EDITION FOUR THE ONE INITIATIVE JULY 2019 NEWSLETTER 2019… · MEDITECH Expanse uses a closed loop...

EDITION FOURJULY 2019

NEWSLETTERTHE ONE INITIATIVE

SAFER. BETTER. SMARTER. The ONE Initiative is making patient care safer, better, smarter.

Safer…because the new system helps prevent medication errors.

MEDITECH Expanse uses a closed loop medication management (CLMM) process, in which all steps of the medication cycle are supported electronically: ordering, verifying, preparing, distribution and administering.

This is just one of the ways in which the ONE Initiative improves patient safety.

You can learn about CLMM on pages 2 to 3 of this newsletter.

NAVIGATING THROUGH CHANGE TOGETHER.

NOT ALL HEROES WEAR CAPES!When WAVE 1 hospitals go live with MEDITECH Expanse in October, we want everyone at the sites to be able to identify a superuser. Each superuser will be given an item of ONE-branded apparel to wear during the launch period.

THANK YOU TO OUR SUPERUSERS!

WHAT’S INSIDE:Patient benefit spotlight: Closed Loop Medication Management

PAGE 2

Behind the scenes with the Regional Change Management Lead

PAGE 4

Tools supporting change at the three WAVE 1 sites

PAGE 10

Update about ambulatory care and patient portal planning

PAGE 15

WAVE 2 update

PAGE 15

Keep & trim project calendar

PAGE 18


ONE INITIATIVE NEWSLETTER 32 ONE INITIATIVE NEWSLETTER

ORDERING PREPARINGVERIFYING DISTRIBUTION

ELECTRONIC SUPPORT

SAFETY FEATURES

Once entered, the orders are sent directly to pharmacy for verification and dispensing. The medication orders update the electronic medication administration record (eMAR).

Clinical decision support is integrated into the MEDITECH eMAR solution, with PRN (as-needed) warnings, dose verification, and cumulative dosing alerts all part of the workflow.

ELECTRONIC SUPPORT

SAFETY FEATURES

Using the Computerized Provider Order Entry (CPOE) feature, care providers enter orders directly into the computer.

Eliminates unreadable handwritten notes and reduces errors that can happen when copying physicians’ medication orders.

ELECTRONIC SUPPORT

SAFETY FEATURES

The medication is dispensed as bar-coded unit dose medication to automated dispensing cabinets, medication carts or workstations on wheels in the patient care unit; pre-mixed IV solutions purchased and prepared.

With a few possible exceptions, nurses no longer have to dispense most medications from bottles of medicine or mix most of the IV solutions for their patients.

ELECTRONIC SUPPORT

The medication is securely stored in automated dispensing cabinets, workstations on wheels or medication carts.

PATIENT BENEFIT SPOTLIGHT: CLOSED LOOP MEDICATION MANAGEMENT (CLMM)

ADMINISTERING

ELECTRONIC SUPPORT ELECTRONIC SUPPORTSAFETY FEATURES SAFETY FEATURES

The eMAR is updated and quality improvement reporting is performed and acted upon, closing the loop.

The nurse validates orders from the eMAR and collects the patient’s medications.

As part of the Bedside Medication Verification (BMV) functionality, the patient armband and medications are scanned prior to administering the bar-coded medication, to verify the ‘5 rights’ before administering the medications.

MEDITECH provides administrative reviews of eMAR activity through monitoring reports and pharmacy prescription auditing, to help ensure nurses maintain compliance with bar-coded medication administration and avoid workarounds.

The system will alert the nurse if the medication scanned does not match a medication ordered for the patient.

The system minimizes the risk for missed medication doses by helping to identify the medications due to be given to a patient.

The medication administration is recorded electronically.

ADMINISTERING



BEHIND THE SCENES WITH THE REGIONAL CHANGE MANAGEMENT LEAD

An interview with Alison MacDonald, ONE Regional Change Lead, certified in Prosci© ADKAR Change Model.

Introducing a new shared electronic health system to three hospitals is an enormous undertaking. How does one implement such significant change at three distant and unique sites?

The ONE Initiative change management plan is based on the ADKAR model, which stands for Awareness, Desire, Knowledge, Ability and Reinforcement (ADKAR). The ADKAR © framework serves as a checklist to ensure that our change management plans focus on the following areas:

Awareness: Ensuring stakeholders are aware of the need for the change.

Desire: Increasing stakeholders’ desire to participate and support the change.

Knowledge: Enabling stakeholders to gain the knowledge on how to change.

Ability: Ensuring stakeholders acquire the new skills and behaviours required to successfully implement the change.

Reinforcement: Supporting stakeholders during and after the change to reinforce new skills and behaviours.

In summary, our change management plan outlines how we will communicate, train and support our end users to implement MEDITECH Expanse in the WAVE 1 hospitals.

