implementing a clinical information system – the role of
TRANSCRIPT
Implementing a Clinical Information System – The Role of Informatics Nurses
Helen Edwards RN MNCarol Warren RN
November 24, 2009
OutlineEvolution of Computerization at SickKidsBuilding a Nursing Informatics PortfolioImplementing a Clinical Information System
DesignCommunicationEducationGo-LivePost Go-Live
Key Success FactorsLessons Learned
SickKids Hospital
Grand Total Planned Beds 274Clinic Visits 73,907 Medical Day Care Visits 28,971 Day Surgery Visits 5,146Inpatient Surgical Visits 6,238 Emergency Visits 54,580 Discharges 13,803 Average LOS 7.3Patient Days 100,332 Average Daily Census 274.9
Evolution of ComputerizationComplex infrastructure - comprises diverse platforms, applications, client devices
Complex and dynamic technological environment with >140 information technology systems/applications in use
44 main clinical applications
12 patient management
5 decision support
3 interface technology
15 scheduling and departmental
14 personal productivity
23 business services
18 network/computing infrastructure
6 communications
Evolution of Computerization cont’d
1980s first clinical information system – home grown system (functionalities included laboratory order entry / results retrieval and dietary order entry)
1989 Poison Control Centre switches from microfiche to electronic database (electronic charting 1997)
Evolution of Computerization cont’d
1992/1993 DOS based system (Kidcom) – ADT, CPOE, eMAR, some clinical documentation
1996 Telemedicine launched
2000 - ICUs – all clinical documentation except CPOE
Evolution of Computerization cont’d
Other common systemsPACSScanned historical paper chartSchedule BookTranscription and Dictation SystemAmbulatory Referral Management SystemeCHN – EHRSurgical Information SystemEmergency Department Information System
Evolution of Computerization cont’d
2005 –KidCare Phase I (transitioning Kidcom to Windows based system)
Patient ListsResults retrieval
2008 – KidCare Phase II (transitioning remaining functions)
CPOEeMARClinical Documentation (e.g. Admission Assessment, LOA, Discharge Summary)
Our VisionFully electronic patient chart across the inpatient and ambulatory areas
Progress NotesFlow SheetsConsentsDiagrams/Photographs, etc.
Universal WorkstationsSingle Sign-onMultiple form factors
Building a Nursing Informatics Portfolio
Prior to 2003Variety of titlesVariety of responsibilitiesVariety of compensation strategiesLittle opportunity for specialist-specific professional development
2003First Director of Nursing InformaticsMandate – build a portfolio
Building a Nursing Informatics Portfolio
2007/2008 Informatics Nurse – common job description and ranking
Informatics Nurse – Application SpecialistInformatics Nurse – Education SpecialistInformatics Nurse – Workload Specialist
CurrentlyMonthly business/professional development meetingsBi-monthly hospital CIT Forum
C.I.T. Matrix Organizational Chart
Chief – Inter-Professional Practice and
Chief Nurse Executive
Director – Clinical Informaticsand Technology
Chief Information Officer
Directors – Clinical Programs
Centre for NursingIN – Workload SpecialistsIN – Application SpecialistsClinical Technology PM
Clinical ProgramsIN – Application Specialists
ISMgr – Informatics EducationIN – Application SpecialistsIN – Education Specialists
Directors/Managers - IS Managers – Clinical Programs
Direct ReportsMatrix Reports
Implementing a Clinical Information System
Design
Communication
Education
Go-LiveCommand CentreSupport
Post Go-Live
DesignApplication and Education Specialists
Knowledge of practices and processesConsultation with clinical departments/ areas and IS staffAdvocacy / LiaisonTheoretical perspectivesTesting – unit, functional, integratedReports
CommunicationHospital-wide engagement/profile
Steering CommitteeExecutive SponsorPhysician LeadershipNursing LeadershipProfessional Services
Project TeamDiverse membership - Application and Education Specialists – IS and Clinical Programs
Communication cont’d
Built off of successes of KidCare Phase I
User GroupsNursing, Professional Services, Physicians, Others
