whitepaper Elsevier CPM Resource Center: CPM Integration Methodology

whitepaper Elsevier CPM Resource Center: CPM Integration Methodology

Abstract The following document describes the methodology used by Elsevier CPM Resource Center (CPM) to integrate into the electronic health record (EHR) CPM s intentionally designed, evidence-based clinical documentation tools and clinical practice guidelines. The five-stage approach optimizes CPM clinical content within the dictates or constraints of the existing EHR and requires no modification to EHR source code. CPM s integration methodology adheres to the principles of Intentionally Designed Automation (IDA), a design approach that achieves a highly integrated and efficient clinical work flow. Developed by clinicians for clinicians, IDA takes into consideration the complex work flows, practice standards and knowledge requirements of interprofessional end-users as well as EHR technical and functional capacity to maximize the practical usability of an EHR. A Proven Process for Implementing CPM s Comprehensive Documentation Solution The CPM Framework - Background The CPM Framework leverages the EHR by providing clinical care teams access to more than 200 evidence-based clinical practice guidelines and a full spectrum of dynamic clinical documentation tools at the point of care. The guidelines and tools are designed to facilitate coordinated, interprofessional care. This approach breaks down barriers between caregivers by strengthening communication and patient-specific knowledge-sharing. The result is patient-family-centric care, with concurrent improvements in quality, safety and consistency. The components of the CPM Framework collectively represent more than 25 years of evolution, tens of thousands of hours of development effort, continuous real-world validation by thousands of point-of-care clinical experts and many years of actual use at more than 100 installed sites. As such, the CPM Framework stands as a proven and costeffective alternative to the in-house creation of a clinical documentation system. CPM s EHR integration methodology ensures that the clinical documentation implementation unfolds in a predictable, timely fashion. In addition, the methodology makes certain that the intentionally designed and built Framework reliably delivers an efficient documentation system that supports the point- of-care clinician while taking advantage of all EHR platform functionality. Integration Methodolgy Components: Database Structure and Content Delivery CPM CarePoints content is stored in a Microsoft SQL Server as a relational database and typically is uploaded to an FTP site for download by the client organization. The content can be delivered in a number of different formats, including Access, XML and Excel, depending on client requirements or preference. 1

The database is normalized to minimize redundancies and to ensure that modifications can be made once, then propagated via well-structured relationships. Specifically, the CPM database features small, concise data tables, data appearing only once and use of foreign keys when appropriate. A hierarchical structure provides the blueprint for building clinical documentation tools, while comprehensive documentation of the data allows build teams to easily follow the IDA blueprint and mapping requirements. Finally, strict versioning rules streamline management of current and historical releases. The database also includes a web-based content viewer. This utility allows the build teams to structurally view the full range of evidence-based guidelines and documentation content during the integration process. The viewing capability provides the IT build team with a valuable resource for understanding the structure and layout of the documentation elements, and visualizing how and where those elements come together. Prototype Development The development of a prototype begins with a technical assessment. This analysis focuses on the EHR s functionality, database and substructure, and is conducted jointly by the CPM integration team and the client s build and configuration experts. From the assessment, EHR functionality is identified to address each CPM Framework design consideration. A design and build strategy is then developed that is consistent with the principles of IDA. IDA allows for a rapid/agile approach in the prototype design and build. By following an agile design process, the CPM integration and client build team are able to quickly construct and validate the components of the prototype. Validation ensures that the prototype meets all IDA elements, provides the full range of Framework design considerations and fosters efficient work flow by optimizing EHR functionality. Content Build The content build begins after the prototype is completed. Functional mapping, or the matching of CPM data elements with EHR data field naming conventions, is the first step. Once this process is complete, import scripts are then created to bulk-load the CPM content into the EHR. The reliance on scripting minimizes the necessity of a manual build and thus dramatically reduces the number of build hours. For example, the CPM CarePoint database contains more than 13,000 pick list items. Experienced configuration specialists estimate that it takes up to three minutes to manually build each pick list item. By scripting in the tagged-and-mapped CPM database, an organization can save approximately 650 build hours on the pick list choices build-out alone. It is important to note that the use of scripting and the overall installation of the CPM solution do not require any manipulation of the EHR operational/source code or database. 2