When people experience change, they go through predictable stages outlined by Blanchard. The goal in leading change is to diagnose and treat each of the stages, in those people experiencing to change.

What is the first stage of change management?

The implementation teams and end users at the WAVE 1 hospitals need to understand why it is important to change right now, and that it is worth pausing their busy lives in order to make the effort to change. This focus is around two particular areas in the ADKAR model – awareness and desire.

What are the key reasons for this change?

A shared MEDITECH Expanse system helps make patient care safer, better, smarter.

The new system:

• Reduces care variation. Helps patients receive more consistent care across different hospitals, which share the electronic system.

• Helps prevent medication errors before they happen. As part of the Bedside Medication Verification (BMV) functionality, the patient armband and medications are scanned prior to administering medication. The system will alert the nurse if the medication scanned does not match a medication ordered for the patient.

• Minimizes the risk for missed medication doses. The improved Bedside Medication Verification (BMV) functionality of MEDITECH Expanse medications can be filtered to help identify medications due for administration.

• Improves the medication reconciliation process.

• Reduces transcription errors. Eliminates illegible notes. No more trying to understand someone’s handwriting!

• Reduces the need for patients to repeat their history.

• Provides complete and timely access to a patient’s journey.

• Improves point-of-care access to critical patient information to enable timely clinical decisions.

• Reduces duplication of certain diagnostic tests.

• Improves information available at discharge for patients.

• Reduces fragmented medical records.

• Fosters a more collaborative culture within the region.

• Creates opportunities for hospitals to learn from each other.

• Improves access to evidence-informed care, leading to improved outcomes: the system will contain over 300 standardized, evidenced- informed, order sets.

• Supports transfer of patients from one site to another.

• A problem list (diagnosis list) follows the patient through their lifetime, at each hospital on the system, in which the patient is seen. This assists with history taking.

• Improves clinical decision support through automated alerts, reminders and suggestions:

o Responses on the nursing admission assessment suggest a care plan or additional assessment.

o Physicians receive alerts while ordering medications and tests, notifying them if the patient has allergies or other contraindications.

o The system is able to evaluate patient problems (diagnosis) and make recommendations for treatment.

• Improves the safety and transparency of the process for blood transfusions.

• Enables the implementation of a comprehensive patient portal, in the future.

• Define your “Why”• Communicate your “Why”• Have stakeholders communicate the “Why”

• Allow and encourage the expression of fears and emotions• Name it to tame it• Arrange for one-on-one contact

• Provide multimodality training• Offer accessible help• Deliver step-by-step guidance

• Set proper expectation using the j curve• Present metrics• Praise progress toward change goals

• Identify conflicts between groups• Educate to fill knowledge gaps• Facilitate interdisciplinary workflow optimization sessions

• Communicate the process for requesting refinements• Display a transparent issue log• Encourage people to participate in optimization

INFORMATION

PERSONAL

IMPLEMENTATION

IMPACT

COLLABORATION

REFINEMENT

TREATING THE STAGES



When MEDITECH Expanse goes live in October at the WAVE 1 hospitals, will staff be as efficient as they were before this change was implemented?

Significant workflow changes result in an initial decrease in productivity, as people take extra time to learn new ways of working. This is what is referred to as the J curve. It is important to ensure adequate expectations are set for the implementation.

The drop in productivity is likely to last approximately eight weeks to six months, depending on multiple factors, including the efforts put into education, the quality of the build, and the accessibility and quality of support provided.

To help manage this period of time, several steps are being taken (These steps focus on the knowledge, ability and reinforcement component of the ADKAR model). Trainers are teaching end users how to use the system. Superusers are being trained in advance of go live and deployed at go live to support end

users. Staffing is being increased during go live to support patient care.

Work is being done to help manage go-live performance expectations. Patients are being advised to anticipate delays during go live. Management and staff are being informed of the J curve, to provide realistic performance expectations.

It is the responsibility of all local and regional implementation team members to reinforce the concept of the J curve of implementation prior to or during training when addressing the stakeholders who are experiencing change.

Is there anything else you would like to highlight to readers at this time?

This is an enormous hospital-wide change occurring at three sites, which is requiring a tremendous amount of work and time from everyone. The site change leads have been essential to supporting change locally. We appreciate how everyone is pulling together to make this project a success.

Illustration of the J curve (Jerald Jellison)

J CURVE

EXPECTATIONS

IMPLEMENTATION

STATUS QUO

NEW STATUS QUO

THE GAP

PR

OD

UC

TIVIT

Y

TIME

Time will be dependent upon:• Quality of preparation• Workflow design• Supports

Legible electronic orders mean safer care and few interruptions for clarify.

Physicians will have access to more than 350 peer-reviewed,

evidence-based order sets.

