplines GTA WEST DI-r PACS Clinic Scheduling, Order Entry, Signed Reports, EMR, Physician Order Management, (100% participation!) Fixed Assets Electronic Medication Administration Moved to a brand new facility, merging 2 sites into 1 Physician Care Manager Ambulatory documentation

7 HIMSS Analytics EMR Adoption Model Holland Bloorview (EMRAM) Score Q2, (Stage 4) Average EMRAM score for all acute Ontario hospitals Average EMRAM score for your peer group (CCC, Rehab & Mental Health) Average EMRAM score of Hospitals in your LHIN (Toronto Central)

8 Setting us up for success Massive cultural change requires the establishment of governance and operational structures to support change EHR Steering Committee Clinical Documentation Change Team EHR project team 8

9 Family Partners of the EHR project Documentation Change Team Cheryl Peters Joanne Downing EHR Steering Committee Gideon Sheps Cheryl Peters

10 What does EHR implementation mean to for clients and families? Sharing of information between clinicians Not having to repeat history over and over again Families can request printed copies of instructions at the end of a visit Timeliness of relevant documentation Families will notice clinicians using point of care technology during sessions ( documentation, motivation, education) 10

11 Understanding Current Practices and Processes Lifting up the rock Focus groups Audit of 100 paper charts Evaluation of the inpatient use of the EHR Comprehensive survey User knowledge quiz Focus groups Family survey

12 Documentation Redesign Form follows function First standardize documentation practices and establish clear practice guidelines before proceeding with development of an electronic documentation format

13 Debunking the myths My College Says linkshare&utm_medium=linkshare&utm_campaign=userco ntent

14 Regulatory Colleges Forum In June 2012, we hosted a forum of representatives from the various Ontario Regulatory Colleges Concerns raised from clinical staff that these new standards would not meet expectations for documentation of their Regulatory Colleges Enabled the creation of a consistent understanding of legal and regulatory requirements, re-assuring clinicians and validating our proposed guidelines

15 Regulatory Colleges Forum

16 Training Education and Evaluation Multi-faceted and highly structured education plan: Introduction to structure and principles through Practice Councils Mandatory e-learning modules Optional in class computer sessions prior to & after launch Mandatory small group clinical sessions Super-user model Simulation events to increase adoption of technology at the point of care

17 Evaluation and Monitoring for Optimization Evaluation dimensions Accessibility Acceptability Effectiveness Efficiency Quality of Care Workflow Education and training Compliance to standards Ongoing monitoring Weekly survey of adoption, utilization and proficiency Health records inventory PCS reports by user and screens 17

18 Our journey continues Successful change means spending a lot of time on the important conversations

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