Regardless of the EHR, the CPM Integration Services Methodology and the CPM CarePoint database can be harnessed to design and build the clinical documentation tools in a way that maximizes the inherent functionality of both the EHR and embedded CPM content. When considering deployment of the CPM Framework, it is important to remember that organizations can easily spend thousands of hours designing and building their own documentation tools. Yet this investment may not include the hours required to keep the content updated and current with the latest clinical standards. In addition, building internally frequently leads to redesign and rework, and issues with end-user satisfaction and adoption can severely undermine the process. Perhaps most importantly, the time- and resource-intensive nature of internal documentation development can impede organizations from moving forward with other strategic IT and optimization initiatives. CPM CarePoints, in contrast, is a tested, proven system that meets the needs of eight clinical disciplines and represents the most comprehensive care planning documentation solution available on the market today. Testing Once the build is complete, the next task is refinement and testing. The integration team works closely with the hospital build team to identify any content gaps and to design and build the necessary elements within the CPM Framework. By following IDA principles, the Integration Services Team leverages the content to minimize redundancies and thus ensure efficient work flows. The testing phase involves unit, functional and integrated testing to confirm that the documentation system is working as designed and to minimize issues during and post-go live. The CPM Transformation Services team works closely with the hospital to ensure that the testing is conducted appropriately and covers all aspects of IDA principles. Deployment Simultaneous to the documentation build, CPM s Transformation Services team will assist the client in developing the end-user education and go-live strategic plan. Once the application is end-user ready, the education and go-live strategy can be implemented. End-user education is a critical phase and consequently requires thoughtful planning and coordination. During the education planning, three key streams must be addressed: pre-in-the-seat education, in-the-seat training and post-in-the-seat education. An appropriate activation plan also is essential to a successful deployment. During the planning stage, some key decisions and tasks include: super user support strategy, super user selection process, super user scheduling, communication plan during activation, unit manager involvement and communication, patient conversion strategy, command center logistics and issues management. Transformation Services will work with the clinical and IT leadership to develop a comprehensive activation plan that will meet the individual resource needs of the organization. 3

Staffing Requirements To ensure an effective development and deployment cycle, CPM requires that clients dedicate a minimum of 3.5 IT FTEs to the project for the duration of the effort. Typically, this team includes a clinical analyst, IT analyst, project lead and project manager. It is important from a strategic perspective that the Framework implementation project be designated and defined from the outset as a clinically driven initiative as opposed to an IT-led project. This distinction will help generate interest and optimize adoption by the clinical staff, while producing the level of organizational commitment needed for success. Because the CPM Framework requires that clinicians learn both new tools and new work flow processes, sustaining clinical buy-in from start to finish is essential. Timeline The timeline for development and deployment of the CPM Framework generally takes 12 months. Below are the key development stages and associated durations: Month 1...Technical Assessment Month 1.5...Content Delivery Month 1.5 to 3.5...Design and Validation Month 3.5...Prototype Validation Month 1.5 to 4.5...Content Review and Validation Month 4 to 5.5...Functional Mapping Month 5 to 6...Import of Content Month 6 to 8...Content Building Month 8 to 10...Testing Month 10 to 12...End-User Training Conclusion The CPM integration methodology is a proven, well-tested approach that reflects experience gained over the course of CPM Framework implementations at more than 100 existing sites. Because both the Framework and the integration methodology are inherently flexible, accommodating the full range of EHRs currently in operation is a straightforward and predictable process. Hospitals that deploy the CPM Framework within their existing EHR avoid the often substantial costs in both time and money associated with the internal development of clinical decision-support tools. That means resources can instead be focused on clinical adoption, support and outcomes realization. With this approach, organizations can more quickly realize the improvements in patient care and safety associated with true, evidence-based interprofessional care. 4

About Elsevier CPM Resource Center: For more than 25 years, Elsevier CPM Resource Center (CPM) has been offering evidence-based, interprofessional clinical practice guidelines, care planning and documentation at the point of care. Based on the CPM Framework, these EHR compatible and web-based solutions are developed and maintained by expert interprofessional colleagues, and tested/validated through a Consortium of over 300 member hospitals. In addition, the company offers Practice Transformation services to assist organizations with clinical practice advancement, team-based care and EHR implementation and adoption. CPM is a business unit of Elsevier, the world s leading provider of science and health information 5

www.cpmrc.com Inquiries 866 416 7783 cpmrc@elsevier.com Copyright 2012 Elsevier, Inc. All rights reserved. Details provided in this document are for information purposes only and, unless specifically agreed to the contrary by Elsevier in writing, are not part of any order or contract. CPMRC718pod