The access reduces repetition and assists with decision support

in situations that are not encountered frequently.

Order sets reduce repetition and assist with decision support in situations

that are not encountered frequently.

All orders and dictated documents will be signed using a unique

electronic signature (PIN).

Patient demographic labels and a printable patient list will be available

to assist with billing.

Vital signs will be available in real time and can be trended

for a quick visual glance.

Patient information is available immediately using embedded voice

recognition (Nuance Dragon Medical One) recorded from any device.

The system is designed to auto-populate fields such as medications,

allergies, past medical history or the physician’s frequently used phrases.

Better shift hand-off procedure using the new sign-out feature

in MEDITECH Expanse.

“Call in reception” in MEDITECH Expanse allows the provider to document

orders for the patient even before they arrive (e.g. the reason the patient

is presenting, concerns from the sending provider, etc.). This information

is easily accessed by the triage nurse.

Secure access to patient information on devices from wherever it is

needed—the hospital, office, patient’s bedside.

“Call back” in MEDITECH Expanse creates an organized way

to ensure patients get added to a list and are called back as needed

(e.g. culture result).

Redesigned and streamlined medical directives to facilitate

timely patient care.

Improved patient trackers to navigate and communicate the flow

of a patient throughout their journey in the ED.

Physicians enter orders which are then sent immediately to the

appropriate area (e.g. Lab, DI etc.).

Written, hard-to-read orders.

Minimal order sets currently exist—physicians

have to write repetitious orders and at times

recall infrequently ordered items.

Handwritten signature on orders.

Physician billing is facilitated by using blue cards

or chart carbon copies.

Vital signs are not visible electronically

to providers.

Dictation is done using a traditional

transcription model.

Patient information on the chart is not timely and

accessible to all providers.

Shift hand-off not consistently happening.

Receiving call-in information about patients

requires the provider to call someone or hand

deliver a note to triage.

Time is spent hunting down the patient’s

information that is needed.

Not always an organized way to ensure patients

are called back when needed.

Medical directives in place.

Patient trackers in place.

Physicians currently write orders for others

to enter.

WHERE WE ARE NOW... SAFER. BETTER. SMARTER.

ED P

HYSIC

IAN

A snapshot into the new day-to-day role of a

ED PHYSICIANHOW WILL MY ROLE CHANGE?

Last updated: June 20

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The creation of a longitudinal chart where information (allergies, home meds, patient’s medical history) is accessible visit to visit and across multiple sites.

Expanse has a snapshot view that summarizes the patient’s care. It’s like a self-transcribing Kardex that automatically updates in real time as documentation occurs.

Centralized multidisciplinary care plans, multiple people can access the record at the same time, improved and customized status boards, and surveillance tools for better care coordination.

Orders are entered directly and automatically by providers (e.g. physicians) and flow to the appropriate departments—no transcription or co-signatures for medications.

A medication list can easily be retrieved and updated at every patient visit.

Orders are entered directly by the provider and are legible.

Barcodes on patient wristbands and medication labels are scanned to verify all requirements of safe medication administration: right patient, right medication, right dose, and right time.

Vital sign information from cardiac monitors directly flows into the patient record (CCU, ICU, ED, PACU & NICU) in real time.

Universal discharge: everyone on the care team is contributing to the discharge plan, creating a multidisciplinary approach that can start anytime during the patient’s admission. A paper patient discharge summary is generated with standard design and predictable information.

A work list is generated for each patient indicating when and what care is needed.

Scan and verify blood products with information stored in a patient's Transfusion Administration Record (TAR) to meet all requirements of safe transfusion administration.

Patients tell their story over and over again.

Kardex is only accessible at the nursing station and the information on the Kardex is not always reliable and up-to-date.

Important patient information is scattered throughout the paper chart. Searching through paper medical records and online content is time consuming and can be confusing.

Orders require transcription and medications must be faxed to pharmacy.

A new best possible medication history is created at each patient visit.

Handwritten orders are sometimes illegible and prone to transcription error.

A nurse checks medications manually on the chart and then takes it to the patient to be administered.

Vital signs are handwritten or batch entered in the chart and are often not done in real time.

The physician guides the discharge process.Information on discharge is scattered throughout the chart.

People are creating personal reminders and to-do lists to stay on track.

Several manual steps involved in the transfusion of blood product process.


NU

RSEA snapshot into the new day-to-day role of a

NURSE

HOW WILL MY ROLE CHANGE?


19

The creation of a longitudinal chart where information (allergies, home meds, patient’s medical history) is accessible visit to visit and across multiple sites.

Physicians will have access to more than 350 peer-reviewed, evidence-based order sets. The access reduces repetition and assists with decision support in situations that are not encountered frequently.Physicians have the ability to mark their favourite order sets with a yellow star for quick access.

