3.5 Weeks from EMR Go-Live to HIMSS Stage 6 Clinicians ... · 3.5 Weeks from EMR Go-Live to HIMSS...

3.5 Weeks from EMR Go-Live to HIMSS Stage 6 – Clinicians Adoption & Engagement

Tamara Sunbul, MD, CPHIMS, PMPMedical Director of Clinical Informatics

March 18, 2019

Agenda

Introduction

Johns Hopkins Aramco Healthcare (JHAH)

Epic@JHAH Project – Challenges & Successes

Key Success Factors

Clear Governance

Strong Clinical Engagement

Methodical Testing

Extensive Go-Live Support Preparation

Effective Communication

Objective Adoption Measurement

HIMSS Adoption Metrics

Post Go-Live Staff Survey Results

Post go Live Clinical Adoption

Patient Adoption & Partnership

Introduction


Strategic alignment of two renowned institutions

• Saudi Aramco the national oil company of the Kingdom of Saudi Arabia provides healthcare to its employees and dependents (360,000) throughout the kingdom

• Johns Hopkins Medicine (JHM) a premier academic health system bringing healthcare administration, clinical services, education and research; a vast experience in global healthcare delivery


JHAH main hospital is located in the Eastern Province city of Dhahran, Saudi Arabia with satellite health centers in four additional Eastern Province locations:

Abqaiq

Al-Hasa

Ras Tanura

‘Udhailiyah

JHAH also operates 55 remote area clinics, providing around-the-clock emergency medical support to Saudi Aramco operations.

JHAH also contracts 80 medical designated facilities as part of its healthcare network.

Application Description

1 ADT (Grand Central) ADT

2 Anesthesia Anesthesia

3 ASAP Emergency

4 Beacon Oncology

5 Cadence / Prelude Scheduling / Registration

6 Canto iPad App

7 ClinDoc Clinical Documentation

8 Cupid Cardiology

9 EpicCare Ambulatory Ambulatory

10 EpicCare Link Community Access

11 Haiku iPhone App

12 Healthy Planet Population Health

13 HIM HIM

Application Description

14 Kaleidoscope Ophthalmology

15 MyChart Patient Portal

16 Nurse Triage Nurse Triage

17 OpTime Surgery

18 Inpatient Orders Inpatient Orders

19 Radiant Radiology

20 Referrals Referrals

21 Resolute HB Hospital Billing

22 Tapestry Managed Care

23 Stork Labor & Delivery

24 Willow Ambulatory Ambulatory Pharmacy

25 Willow Inpatient Inpatient Pharmacy

26 Willow Inventory Pharmacy Inventory

Epic@JHAH Project

Big bang go-live on January 26, 2018

Epic Applications:

Epic@JHAH Project –Unique Challenges

First Epic implementation in the Kingdom of Saudi Arabia

Concurrent with multiple major transformative initiatives at JHAH

Strong security constraints due to infrastructure hosting at Saudi Aramco, a

prominent target for cyber attacks

Epic@JHAH Project –Success Stories

HIMSS Stage 6 on February 20, 2018 <------------------------- 25 Days Post Live!

The HIMSS Analytics Electronic Medical Record Adoption Model (EMRAM)

The HIMSS Analytics Outpatient Electronic Medical Record Adoption Model (O-EMRAM)

Successful big bang go-live on January 26, 2018

First day among the most successful in Epic’s experience with fewer than expected operational and technical issues

Faster than anticipated recovery from planned schedule reduction

Post Live Survey results in top quartile of all Epic customers with overall satisfaction at 85%

Fastest international MyChart registration ramp-up in history

Key Success Factors

Clear Governance

Epic@JHAH Work GroupsLevel 0

Nursing and Clinical Services Advisory Council

Epic@JHAH Project Management Office Clinical Chiefs

Physician Champions

Level 1

Level 2 Cross Council Advisory Group Data & Doc. Governance Group

Clinical Leadership CouncilLevel 3

Level 4EHR Steering Committee

Level 5 Executive Committee

Level 6 Board of Managers

Healthcare IT Committee

Clear escalation path for issue resolution, change control, and decision approvals

Minor items resolved by work groups consisting of project team analysts and operational Subject Matter Experts (SMEs)

Weekly PMO meeting led by project manager determined appropriate escalation points and required approvals

11


• Physician / Nurse / Operational Champions• Engaged throughout the project lifetime• Key tasks: coordination and facilitation; issue escalation and resolution; system customization

(e.g. Physician Builder); operational readiness; heroes!

