Ten for Patient Safety: Healthcare Optimization in Ontario. April 15 th 1:00PM to 2:00PM Session 173

Transcription

1 Ten for Patient Safety: Healthcare Optimization in Ontario April 15 th 1:00PM to 2:00PM Session 173 Dr. Robin Walker & Glen Kearns London Health Sciences Centre and St. Joseph s Healthcare London DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

2 Conflict of Interest Dr. Robin Walker Glen Kearns Have no real or apparent conflicts of interest to report. HIMSS 2015

3 Learning Objectives 1. Analyze the challenges associated with a multiorganization implementation. 2. Demonstrate successful practices for addressing difficulties with a multi-organization implementation. 3. Assess the effects of CPOE, emar, CLMA and e Med Rec implementation on patient safety and outcomes. 4. Discuss the role of organizational and project leadership in driving cooperation, provider engagement and adoption.

4 VALUE STEPS T Treatment/Clinical Hugo was designed to reduce Adverse Medication Events for patients receiving services in our hospitals. The specific goals include: - A reduction of wrong drug/wrong patient occurrences by - 75%-80% - A reduction of transcription errors greater than 50% - Improved medication turn around time delivery for patients

5 We are only at the start of this journey. 5

6 Agenda Scope Goals Safety for our Patients Key Learnings Training Timelines & Budgets Leadership Where are we Today? Governance Transition Schulich School of Medicine Stabilization Actions How does Hugo position us for the Future? Innovation PGx Workflow Enhancement: ED & Ortho Clinical Documentation, the next step! Why did we do this?

7 Scope

8 hugo Healthcare UnderGoing Optimization Consists of four components: Computerized provider order entry(cpoe) Electronic medication administration record (emar) Closed loop medication administration including barcoding (CLMA) Electronic medication reconciliation (e Med Rec)

9 10 Participating Hospitals

10 Current Service Model/Services in London/ ThamesValley Eleven hospitals on same Cerner platform Two large academic hospitals 9 community hospitals Toronto, Canada Detroit

11 hugo Project Commenced August 2011 Go Live May Hospitals across our region $30 Million biggest portion on engagement 40 people on the core project team Over 1,000 super users Every single clinical/medical person trained 6,000+

12 hugo Project Multi-site Success Key Success Factors Clear project governance with all sites represented A regional project lead was the liaison with the core team CEO support for the project Key Learnings Had a dedicated Communication resource; needed another More backfill of day-to-day ITS staff to keep Operational Issues being addressed

13 The Goal Safety for our Patients

14 hugo Benefits Improved Access through decreased turnaround time Decrease medication errors Improved outcomes through standardized evidence-based care Meet ROP Accreditation Standards Improved compliance with medication reconciliation Reduction in duplicate orders Improved antibiotic therapy Improved communication Improved trending and reporting of quality indicators Reduced HSMR

15 How Big a Difference is IT?

16 St. Joseph s Health Care London Adverse Medication Events Number of Events St. Joseph s Medication Adverse Events Jan 13/14 Feb 13/14 Mar 13/14 Apr 14/15 May 14/15 June 14/15 July 14/15 Aug 14/ % Reduction Adverse Medication Events Number of Medication Events Severity of Medication Errors by Month Jan 13/14 Feb 13/14 Mar 13/14 Apr 14/15 May 14/15 June 14/15 July 14/15 Aug 14/15 Near Misses 3-Minor to Moderate Injury/Harm 2-No Injury/Harm Intervention Monitoring Required 1-No Injury/Harm- Assessment Req'd (if applicable)

17 LHSC Adverse Medication Events 37% Reduction Medication in Adverse Events

18 Medication Errors across the Region Across 6 of the HUGO Sites, a total average of 30 medication errors a month have been avoided. Site Med Error, Event or Incident Counts were reduced by: Hospital 10-58% Hospital 5-51% Hospital 11-46% Hospital 18-36% Hospital 15-15% Hospital 16-1% Source: HUGO Benefits Evaluation Report, Sponsored by Canada Health Infoway

19 Other Core Metrics Improved Analyzing the order to verification times from two of the hospitals shows an 87% and 95% reduction in time. Over 5.2 million medications have been administered and documented in the emar since go-live: 86% of those medications had a successful patient armband scan. 85% had a successful medication barcode scan.

20 Key Learnings

21 Training & Adoption We didn t do enough department specific pre- go live training. Many regional sites re-trained their physicians. Post go live support should have been 6 months after go live. Key Adoption Metrics CPOE Percentage Medication and Patient Scanning Percentage Clicks and Seconds per order Use of care sets vs individual orders Med Rec Completeness

22 Timelines & Budget Timelines No flexibility built into our rolling 6 month go live schedule. Not enough recovery time for our implementation team between sites; given 24/7 support. Winter go live travel difficulties. Budget More contingency 20% not 10%. More post go live support not six weeks but six months. Operating budget closer to 70% of project team not 38%.

23 Leadership is the greatest factor of success KEEP CALM and hugo on Leaders must: Observe Communicate Take Action Have Compassion

24 Debrief Ivey School of Business Improve Adaptability Accountability & Engagement

25 Where are we Today? 6 months later.

26 Governance Transition Pre- Go Live Post Go Live Senior Teams 10 Hospitals Regional MAC/CNE Hugo Steering Committee Integrated Care Committee Physician Advisory & Clinician Advisory Teams 10 epractice Committees

27 Schulich School of Medicine Needed more Engagement for our Medical Residents & Medical Students. Functionality of assigning orders from medical student to the medical resident. Additional post go live support for medical residents. A strategy for rounding using CPOE. Formalized escalation mechanism just for medical residents.