Computer provider order entry, means safer care and fewer interruptions to clarify illegible orders. Orders are immediately sent to the appropriate area (e.g. Lab, DI).

All orders and dictated documents will be signed using a new and unique electronic signature (PIN).

Secure access to patient information on devices from wherever it is needed—the hospital, office, patient’s bedside.

Patient information is available immediately using embedded voice recognition (Nuance Dragon Medical One) recorded from any device.The system is designed to auto-populate fields such as medications, allergies, past medical history or the physician’s frequently used phrases.

Universal discharge: everyone on the care team is contributing to the discharge plan, creating a multidisciplinary approach that can start anytime during the patient’s admission. A paper patient discharge summary is generated with standard design and predictable information.

Patient demographic labels and a printable patient list will be available to assist with billing.

Patients tell their story over and over again.

Minimal order sets currently exist. Physicians have to write repetitious orders and at times recall infrequently ordered items.

Written, hard-to-read orders

Handwritten signature on orders and documents are distributed by health records in draft status.

Time is spent hunting down the patient’s information that is needed.

Dictation is done using a traditional transcription model.Patient information on the chart is not timely and accessible to all providers.

The physician guides the discharge process. Information on discharge is scattered throughout the chart.

Physician billing is facilitated by using blue cards or chart carbon copies.


PH

YSIC

IAN

A snapshot into the new day-to-day role of a PHYSICIAN

HOW WILL MY ROLE CHANGE?


19

CPOE (Computerized Provider Order Entry) and

verification by pharmacist

• orders appear in pharmacy and eMAR in real time

via computerized provider order entry (CPOE)

• pharmacist verifies order (passive order verification)

Benefits

• reduce turnaround time for verification/access/

delivery of medication

• eliminate transcription errors and illegible

written orders

24/7 Pharmacist Services

• on-site hours combined with remote pharmacy

services to provide 24/7 verification

• decreases number of doses given without

pharmacist verification

FDB AlertSpace®

• reduce alert fatigue using software maintained

by the ONE support team to make medication

alert changes through clinical feedback from our

own pharmacists and physicians

• increased requests to customize individual

patient allergy profiles

Electronic Medication Reconciliation

• reduce time to collect a best possible medication

history (BPMH) using history from our electronic

medical record for returning patients

• medication reconciliation is completed at all

transitions of care for all inpatients

• discharge transfer (current status change) and

manage transfer (current BPMTL) – all orders

are re-verified

Handwritten medication orders by provider:

• scanned/delivered to pharmacy

• transcribed to MAR by nurse

• entered into patient profile by pharmacist

(active order entry)

Limited pharmacist order entry hours:

• morning backlog of orders

• there is not always time for a pharmacist to verify

orders before the first dose is due

Alert fatigue:

• without the ability to customize drug-to-drug and

drug-allergy interactions clinicians might experience

alert fatigue

Paper process for medication reconciliation:

• on transfer, difficult to interpret when changes

are made and new information is provided

• transfer and discharge not currently implemented

throughout all inpatient locations and for all

transitions of care

• status changes are discharged-re-admit – all orders

are re-entered


PH

AR

MA

CIS

T

A snapshot into the new day-to-day role of a

PHARMACIST HOW WILL MY ROLE CHANGE?


19

A Before After Card from NBRHC, and example of the change management tools used at the WAVE 1 sites. Each of the WAVE 1 hospitals are adapting this tool for use at their site, to demonstrate workflow changes.



EVERYONE’S CONTRIBUTIONS TO THIS PROJECT ARE IMPORTANT

We all have a role in making this transformational change initiative successful. Here are some of the many key ways each of the following roles contribute.

CEOs/Senior management/Project leadership

• Repeat, repeat and repeat the story of how this change will provide safer patient care.

• Highlight successes and shine the spotlight on change “superheroes,” as they emerge.

• Have the right people in the right role to make this change successful.

• Pave the way for effective, efficient, well-socialized decision-making.

• Support and communicate key milestone dates, project vision and project benefits within the organization.

Physician Leadership

• Manage expectations: at the beginning of go live it will take longer for physicians to complete their work as they adjust to the new technology and workflow; it will take about two to six months to reach the previous level of performance.

• Help all stakeholders (including patients) understand how this change will provide safer patient care.

• Communicate how physicians can be patient-focused while using an electronic medical record.

Clinical Leadership

• Be the primary change management lead with the nursing and allied health community.

• Build a change network of superusers at local WAVE 1 hospitals, who will provide input on system design, build, training and go-live support activities.

• Plan staffing to support the decreased productivity that occurs in the first months of go live.

Communications Site Leads

• Help all stakeholders understand how this change will provide safer patient care.

• Help ensure the right message is delivered at the right time, to the right people, by the right person.

