Clinical Information Systems Medications Implementation. Libby Owen-Jones Project Director

Transcription

1 Clinical Information Systems Medications Implementation Libby Owen-Jones Project Director

2 Overview Overview Austin Health E-Medications 8 Lessons

3 Austin Health Major tertiary health provider in northeast Melbourne 3 campuses The Austin Hospital Heidelberg Repatriation Hospital Royal Talbot Rehabilitation Centre Major services Liver & Gastro-intestinal transplantation Spinal Cord Injuries Oncology Vic Respiratory Services ONJ Centre

4 Organisational Statistics Measure Staff (EFT) Structure Throughput Year Medical 647 Nursing 2,098 Allied 471 IT / Informatics 50 Total 5184 Facilities Beds Theatres Admissions (Overnight / Day) 3 campuses 900+ beds 22 theatres 99,363 WIES 70,783 Attendances Emergency Visits 68,170 Operations 24,192

5 What is Live Now Implementation first release Single sign on to clinical applications eordering Pathology and Radiology eordering of Discharge Prescriptions Results reporting and tracking of Acknowledgment Clinical Decision Support Electronic Discharge Summaries

6 What is Live Now Implementation second release 2012 Replace the National Inpatient Medications Chart VTE & Allergies Documentation Inpatient medications» Prescribe» Verify and dispense» Administer at bedside Fluid Balance Chart documentation Nurse/Patient Care Orders Patient ID via scanning Immunisation Documentation 724 downtime solution

7 Lesson 1 Link to Strategic Priorities Advancing leadership and INNOVATION Build capacity in systems redesign to improve quality, value and efficiency. Provide contemporary clinical and business information systems that support excellence in decision making, patient care and accountability. Continually enhance information technology and communication systems.

8 The Austin Cerner EMR Journey 2011 Rad/Lab orders PAL lab collections eprescribing Disch Summary 2012 Results & Results Endorsement Inpatient medications MAR Fluid balance chart 724 Access (downtime) 2013 Clinical Documentation Phase 1 Clinical Documentation Phase 2 FirstNet? Oncology system? Device Integration? Surginet

9 EMR Adoption Model EMR Adoption Model Structure Ensures Objectivity Current Self Assessment for Austin Health = Stage 5 but missing full nursing documentation on level 3 Notes: Post meds?6 but really missing documentation Advanced Clinical Documentation project

10 Lessons 2: Know your scope Proof of Concept July 2012 to October 2012 Anticipated Build time Scope defined What is in and what is out Gaps in Functionality Nurse orders Clinical documentation Implementation / deployment plan Staged approach

11 Lesson 3: Don t underestimate Infrastructure Investment New medical grade wireless network Servers and switches, cabling, datapoints Links between campuses Mobile devices & upgrade PCs 200+ Mobile tablets 160 laptops & 150 lap-top/flat top carts Custom designed pathology carts 170 custom designed medication carts 140 pathology label printers printers fixed & wireless UPS Power

12 Lesson 4 :Investment in Change Management Project Management 2EFT Change Team 9 EFT Pharmacy Build Team 4 to 9 EFT Orders Build Team 2 EFT Learning Team 5 EFT Integration Team 2 EFT Technical Team 1-10 EFT Super-Users IT Service desk / Technical support 3 EFT Organisation Effort and Goodwill - unlimited

13 Lesson 5: Find key to Clinical Adoption Rate of Clinical adoption is in direct proportion to level of participation in pre- go live change process Nursing High level participation = Good adoption rates Pharmacy Actively participated pre go live = relatively well accepted Medical staff Variable levels of adoption Lesson : Persist, Persist, Persist. Change can be slow progress

14 Clinical Adoption Change management Model Workflow groups to prepare and address issues» Nursing Groups worked well» Pharmacy worked well» Medical patchy. Clinical adoption success factors Staff in Unit aware of clinical guidelines Engaged in Change process and established their prescribing requirements in the system Attended training and trained together Follow-up with any queries and address issues Right devices at the Right time

15 Clinical adoption Improving practice Data/Evidence is the key to change

16 What has changed

17 What needs to change to improve clinician experience and meet clinical expectations

18 Lessons 6 Build a Catalogue that supports clinical practice Clinical System supports Clinical practice ensure build follows published Clinical Guidelines» VTE» Nurse initiated medications Medication catalogue build Have guidelines developed to support what can and can t be done eg NHS Guidelines for e- medications eprescribing@nhs.net National Health Service (NHS), National Patient Safety Agency (NPSA). Design for Patient Safety. Guidelines for Safe On-Screen Display of Medication Information. London: NHS NPSA, Document your own guidelines/build decisions eg Order Sentence Guidelines

19 Lessons 7 Deployment Plan needs to be adaptable Big Bang vs Staged/Phased Support levels Complexity of functionality Training hours Project team resources Patient safety E-Orders Path and Radiology = Big Bang E-Medications = Phased Go Live

20 Deployment Plan e Medications Project Team support Medical Officer, Pharmacy, Nursing critical to have all disciplines Overnight support Ward super-users critical to clinical adoption, but allow ward to judge when support can be rolled back Deploy deices well in advance Commincate

21 Lesson 8: Measuring Value is more that ROI Benefits defined in Business case focus on efficiency or ROI Changes to clinical practice practice Linking to patient outcomes Did not know what we did not know May be an increase in reporting near misses Now we know what the near misses are consistency of Use system to safeguard against repeating near misses Incidental Benefits associated with improved infrastructure ipads for patient education

22 Final words Sustainability Keeping the Energy Alive Go Live is only 50% of the journey Investment in clinical adoption needs to continue Project team to Support transition Retention of skills Investment is ongoing: Technology changes/ tech refresh, upgrades etc needs to be factored into budgets for the future