28 Stabilization Actions Resolved over 3,000 in the moment go live issues. Established a strategy for 140+ major go live issues. Three task teams: Medication, Imaging, Laboratory. Two Comprehensive Reviews: Emergency & Orthopaedics. Educating leaders how to use new real time data. Training ITS staff to support leaders differently. New structures that ensure clinicians and physicians approve changes.

29 Thinking ahead. We are continuing to help our providers and clinicians adapt to the changes. There is new information from HUGO that allows us to review our workflow more intensively. Standardization of care processes and increasing consistency of care is a new goal supported by automation. Many learnings as we prepare for full Electronic Clinical Documentation and HIMSS 6/7. 29

30 How does Hugo position us for the Future?

31 Innovation LHSC has a Pharmacogenomics Program; focusing on the use of genetic testing to drive medication management. Order sets that require certain tests/results to guide prescription ordering. Patients will get personalized medicine to a new standard of care.

32 Workflow Enhancement Emergency Department Physicians Orthopaedic Services

33 Clinical Documentation HIMSS 6/7 Goals Improve quality of care. Automation of all care processes. Position us for Advanced Analytics. Strategies for Success Clinician Engagement. Accountability for decisions and metrics of success. Software Vendor AND Transformation Services Vendor.

34 Who was hugo really about?

35 Questions?

36 Appendix

37 Medication Reconciliation In general, there have been improvements to Med Rec rates. Additional work is underway to further improve Med Rec by looking at changes to system functionality and workflow. The challenges that were experienced relate to: 1. Completion Rates: Providers have expressed that there is difficulty completing Med Rec due to system and process challenges. 2. Data Quality: The quality of the Med Rec is dependent upon the information being entered (i.e. a current and accurate Best Possible Medication History BPMH) Source: HUGO Benefits Evaluation Report, Sponsored by Canada Health Infoway

38 Medication Turn Around Times The time from med order to med verification has been reduced significantly as a result of CPOE. Analyzing the order to verification times from two of the hospitals shows an 87% and 95% reduction in time. Source: HUGO Benefits Evaluation Report, Sponsored by Canada Health Infoway

39 Barcoding Process Across all the HUGO Sites, in the Units using CLMA, over 5.2 million medications have been administered and documented in the emar since go-live: 86% of those medications had a successful patient armband scan 85% had a successful medication barcode scan. Source: HUGO Benefits Evaluation Report, Sponsored by Canada Health Infoway

40 CPOE Rates In the areas using CPOE, the average CPOE Adoption Rate across the HUGO sites in September 2014 is 81%. Source: HUGO Benefits Evaluation Report, Sponsored by Canada Health Infoway

41 Clicks & Time Per Order Physicians are becoming faster and more efficient at ordering. The time it takes for Physicians to enter an order dropped from 70 seconds per order in November 2013 to 44 seconds per order in September The number of clicks per order has also reduced from 29 to 18 clicks. Source: HUGO Benefits Evaluation Report, Sponsored by Canada Health Infoway

42 Orderset Usage Standardized Ordersets, developed using best practice, have been used over 240,000 times since the first HUGO Go-Live. The top 10 most used ordersets are listed below. Source: HUGO Benefits Evaluation Report, Sponsored by Canada Health Infoway

43 UH % CPOE Trend Apr % Apr Apr 28 - May 4 May 5-11 May May May 26-June 1 June 2-8 June 9-15 June June June 30 - July 6 July 7-13 July July July 28-Aug 3 Aug 4-10 Aug Aug Aug Sept 1-7 Sept 8-14 Sept Sept Sept 29-Oct 5 Oct 6-12 Oct Oct Oct 27-Nov 2 Nov 3-9 Nov Nov Nov Dec Dec 8-14 Dec Dec Dec 29-Jan 4 Jan 5-11 Week Week 1Week 2Week 3Week 4Week 5Week 6Week 7Week Week 8 Week 9 10 Week 11 Week 12 Week 13 Week 14 Week 15 Week 16 Week 17 Week 18 Week 19 Week 20 Week 21 Week 22 Week 23 Week 24 Week 25 Week 26 Week 27 Week 28 Week 29 Week 30 Week 31 Week 32 Week 33 Week 34 Week 35 Week 36 Week 37 Week 38 39

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46 % VH Barcode Scanning Trend May 5-11 May May May 26-June 1 June 2-8 June 9-15 June June June 30 - July 6 July 7-13 July July July 28- Aug 3 Aug 4-10 Aug Aug Aug Sept 1-7 Sept 8-14 Sept Sept Sept 29-Oct 5 Oct 6-12 Oct Oct Oct 27-Nov 2 Nov 3-9 Nov Nov Nov Dec Dc 8-14 Dec Dec Dec 29-Jan 4 Jan 5-11 Week Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 8Week 9Week 10Week 11Week 12Week 13Week 14Week 15Week 16Week 17Week 18Week 19Week 20Week 21Week 22Week 23Week 24Week 25Week 26Week 27Week 28Week 29Week 30Week 31Week 32Week 33Week 34Week 35Week % Medications administered with Positive Patient Scans % Medications administered with Positive Med Scans

47 Physicians only