• Assess if communication is being received and understood.

Build Team/Working Group Members

• Connect with local stakeholders to ensure input in the design and build of MEDITECH Expanse system.

• Facilitate and participate in workflow review sessions.

• Support and communicate key milestone dates, key messages, project vision and project benefits within the organization.

Superusers

• Learn how to use the system before go live, to help colleagues become familiar with their new workflow and the new technology.

• Communicate how this change will improve patient care.

• Provide support over several phases of this project – during training sessions, at go live, and in the months to follow – as we all go through the normal period of adjustment that happens with any significant new change.

Local Training Leads

• Train staff to use the new technology and understand their new work.

• Communicate how this change will improve patient care.

• Provide support over several phases of this project – during training sessions, at go live, and in the months to follow – as we all go through the normal period of adjustment that happens with any significant new change.



TOOLS SUPPORTING CHANGE AT THE THREE WAVE 1 SITES

Each site has established a team of superusers, frontline staff who get additional training that enable him or her to provide support and teaching to co-workers in the initial days of ONE implementation. While there is formal training for end users in MEDITECH Expanse and practice planned prior to go live, superusers will serve an essential source of support within their departments. They will answer questions, help their co-workers navigate through the system, and report issues to the project team to ensure prompt resolution.

Here is a snapshot of superuser experiences and insights across the three sites of WAVE 1.

SAULT AREA HOSPITAL (SAH)

One of the ways Sault Area Hospital is preparing their superusers is by training them in the human dynamics of change (“How do we change mindsets and behaviours?”), as well as a structured process to effectively deliver a transformational change such as the ONE Initiative. Applying a change management framework provides guidance and tools for how to change, and how to engage impacted groups throughout the change effort to ensure commitment and buy-in.

This content is presented in a fun, interactive workshop called “ExperienceChange™” that simulates a year-in-the-life of a team leading change. Participants learn that by applying the right tactics at the right time and leveraging their understanding of how people deal with change, buy-in for the change can be increased and accelerate benefits realization.

ExperienceChange™ was offered to change leads of other WAVE 1 sites. Sault Area Hospital’s team of certified ExperienceChange facilitators will continue to offer the workshop as part of their ongoing efforts to build change capability, as well as being available to support other hospitals.

The delivery of the ExperienceChange workshops are led by SAH change management lead Darlene Osborne.

Legible electronic orders mean safer care and few interruptions for clarify.

Physicians will have access to more than 350 peer-reviewed,

evidence-based order sets.

The access reduces repetition and assists with decision support

in situations that are not encountered frequently.

Order sets reduce repetition and assist with decision support in situations

that are not encountered frequently.

All orders and dictated documents will be signed using a unique

electronic signature (PIN).

Patient demographic labels and a printable patient list will be available

to assist with billing.

Vital signs will be available in real time and can be trended

for a quick visual glance.

Patient information is available immediately using embedded voice

recognition (Nuance Dragon Medical One) recorded from any device.

The system is designed to auto-populate fields such as medications,

allergies, past medical history or the physician’s frequently used phrases.

Better shift hand-off procedure using the new sign-out feature

in MEDITECH Expanse.

“Call in reception” in MEDITECH Expanse allows the provider to document

orders for the patient even before they arrive (e.g. the reason the patient

is presenting, concerns from the sending provider, etc.). This information

is easily accessed by the triage nurse.

Secure access to patient information on devices from wherever it is

needed—the hospital, office, patient’s bedside.

“Call back” in MEDITECH Expanse creates an organized way

to ensure patients get added to a list and are called back as needed

(e.g. culture result).

Redesigned and streamlined medical directives to facilitate

timely patient care.

Improved patient trackers to navigate and communicate the flow

of a patient throughout their journey in the ED.

Physicians enter orders which are then sent immediately to the

appropriate area (e.g. Lab, DI etc.).

Written, hard-to-read orders.

Minimal order sets currently exist—physicians

have to write repetitious orders and at times

recall infrequently ordered items.

Handwritten signature on orders.

Physician billing is facilitated by using blue cards

or chart carbon copies.

Vital signs are not visible electronically

to providers.

Dictation is done using a traditional

transcription model.

Patient information on the chart is not timely and

accessible to all providers.

Shift hand-off not consistently happening.

Receiving call-in information about patients

requires the provider to call someone or hand

deliver a note to triage.

Time is spent hunting down the patient’s

information that is needed.

Not always an organized way to ensure patients

are called back when needed.

Medical directives in place.

Patient trackers in place.

Physicians currently write orders for others

to enter.

WHERE WE ARE NOW...SAFER. BETTER. SMARTER.

ED P

HYSIC

IANA snapshot into the new day-to-day role of a

ED PHYSICIANHOW WILL MY ROLE CHANGE?

