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Andrew Hargreaves – Clinical Design Governance Manager
Mina Georgy – Design Lead
eMR Connect Program
Standardised eMeds System
Design
Improving Safety & Quality Outcomes
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Support for Local Health Districts
Design & Build
Safety and Quality
Change and Adoption
Project Management / Vendor Management
System Maintenance
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Promoting Safety and Quality
Detailed consideration must be given to impacts of electronic medical
records on quality of care and patient safety
• eHealth NSW safety principles
– Design a safe system
– Ensure people are equipped and trained to use it safely
– Use the system to improve safety and quality of care
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Clinical Design Governance
EVOLUTION
• Historical, centralised approach
– Longer design and documentation process
– Lack of clinical representation from each Local Health District
– Resulted in single state-wide design, with elements of local deviation
• Adopted a lead site model
– Lead site-led vs design by committee
– Empowerment of local governance structures
– Iterative review vs single development
– Resulted in self-regulating community of practice; a reference model design
with consistency in key areas
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• Promoting standardisation of appropriate design
elements– Promotes patient safety and quality of care
– Reduces inappropriate / unwarranted clinical variation
– Reduces re-training liability
– Reduces repetition of design activity
• Clinical risk management
– Managing the risk associated with variance
Delivering Safety and Quality
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Delivering Safety and Quality
• Stakeholder-led clinical governance frameworks
• Clinical leadership and engagement
• Considering impacts of eMR design and
implementation on– Patients
– Clinical staff
– NSW Health and LHD Policy and Legislation
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GOVERNANCE MODEL
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LHD-led group of application specialists and all project teams
Quality & Safety Experts, NSW Health Pillars and other Reference Group reps
Senior Executive and Senior Executive Clinicians across LHDs and NSW Health Pillars
Clinicians and NSW Pillars reps supported by application specialists
Design Assurance Governance Groups
AAGs
Clinical Ref
Groups
SQAG
eMR Connect SC
Consider impact and risk management recommendations, accountable for decisions
Develop vendor agnostic principles / standards, provide clinical validation of workflow
and design
Develop solution specific standards, oversight of solution design decisions from a
state perspective, manage operational governance
Peak safety and quality body, provide advice to Steering Committee on safety and quality
and clinical risk management, oversight of quality and safety impact assessments
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eMeds Design Standards
DEVELOPMENT PROCESS
Proposed Standard
Interim Standard
Final Standard
• Developed by clinical reference groups
• Reviewed and approved by clinical design governance process
• Optional for implementation in new and existing sites
• eMR Connect SC approve a standard as ‘Interim’
• Regular review cycle to optimise
• Required to be implemented in new sites; optional for existing sites
• Following successful implementation in a number of sites, standard approved as ‘Final’
• Regular review cycle• Required to be
implemented in new and existing sites within 1 year of publication
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Justice Health Network
eMR Connect – NSW Footprint
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System blueprint for all Cerner implementations
Detailed future state process flows based on common lead site workflowsWorkflows
Documentation of lead site design decisionsConfiguration Decisions (DDMs)
Including documentation of detailed design guidance
Data and Build Content (DCWs)
NSW Design Specifications and Custom DevelopmentsDetailed design specifications for NSW specific build, e.g. prescription output,
downtime MAR etc.
eMeds / eMR Crossover and Integration PointsDocumentation of prerequisite eMR components and
associated design
eMeds Reference Model
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STRENGTHS
• Increased adoption of design
• Sites using solutions earlier
• Encourages diversity
• Access to a large number of
clinicians
Implementations in Federated System
CHALLENGES
• Permits divergence
• Duplication of effort
• Increased maintenance
• Governance is difficult
Multiple layers required
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Building on PartnershipsCLINICAL DESIGN
FOCUS GROUPS
Western Syd
CEC
NS / CC ACI
• Clinical Excellence Commission (CEC)
• Agency for Clinical Innovation (ACI)
NSW Health Pillars
• Senior Clinicians
• Project teams (application specialists, BAs)
• End users
Local Health Districts
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Design Principles
User CentredConsistency &
Simplicity
Iterative
DevelopmentUsability Testing
Evaluate &
Feedback Early
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Design
MethodologyGATHER REQUIREMENTS
DESIGN FOR USABILITY
EVALUATE
FEEDBACK
BUILD & DEPLOY
• Identify users
• Analyse user needs and scenarios
• Develop business & functional requirements
• Conceptual designs
• Detailed designs
• Evaluate early and continuously
• Measure usability, business &
effects
• Suggestion for changes
• Project planning based
on the outcome
• Iterative development
• Continuous focus on users and usability
• Usability testing & monitoring
PRIORITISE SCOPE
• Identify Business Objective
• Initial Concept
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Insulin
Paper
Chart
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Available Functionality
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Iterative PrototypingEARLY CONCEPTS
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Iterative Prototyping
INITIAL
WIREFRAME
(FEB 2016)
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MARCH 2016
Iterative Prototyping
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APRIL 2016
Iterative
Prototyping
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MAY 2016
Iterative
Prototyping
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JUNE 2016
Iterative
Prototyping
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FINAL
DESIGN
JULY 2016
Iterative
Prototyping
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WHAT WORKED WELL?
• Collaboration between eHealth NSW, LHDs and Pillars
Knowledge domain experts own design
Leveraging resources / expertise across LHD and eHealth NSW teams
• Broad stakeholder engagement across several clinician groups Clinician led – doctors, nurses, pharmacists represented
Usability testing
High level of clinical engagement
• Requirements gathering and design Design based on clinical business requirements rather than on current paper forms
Wider eMR touch-points identified early
Rapid prototyping and high visibility of progress allows for timely change
Lessons Learned
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WHAT CAN WE IMPROVE?
• Project management
Clearer agreements around scope, resources and timelines
Dedicated project management resources
Shared access to repositories
• Stakeholder engagement Group membership continued to grow/change throughout project
Not all clinicians groups present at each meeting
Engage actual system users much earlier in the project
• Requirements & Design Dedicated resources for rapidly prototyping wireframes and design concepts
Engage Human Factors experts and conduct usability testing much earlier in project
Lessons Learned
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Summary
• Standardisation is key to improving safety & quality in system design
• A clinical risk management methodology is required for difficult decisions
• A state-wide clinical governance framework facilitates appropriate decisions
& recommendations
• Standardisation in a federated environment is not without its challenges
• Creating meaningful partnerships with LHDs is critical to adoption
• Establishing speciality focus groups and applying best practice design
principles ensures state solutions meet clinicians needs
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