Super UsersMeetingsEmails
Communication cont’d
Hospital publicationsThis Week (print)Daily News (homepage)
WebsiteKidCareCountdown
Communication cont’d
Clinical Program Director meetings
Clinical Program Manager meetings
Nurse Educator meetings
Division/Department meetingsMedical Professional Services
Informatics Education
3500+ staff
8 Weeks
Education Design3 team leads
NursingPhysicianProfessional Services and Administration
Instructor led class curriculum
Reference material
Education
Pre - Education
Pre – Education Open Forums
Pre – Education Open House
Pre – Education Open House
Communication and Advertising
Communication and Advertising
Communication and Advertising
Communication and Advertising
Communication and Advertising
Leadership
Nursing
Physician
Professional Services and Administration
Communication and Advertising
Communication and Advertising
Blended Learning ApproachComputer-based Tutorials (CBTs)
Mandatory pre-requisite General/Basic informationDecreased in-classroom timeStaff themselves decided when and where
Instructor Lead Classes (ILC)Complex process or changes in process/ conceptsTo anchor knowledge – providehands-on training
CBTs5 modules
General Overview
Order Entry
Documentation
eMAR
Task Viewer
CBT Agreement Form
Super User EducationJob Description
proficient at all functionality on legacy system and KidCare Phase I
recognized ability to lead and support all health care colleagues
availability to act as a SU during implementation
Attend Super User training
3500+ staff
8 Weeks
Original Goal
Outcome:Between Sep 4th and Nov 4th
3083 staff were trained 585 classes were held
88% of staff were trained by go-live
Go-LiveEducation continued through go-live
3 Informatics Educators Scheduled and adhoc trainingOngoing education for existing clinical systems
4 Informatics EducatorsGo-live support
Reference material
Go-Live Command Centre
Command Center Help Desk
Informatics Nurses
Communication tools
External Support Staff and Super Users
Go-Live cont’d
Daily meetings at 1300 with all clinical managers – get a sense of how staff were doing
Tips and Tricks
Post Go-LiveOngoing education
Clinical Applications Resources and Education Support (CARES)
Ongoing communicationTips and TricksWebsite updates
KidCare Duty Officer (KDO)
Stabilize the system for a period of time before making any revisions
Key Success FactorsHospital engagement
Hospital-wide project – ownershipGo-live day was a “marked event”
Communication mechanismsCountdownPostersClinical Managers, Directors, VPs
Education ModelDaily communicationCME Credits
Key Success FactorsGo-Live Support Model
Command centreSuper UsersInformatics nursesHiring skilled activation support resources helped the front-line users tremendously throughout the activation process.
Post Go-Live Support ModelContinuing training sessionCARES
Lessons Learned Application
Ensure sufficient resources for both the project team and support staff
Cross-train more of the project team members on system configurationHaving one consistent vendor project manager is necessary for continuity
Lessons LearnedApplication
Changes to a legacy system should be restricted to only those that are critical
Printing should be tested earlier in the Project
Lessons Learned Training
Ensure you have sufficient technical expertise to support trainingNo grab bags
Have an admin assistant
An LMS would help!
Regular debrief sessions
Lessons Learned Training
Create a mock training environment for educators to practice
Create a practice database for staff to practice after attending training
Lessons LearnedCommunication
Communicate project scope to the users – functionality
Communication mechanism to all relevant project team members re changes and decisions
Lessons LearnedSupport
Extended activation support should be planned for and acquired (for example, contracted project team members should not be released shortly after activation)
Helen Edwards RN MNDirector – Clinical Informatics and TechnologyCentre for NursingHospital for Sick Children (SickKids)[email protected]
Carol Warren RNManager – Informatics EducationInformation [email protected]
Contact Information