Last updated: June 2019 REGIONAL TEAM ABOVE AND BEYOND AWARD

Help us shine the spotlight on the superheroes in this project: the person who kept team spirits up, contributed unique ideas, or rolled up their sleeves in ways that motivated and inspired others.

Healthtech is giving out five - $200 gift-cards to members of the regional team, nominated by their peers as having gone above and beyond over the last year on the ONE project.

The gift card recipients will be selected by reviewers at Healthtech and announced in the August/September newsletter issue of 2019.

If you have a superhero to nominate, please complete the nomination form at the following link: Nomination Form

Be sure to include:

· The name, site, role, email address and phone number of your above and beyond award nominee.

· Your name, site, role, email address and phone number.

· A 200 to 400-word summary of why you are nominating them for the award.

Nominations will be accepted until August 7 at 5 p.m.

By submitting a nomination, you are consenting to the publication of your submission information, including your name, in this regional newsletter.

“This game helped me understand the big picture of facilitating a massive change in an organization.” “It helped me understand the change process and my role in it!” “I learned how hard it is to implement change and I can truly appreciate SAH for taking this on.”~ SAH Workshop participants

Left to Right: SAH Superusers and Change Network Leads: Erica Bickell, Community Treatment Coordinator, MH&A; Robin Neveau, RN, Maternity; Samantha James, RPN, MDS Assessment.

https://www.surveymonkey.com/r/DSQ3XVZ



NORTH BAY REGIONAL HEALTH CENTRE (NBRHC)

Over 200 superusers participated in the North Bay Regional Health Care (NBRHC) Superuser Bootcamp on May 21 and 23 in the auditorium. Facilitated by Healthtech, superusers learned more about MEDITECH Expanse, through a demo and question and answer period, and their role as superusers and how to support the hospital staff.

(Picture, far left) L to R: Ken Crosby, Physician Assistant, CCU; Laura Biskey, Physician Assistant, ED. (Picture, far right) L to R: Joanne Szalajko, Coordinator; Shirley Jones, Coordinator.

How can your colleagues best support you in your role? (Superusers need support, too!)

Bring coffee!

What have you learned about the shared health information system being introduced at go live, which you find particularly exciting?

It will be very beneficial to have access to all patient records from all the WAVE 1 sites. It will reduce time in the ER calling other hospitals’ health record departments and getting them to fax health records. It will save paper and time.

What advice do you have for end users at this point time?

Embrace the change!

WEST PARRY SOUND HEALTH CENTRE (WPSHC)

Behind the scenes with superuser Jordan Patten, an Emergency Department Registered Nurse at WPSHC.

At which of the three WAVE 1 sites do you work, and what is your current role?

WPSHC, emergency room nurse.

What motivated you to become a superuser?

Passion for technology and enthusiasm to bring WPSHC up to the 21st century. I have used other EHR systems before and believe due to my previous experience I will be a quick learner and be able to help many users learn the system.

What has your superuser experience involved to date?

I was involved in evaluating the assessment tools put together by the EHR team from all sites. I have been shown the emergency room charting throughout the build process and have been able to give my input when required.

What do you see as one of your biggest challenges at go live, as a superuser?

The biggest challenge I see is the change in workflow and adapting from grabbing an assessment form from the file cabinet to sitting down at the computer and filling out the various assessments. I anticipate there will be many new assessment forms we do not currently use that we will now have access to and have to use. Which is a benefit and a challenge.

SUPERUSER JORDAN PATTENAN EMERGENCY DEPARTMENT REGISTERED NURSE AT WPSHC.



AMBULATORY CARE AND PATIENT PORTAL IMPLEMENTATION PLANNING PROJECT

With a focus on facilitating digital-enabled clinical and system health transformation opportunities, the ONE Initiative is leveraging its One Person, One Record, One System vision to advance the full integration of digital health services across all health sectors. As go live for WAVE 1 Implementation draws near, work on the Ambulatory Care and Patient Portal Implementation project is ramping up.

The scope of the Ambulatory Care and Patient Portal Implementation project is to develop two implementation plans:

• An Ambulatory project plan that expands the WAVE 1 Expanse implementation to include the Wave 1 hospitals’ outpatient programs and clinics, and lays the groundwork for adoption of the Ambulatory module by the WAVE 2 hospitals during their implementation.

• A Patient Portal readiness assessment and plan to support the implementation of a Patient Portal across the WAVE 1 and WAVE 2 hospitals.

The project consists of three distinct phases, each consisting of one or more activities:

1. Discovery

• Establish a Steering Committee with representatives from outpatient services, health records, physicians, privacy and communications across WAVE 1 and WAVE 2 hospitals.

• Hold a kick-off meeting with the Steering Committee to get input and feedback on various aspects such as objectives, schedule, and stakeholder engagement approach.

