Implementing MICO Beyond the EMR
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1 Implementing MICO Beyond the EMR Dr Wong Yue Sie Group COO, SHS COO & Div Chair ACSS, SGH National Health Informatics Summit 18 July
2 SingHealth Institutions 3 Hospitals 5 National Specialty Centres 9 Polyclinics 3,300 Beds 42 Specialties 2,000 Doctors 1.9 million Specialist Outpatient visits 1.6 million Polyclinic visits 186,473 Admissions 76,615 Inpatient Surgeries 110,857 Day Surgeries SGH Postgraduate Medical Institute 2
3 Year Events 1998 Eclipsys SCM implemented in SGH 2000 Cluster was formed. A strategic decision was made to have a common EMR platform for the cluster. isoft acquired the international rights for Eclipsys products 2002 Cluster Results Reporting and HIDS on isoft icm - Lab/Rad results and reports 2003 OT reports Image Management System integration with EMR system 2004 Cluster erx (Outpatient and Discharge Prescription Orders) EMRX implementation 2005 Filmless at SGH and Outram Campus Centres 2007 Sign agreement with Eclipsys to migrate EMR to SCM 5.0 on 26 th Sep 2008 Cutover to SCM 5.0 on 26 th Oct cluster-wide. Implemented elab/erad orders at CGH on 15 th Dec & completed Feb09. Filmless at CGH & KKH Implemented SCM 5.0 SP2 cluster-wide & KKH. Implemented CLMM in pilot wards in KKH. 3
4 SingHealth Systems SCM HIDS CIIMS CMUS Analytics Dashboard (future) Integrated EMR Clinical Workstation IMS EMRX (NHG) EBM Drug Info Genetic Information (future) A&E SYSTEMS OTM SYSTEM NUCLEAR MED SYSTEMS INPATIENT (SAP-ISH) OUTPATIENT (OAS) and A&E AE notes OTM notes Nuclear medicine results ADT ADT SingHealth Cluster EMR Repository (~760GB) Patient Info Allergies Diagnosis Order Medication Results Discharge CDM QUEST Nurse Charting Poly Notes Medical Alerts / Drug Allergies OG notes ADT Lab Results Radiology Reports EMRX (SingHealth) CMIS (SingHealth) SGH O&G System PHARMACY SYSTEMS LABORATORY SYSTEMS RADIOLOGY SYSTEMS Business Intelligence Analytics 4
5 Perspectives & Perceptions What is the EMR to the clinician? Clinical documentation, research What does it mean for other healthcare providers? Workflow & task manager.. What does the healthcare administrator look for? Patient safety, standardisation, analytics, reporting.. 5
6 Implementation Challenges Technical & Localisation Issues Standardising Workflows Multiple Workstreams User Engagement, Acceptance & Adaptation Transforming the Clinical Workplace 6
7 Challenges Technical & Localisation Standardising interface/messaging requirements & functionality across multiple ancillary systems. Establishing the Unique Patient Identifier & Master Patient Index an evolving environment. SC, PR, EP, S pass, WP (FW), WP (FDW), DP System Availability, Downtime Systems & Procedures Managing system dependencies Patient safety & system availability 7
8 Challenges Mapping Workflow Reconciling varying workflows across multiple institutions. Care Process Variations Across hospitals & institutions. Within hospitals: ICUs, Wards, EDs, Day Surgery, Outpatient, Primary Care, Special Services Reconciling Multiple Ancillary System Workflows LIS (3), RIS (4), Pharmacy (3), OAS. To be paperless or paper-less: how does it impact on work processes, sample & task tracking? Is it necessary for patient communications? Are services delivered on-site or off-site? 8
9 Multiple Workstreams Ambitious goals: Simultaneous staggered implementation of CPOE, CLMM & Clinical Documentation over 3 years. Concurrent replacement of cluster RIS-PACS. Implementation of pharmacy systems together with pharmacy automation. Limited resources: Clinician champions. Clinical informatics resources. IT resources. 9
10 Challenges User Engagement, Acceptance & Adaptation Multiple parties: doctors, nurses, pharmacists, allied health: Building consensus on workflows. Standardising system catalogues (across institutions, between system owners & clinicians). Standardising nomenclatures (ICD, SNOMED, drug etc), accepting structure. Adapting to change version upgrades, enhancements, practice changes & shifting/new responsibilities. 10
11 Transforming Clinical Practice Changing mindsets in Clinical Care Standardising clinical practice through Order sets. Clarifying thinking about clinical problems (Health Issues, Diagnosis, Problem Lists). Redefining responsibilities & roles amongst healthcare providers. Re-designing the workplace Ward workflows for medication administration, managing lab samples. Outpatient workflows for lab samples. Reorganising Lab & Radiology Departments & Pharmacies. 11
12 Consider a Clinical the Ward Clinical Systems (EMR) View Allergy View Results (IMS) Take Notes Orders (CPOE/eIMR ) Discharge (HIDS) EMR Submits orders Pharmacy receives orders Pharmacy View Orders Check Allergies Prepare Meds Patient Wards Preparing / packaging of medications Pharmacy Ward Rounds Nurse Charting View Worklist Take Recordings Enter Data Recording Nurse administers medication emar View Worklist Administer Med Update Worklist Delivering / Dispensing 12
13 The Way Ahead Building multi-disciplinary teams: Doctors, nurses, allied health, IT, clinical informatics, health administrators. Engaging users. Keeping patients & their care needs in focus. Learn from others & each other create platforms for experiential & research based local sharing 13
14 Thank you 14 Medical Patients. Excellence, At the Heart Genuine of All We Care Do
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