• Specialist Training Specialists (STS) Physicians / Credentialed Trainers (CT)• Engaged during the training phase• Key tasks: review training curriculum and material; conduct staff training• Some CTs became Epic certified post live and joined Epic@JHAH support teams!

• Super Users• Engaged during the training phase and go-live phase• Key tasks: staff training support; cutover activities; at-the-elbow

go-live support; issue escalation and resolution

SMEs

Champions

Trainers

Super Users

• Business Owners / Subject Matter Experts (SME)• Engaged from inception and throughout the project lifetime• Key tasks: workflow design collaboration and validation

Cascading & Overlapping Roles


Internally Sourced Trainers and Super Users

Challenges:

• Ensuring full commitment and dedication to training and super user activities

• Minimizing any access to care or operational impact

Benefits:

• Better training experience

• Boost staff confidence

• More effective go-live support

• Faster overall adoption

• Embed deeper Epic know-how among staff

100% of Trainers were internally sourced 95% of Super Users were internally sourced

Training Survey Results

QuestionAverage Response

(max: 5)

Overall Average

(718 responses)

1 The stated objectives of the training were met. 4.67

4.45 / 52 The instructor was knowledgeable about the subject area. 4.74

3 The training materials were clear and easy to follow. 4.54

4 The time allotted was adequate to complete the course material. 4.15

5 I feel confident I can use the tools and functions shown in class. 4.10

6 I understand what is changing in my day to day work due to Epic. 4.48

Do not accept partial commitment

Accommodate overtime as needed

Methodical Testing

Application and Integration Testing

Very strict “pass twice” standard with no relaxation near the end

700+ Test Scripts

War Room approach whereby all designated testers worked in the same area to maximize efficiency of test script handover and processing

Technical Dress Rehearsals (TDR)

Effective commitment and engagement by all IT staff with detailed tracking – all hands on deck!

Three months duration covering all workstations

Effective coordination and communication with clinical and operational staff

Cutover Dry Runs

Four sessions, with the first conducted 3 months prior to go-live

Every cutover assigned super user participated in at least one session


Change ManagementPre Go-Live Implementations

Whenever possible, new systems and processes were implemented prior to the Epic go-live to ease staff adoption, such as:

Dragon for speech recognition

OBIX fetal monitoring

Imprivata for single sign-on (SSO)

CPT coding for OR and OPPA

Online Progress Notes and E&M coding

Policy Changes

Policy changes due to workflow or system changes were prepared and signed off in advance of go-live by the business owners with go-live as the effective date.

Reduction of Appointments & Elective Surgeries

50% reduction in first 2 weeks 25% reduction in following 2 – 4 weeks

Extensive Go-Live Support PreparationChange ManagementClinical Operational Readiness (CORe) Go-Live Readiness Assessments (GLRA) events

with strong executive leadership support and business proponent participation and ownership

Engagement of JHAH Change Management Agents

Open walk-in sessions

Hands-on demonstrations

Workflow Dress Rehearsals (WDR)


dedicated to go-live support

Super User Program 95% internally sourced

Fully dedicated to providing at-the-elbow support

Planned for 4 weeks but returned to normal duties earlier as needed

5:1 ratio for physicians using mix of physicians, nurses, and 5% external

6:1 ratio for everyone else

One master schedule for all 1000+ support staff

Twice daily Super User huddles

Easily identified by green vest

People Fully Dedicated to Go-Live Support


Epic@JHAH Website

Content

Countdown

Key Events Timeline

About Epic@JHAH

Calendar

Go-Live Website

News & Events

Training

Workflows


Go-Live Survival Guide, Mousepads, Phone Labels

ContentTips for Go-Live

How to get help?

How to report issues?

How to access historical data?

Key points to ensure patient safety

Key points to ensure information security

Staff talking points for patients


Go-Live Website

ContentCountdown

How to get help?

How to report issues?