• Organize software demonstrations to ensure that the Steering Committee has a good understanding of the available features and capabilities.

2. Current State

• Conduct stakeholder interviews and focus groups to get a comprehensive understanding of the ambulatory care current state.

3. Plan Development

• Conduct a workshop with the Steering Committee to obtain their feedback and direction on the project plans.

• Develop ambulatory care and patient portal implementation plans based on workshop outcomes.

The project team is currently recruiting Steering Committee members and is planning to hold the initial kick off meeting late July 2019. The current target is to deliver the plans before the end of the calendar year.

WAVE 2 UPDATEWAVE 2 hospital leaders reaffirmed their commitment to the vision of the ONE Initiative, at a face-to-face meeting in June, in Sudbury. The session was organized to achieve agreement on the process and next steps for advancing the ONE Initiative from WAVE 1 to WAVE 2.

Twenty-three of the 24 region’s hospitals participated in the day-long session; one hospital had its annual general meeting the same day and was unable to attend. The attendees included hospital senior teams and physician leaders, as well as four members of the ONE project management office.

Dr. Tyler Christie, the chief medical information officer at Health Sciences North, provided a demonstration of MEDITECH Expanse and outlined the patient care and physician workflow benefits. Mark Hartman, senior vice-president patient experience and digital transformation at Health Sciences North, provided an update about the hospital’s digital priorities in its strategic plan and next steps.

The attendees worked in break-out sessions to look at ways to approach the financial, governance and time logistics. The group will reconvene in the fall.

A group discussion in one of the three breakout sessions, during the meeting.

JULY AUGUST SETPEMBER OCTOBER NOVEMBER

PHASE 1 Discovery

Kickoff meeting Software Demos

On-site visits On-site visits

Current State Documentation

Plannng Workshop

Development of Plans

PHASE 2 Ambulatory Current State

PHASE 3 Build and deployment Plan Development for Patient Portal and Ambulatory care software



AABS Abstracting

AP Accounts Payable

ADM Admissions

ADT Admission, Discharge, Transfer

AOM Ambulatory Order Management (also referred to as RXM)

AP Consolidated Plan according to type (Appearance in the Assessment and Plan component)

APAP Plan by Assessment (Appearance in the Assessment and Plan component)

APR Ambulatory Patient Record

ARM Authorization and Referral Management

BB/AR Billing and Accounts Receivable

BBK Blood Bank

BCA Business and Clinical Analytics

BF Budget and Forecasting

BH Behavioral Health

BMV Bedside Medication Verification (Barcode technology)

BPCK Branded Pack (Branded Drug Delivery Device)

CCCM Chronic Care Management

CDS Customer-Defined Screen

CLI Clinic Account

CLM Claims (insurance)

CLMM Closed Loop Medication Management

CPOE Computerized Provider Order Entry (also referred to as POM)

C/S Client Server (one of the older MEDITECH platforms, SAH’s old platform)

CWS Community Wide Scheduling

DDR Data Repository

DTS Development Tracking System (MEDITECH's system for tracking code changes or bug fixes)

EECIN Extended Care Information Network (used by Case Management)

EDM Emergency Department Management

EFT Electronic Funds Transfer

EMAR Electronic Medication Administration Record

ETAR Electronic Transfusion Administration Reaction (Barcode technology)

EMR Electronic Medical Record

FFA Fixed Assets

FSV Formulary Service Vendor

GGL General Ledger

GPCK Generic Pack (Generic Drug Delivery)

HHCIS Healthcare Information System

HHT Hand Held Terminal (for inventory management)

HPI History of Present Illness

ACRONYMSHR Human Resources

HRP Human Resources and Payroll

IIAS Internet Access for Staff

ITS Imaging and Therapeutic Services

LLAB Laboratory

LIS Laboratory Information System

MMIC Microbiology

MIIS MEDITECH Interpretive Information System

MIS Management Information System (Central database within MEDITECH)

MM Materials Management

MPM Medical and Practice Management

MUSE MEDITECH Users Software Exchange

NNPR Non-Procedural Representation (Report Writing Tool)

NUR Nursing

OOE Order Entry

OM Order Management

PPCI Patient Care Inquiry

PCM Physician Care Manager

PCS Patient Care System

P-DOC Physician Documentation

PDI Patient Discharge Instructions

PDOC Physician Documentation template

PE Patient Education

PFSH Past, Family, Social and Surgical History

PHA Pharmacy

POV Provider Office Visit

POC Point of Care

POM Provider Order Management

PP Payroll Personnel

PTH Pathology

PWM Provider Workflow Management

QQRM Quality and Risk Management

RRAD Imaging and Therapeutic Services

RCG Revenue Cycle Generation

RCR Recurring Account

REF Referred Account

ROS Review of Systems

RW Report Writer

RXM Prescription Order Management

SSBD Semantic Brand Drug (Ingredient, strength and dose form plus brand name)

SCD Semantic Clinical Drug (Ingredient plus strength and dose form)

SCH Scheduling (Included CWS -Community Wide Scheduling


TRIM & KEEP! TRIM & KEEP!

