EMR Transition and Key Nightingale on Demand Lessons Learned to Maximize Adoption. Knowledge Management Learning Event.

Transcription

1 EMR Transition and Key Nightingale on Demand Lessons Learned to Maximize Adoption Knowledge Management Learning Event Christine Randle

2 Lessons Learned/Improvements from AOHC

3 Nightingale On Demand (NOD) Set up Originally started with a blank spreadsheet which required more work and allowed for spelling errors they now receive a file already populated with data from the legacy system Sharepoint/Knowledgebase continually updating and adding resources for the sector Quick Reference Guides A space for Centres to share documents requested by centres Updated Workplan Improved Support for Centres Addition of the Adoption Specialist Role 4 days on-site support Workflow process Improved to a detailed document followed by meeting (s) with the Transition team to evaluate needs/gaps 3

4 Super User training - Was 3 days in person only 2 people per centre very early in the transition process (difficult to maintain the knowledge) - Now a combination of recorded videos, live webinars and in person on-site training can train as many people as appropriate can start early and continue up to and even after go live Survey implementation and training Longer implementation cycles Improved Issue Communication - Regular Bulletins - Weekly calls to discuss high priority issues 4

5 Lessons Learned from Live Sites

6 Sue Leal-Schnarr - Langs Farm CHC When locking down the 01 file from Purkinje, double check staff schedules. I thought everything was confirmed but then staff started changing the schedule in Purkinje and didn t let me know. When we went live with NOD this created a lot of confusion when booking patient appointments. AOHC Tip Check the Configuration Environment before Go Live to ensure that the information is in the system correctly. This can be done for provider info and other system set up options too. 6

7 Yan Jin Anishnawbe Health Toronto Super user training is self-directed. Super Users must be pro-active to start early and continue throughout the transition period. Need to be diligent with hardware set up for the NOD system. There are many nuances that need to be done in advance. Need dedicated super users with strong skills to develop system setup in conversion environment (like templates) before go live. AOHC Tip Use the Getting Started with NOD Guide and ensure all hardware is tested before attempting to use with NOD. Needs to be done per user if multiple people share computers. 7

8 John Elliott Flemingdon CHC It will take more time and be more work than you think before and after! Get a comfy sofa bed and a well-stocked bar fridge for your office. So many meetings during transition it feels like you can t get any work done. So many meetings post go-live it feels like you can t get any work done. IT support has been swamped post go-live (137 tickets related to NOD listed in our help desk software in 6 weeks! There were many other problems solved that didn t go through help desk software.) We have had so many requests for changes/updates that we could employ a FT person just to keep up. 8

9 John Elliott Flemingdon CHC (con t) Many decisions need to be made before you understand the implication of your choices, e.g. Multiple locations versus single location enterprise. Designing workflows with providers before they know how NOD works. Migrating from paper charts to EMR at the same time as moving from Purkinje to NOD will double your trouble! Communicate with staff and clients early and often. 9

10 John Elliott Flemingdon CHC (con t) By the time you go live you realize that NOD doesn t work the way you thought it would (or should). Some of the quirks are mind boggling: If a provider works at multiple locations you can only view their schedule for one location at a time. The printed version of the Activity Log/Audit Report doesn t show what date it was printed or what period was queried. If you CC someone on a message both recipients receive the original message with no indication that anyone else received the message 10

11 John Elliott Flemingdon CHC (con t) The importance of getting the right people involved at the right time balancing expertise with time management and fast decision making, e.g. Finding the right balance between having enough Super Users and too many. Providers aren t necessarily available when you need to make decisions that will impact their workflow. AOHC s primary role is to manage the implementation: You need to manage everything else change management, communications, validation, workflows, post go live problems, change requests, usability, etc. A good project manager will help keep you on track. However, AOHC now includes 3 days of Adoption Specialist time. This time can be used before, during or after go-live. It is a great resource, so be strategic in how it is used. 11

12 John Elliott Flemingdon CHC (con t) It is important to review your proposed workflows as you move through the process: As you learn more about the program you will probably need to modify your work flows. When you go live, you will need to change them again. AOHC often seemed to be in the middle, between you and NIC: It would have been helpful to establish a working relationship with NIC well before go-live. We experienced so many problems during go-live that NIC sent some of their senior people to come and de-brief with some of our team. This was helpful. 12

13 John Elliott Flemingdon CHC (con t) It felt like the focus leading up to go-live was on data migration and not enough time was spent on usability of NOD. (We were a beta site for merged databases). The data migration appears to have gone well the other aspects, configuration and using the system was more problematic. Be prepared to spend lots of time checking configurations at go-live: Many of the lists, permissions, electronic signatures, etc. were not setup correctly by NIC in the production environment. Checking these items is very time consuming because many are at a user level. And sometimes you don t even know what you should be checking. 13

14 John Elliott Flemingdon CHC (con t) Starting running Data Miner ASAP: Run reports to compare against Purkinje/BIRT data. Run Mandatory Data report to check data entry for new items. Don t trust Data Miner reports without verification. NIC Help Desk is very helpful with easy fixes: Bigger issues take a lot longer and sometimes require constant pressure. Many issues (big and small) are considered enhancements a.k.a. it will be addressed in Nexia. We started using NOD on September 26, as of November 11 we had opened 100 tickets with NIC, 82 had been closed. 14

15 John Elliott Flemingdon CHC (con t) Be prepared for the times NOD will not be available: There have been at least 3 times since October 1 that a problem at NIC s end made the system either completely unavailable, or so slow it was unusable. Make sure you have reliable internet connectivity and failover system in place. No internet. No NOD. Breathe! 15

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