Tip sheets

Facility maps

Contact numbers

Cutover schedules

Daily meeting schedules

Support roles and schedules

Various links


Go-Live Email Updates

ContentNews

Interesting Stats

Tips


Face-to-Face

Daily and Weekly Meetings

Super User Huddles

Status Reviews (Access, Registration, Scheduling, Pharmacy, Radiology, Cardiology, Oncology, Perioperative, Anesthesia, etc)

Patient Safety

Ambulatory Clinical Huddle

Inpatient Clinical Huddle

Revenue Cycle

Executive Debriefing

Objective Adoption Metrics

HIMSS Adoption Metric – What?

Health Information Management Systems Society (HIMSS) is a global, cause-based,

not-for-profit organization focused on better health through information and technology.

HIMSS leads efforts to optimize health engagements and care outcomes using information

technology.

Vision: Better health through information and technology.

Mission: Globally, lead endeavors optimizing health engagements and care outcomes

through information and technology.

Electronic Medical Record Adoption Model(EMRAM)

Outpatient Electronic Medical Record Adoption Model(O-EMRAM)

HIMSS Adoption Metric – What?

HIMSS Adoption Metric – Why?

Why HIMSS? Why so soon after go-live?

Objectively measuring user adoption success can be difficult. Exclusive use of internal metrics can be open to interpretation or debate as a result of subjective perceptions or the magnified influence of anecdotal evidence.

There is a higher degree of confidence in accreditation by HIMSS as an external, objective, standardized, and well regarded authority in the effective use of information technology for patient care.

Having the survey take place so close to go-live without room for extensive preparation also ensures an accurate reflection of the true status of EHR adoption at the organization.

Finally, the mere act of pursuing HIMSS accreditation demonstrates organizational commitment to providing safe, timely, effective, efficient, equitable, and patient-centered healthcare through the effective use of information technology.

HIMSS Adoption Metric – How?

How did JHAH prepare for the survey?

Submission of prerequisite survey questionnaire

No formal preparation of staff beyond basic notifications and meeting invites

Post Go-Live Staff Survey Results

Overall, I am satisfied with Epic.

JHAH placed in the top quartile of all Epic customers one-month post-live for almost all areas

1 2 3 4 5 6

4.59

Epic is easy to use, and designed for my needs.

1 2 3 4 5 6

1 2 3 4 5 6

I feel supported in my use of Epic.

4.51

4.59

Top 3 Highest Scoring Questions

Agree(Overall)

Strongly Agree

Agree Slightly Agree

Slightly Disagree

Disagree Strongly Disagree

Epic is easy to use, and designed for my needs 82% 21% 44% 17% 6% 7% 5%

Epic helps me be efficient in my day-to-day job 81% 18% 48% 15% 7% 6% 6%

The response time of the screen is satisfactory 83% 15% 52% 16% 7% 7% 4%

I feel supported in my use of Epic 85% 20% 48% 18% 5% 6% 4%

The training I received helps me do my job 78% 18% 42% 18% 8% 7% 7%

Epic reports help me take appropriate actions 81% 10% 47% 24% 8% 7% 4%

Overall, I am satisfied with Epic 85% 19% 49% 18% 7% 4% 4%

Post go Live Clinical Adoption

Compliance for the month of February 2019 JHAH Target

Medication Reconciliation – Discharge 94.5% 85%

Computerized Physician Order Entry (CPOE) 96% 90%

Barcode Med Admin (BCMA) – Patient 95.4% 95%

Blood Scanning 99% 95%

Epic’s Gold Stars program helps to identify features that can be used to improve clinical and financial outcomes. Epic@JHAH earns 7 out of 10.

User Satisfaction

Latest end user survey results shows 91% overall satisfaction with the Epic@JHAH system.

Patient Adoption & Partnership

MyChart is an online health portal that provides patients easy access to managing their health. From booking an appointment, to looking up test results, or requesting medication refills, patients can take control of their healthcare in just a few simple steps.

25,600+Unique Patient logins

Monthly Metrics (February 2019)

12,114Logins through mobile

7,758Appointment scheduled online

4,942Medication refills requested online

58% Active Patients66,024 / 110,000 eligible

Conclusion

3.5 Weeks from EMR Go-Live to HIMSS Stage 6 Clinicians ... · 3.5 Weeks from EMR Go-Live to HIMSS...

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