AU

GU

ST

AUGUST 5 - AUGUST 9, 2019: Test to Live Copy**AUGUST 5 - AUGUST 16, 2019: Train the Trainer at WPSHC

AUGUST 19 - AUGUST 30, 2019: Train the Trainer at NBRHCAUGUST 19 - AUGUST 30, 2019: Train the Trainer at SAHAUGUST 19 - SEPTEMBER 13, 2019: Parallel Run AUGUST 19 - SEPTEMBER 24, 2019: End User Training at WPSHC

Test to Live Copy ends

Trainer training at WPSHC ends

Trainer training at SAH and NBRHC ends

11

4

18

25

12

5

19

26 29

13

6

20

27 30

14

7

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28 31

1

15

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2

16

9

23

3

17

10

24

SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

JULY

MAY 13 - JUNE 28, 2019: Site Review and Signoff of Future State Clinical Workflows (at all three sites)JULY 1 - JULY 12, 2019: Site Review and Signoff of Future State Business Workflows (at all three sites)

Site Review and Signoff of Future State Business Workflows (at all three sites) ends*

14

7

21

28

15

8

1

22

29

16

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30

17

10

3

24

31

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26

6

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27


*May be extended

**The Test to Live Copy is when all the work to date, which is presently in the test environment, is loaded into the live environment in preparation for go live.

SEP

TEM

BER

OC

TOB

ERNOVEMBER NOVEMBER 1, 2019: SAH Payroll Go Live

NOVEMBER 7, 2019: NBRHC Payroll Go Live

SEPTEMBER 16 - OCTOBER 21, 2019: End User Training at NBRHC SEPTEMBER 3 - OCTOBER 21, 2019: End User Training at SAH

WPSHC Go Live

SAH Go LiveNBRHC Go Live

WPSHC – Hospital & EMS - Payroll Go Live

WPSHC – Hospital and

Lakeland LTC - Payroll Go Live

13

6

20

27

14

7

21

28

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29

16

9

2

23

30

3

17

10

24

31

4

18

11

25

5

19

12

26


End User Training at SAH and NBRHC ends

SEPTEMBER 16 - OCTOBER 21, 2019: End User Training at NBRHC

15

8

22

29

16

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10

3

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4

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7

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14

28


There is one Test to Live Copy (versus a test to live copy at each site), as there is one system used by all three sites. After the copy occurs, the team will continue to make revisions in the test system as required and will also ensure the live system is kept up to date.

Parallel Run ends

End User Training at WPSHC ends

SEPTEMBER 3 - OCTOBER 21, 2019: End User Training at SAH

ABOUT THIS NEWSLETTERThis monthly regional newsletter shares some of the many project accomplishments of the ONE Initiative with hospitals in the North East Local Health Integration Network (NE LHIN), to help you get to know the people behind this transformational work. Readers with questions, requests for more information, or submissions for future articles, are welcome to contact the ONE Initiative Communications Lead, at [email protected]

Articles in this regional newsletter may be copied by hospitals participating in the ONE Initiative, with or without, acknowledging the ONE Initiative regional newsletter.

THE 24 NE ONTARIO ACUTE CARE HOSPITALS IN THE ONE INITIATIVE

WAVE 1 hospitals

WAVE 2 hospitals

NE ONTARIO

THE ONE INITIATIVE IS A TRANSFORMATIONAL PROJECT The vision of the ONE Initiative is to improve the delivery of patient and family-centred care through ONE electronic health information system across northeastern Ontario.

The first phase of the project underway is referred to as WAVE 1; it involves North Bay Regional Health Centre (NBRHC), West Parry Sound Health Centre (WPSHC) and the Sault Area Hospital (SAH). The remaining 21 hospitals—WAVE 2—will follow.

ONE stands for one person, one record, one system. The single HIS being implemented is based on common standards and built to meet the specific needs of the north-east region. The patient record that resides in this system will be available to all health providers at WAVE 1 hospitals involved in the individual’s care, at go live in October 2019.

The transition to a single HIS benefits everyone who gives, receives or supports the delivery of care in ONE Initiative hospitals.

EDITION FOUR THE ONE INITIATIVE JULY 2019 NEWSLETTER 2019… · MEDITECH Expanse uses a closed loop...

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Transcript of EDITION FOUR THE ONE INITIATIVE JULY 2019 NEWSLETTER 2019… · MEDITECH Expanse uses a closed loop...