Implementing a Clinical Information System – Strategies for Success
Helen Edwards RN MN
January 26, 2012PMI – SOCProfessional Development Day
Outline• Evolution of Computerization at SickKids• Implementing a Clinical Information
System– Design– Communication– Education– Go-Live– Post Go-Live
• Key Success Factors• Lessons Learned
SickKids Hospital
TOTAL
Planned Beds 274
Ambulatory Visits 217,707
Day Surgery Visits 4,953
Inpatient Surgical Visits 6,506
Emergency Visits 57,561
Admissions 14,590
Average LOS 6.9
Patient Days 100,595
Average Daily Census 276
Evolution of Computerization• Complex infrastructure - comprises diverse platforms,
applications, client devices
• Complex and dynamic technological environment with >200 information technology systems/applications in use
• main clinical apps
• patient management apps
• decision support apps
• interface technology apps
• scheduling and departmental systems
• personal productivity apps
• business services
• network/computing infrastructures
• communication apps
Evolution of Computerization cont’d
• 1980s first clinical information system – home grown system (functionalities included laboratory order entry / results retrieval and diet order entry)
• 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 systems– PACS– Scanned historical paper chart– Schedule Book– Transcription and Dictation System– Ambulatory Referral Management System– eCHN – provincial paediatric EHR– Surgical Information System– Emergency Department Information
System
Evolution of Computerization cont’d
• 2005 – KidCare Phase I (transitioning Kidcom to Windows based system)– Patient Lists– Results retrieval
• 2008 – KidCare Phase II (transitioning remaining functions)– CPOE– eMAR– Clinical Documentation (e.g. Admission
Assessment, LOA, Discharge Summary)
Our Vision• Fully electronic patient chart across
the inpatient and ambulatory areas– Progress Notes– Flow Sheets– Consents– Diagrams/Photographs, etc.
• Universal Workstations– Single Sign-on– Multiple form factors
Implementing a Clinical Information System
• Design
• Communication
• Education
• Go-Live– Command Centre– Support
• Post Go-Live
Design
• Based on user input working with informatics clinicians– Reflect practices and processes– Engage clinical departments/areas – e.g.
responsible for their order sets– Testing – (unit, functional, integrated)
accomplished by users and informatics clinicians
Communication
• Hospital-wide engagement/profile• Steering Committee
– Executive Sponsor– Physician Leadership– Nursing Leadership– Professional Services Leadership
• Project Team– Diverse membership – IS, Clinical
Programs, Other programs
Communication cont’d
• Built off of successes of KidCare Phase I• User Groups - Nursing, Professional
Services, Physicians, Others• Super Users
– Meetings– Emails
• Hospital publications– This Week (print)– Daily News (homepage)
• Website – KidCare; Countdown • Key Leadership Forums – Executive,
Directors, Managers, Educators, MDs
Informatics Education
3500+ staff
8 Weeks
Education and Support
Pre-education
Communication
and Advertising
for Education
Blended Learning Approach
Go-live Post Go-live Support
Pre - Education
Pre – Education Open Forums
Pre – Education Open House
Pre – Education Open House
Pre – Education Open House
Education and Support
Pre-education
Communication
and Advertising
for Education
Blended Learning Approach
Go-live Post Go-live Support
Communication and Advertising
Communication and Advertising
Communication and Advertising
Education and Support
Pre-education
Communication
and Advertising
for Education
Blended Learning Approach
Go-live Post Go-live Support
Blended Learning Approach
• Computer-based Tutorials (CBTs)– Mandatory pre-requisite – General/Basic information– Decreased in-classroom time– Staff themselves decided when and
where
• Instructor Led Classes (ILC)– Complex process or changes in process/
concepts– To anchor knowledge – provide
hands-on training
Super User Education• Job 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
Incentives
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
98% within 6 weeks of go-live
Education and Support
Pre-education
Communication
and Advertising
for Education
Blended Learning Approach
Go-live Post Go-live Support
Go-Live Command Centre
Command Center Help Desk
Immediate Assistance
Communication tools
External Support Staff and Super Users
Education and Support
Pre-education
Communication
and Advertising
for Education
Blended Learning Approach
Go-live Post Go-live Support
Post Go-Live
• Ongoing education
• Clinical Applications Resources and Education Support (CARES)
• Ongoing communication– Tips and Tricks– Website updates
• KidCare Duty Officer (KDO)
• Stabilize the system for a period of time before making any revisions
Key Success Factors
• Hospital engagement– Hospital-wide project – ownership– Go-live day was a “marked event”
• Communication mechanisms– Countdown– Posters– Clinical Managers, Directors, VPs
• Education – Model– Daily communication– CME Credits
Key Success Factors
• Go-Live Support Model– Command centre– Super Users– Informatics nurses– Hiring skilled activation support
resources helped the front-line users tremendously throughout the activation process.
• Post Go-Live Support Model– Continuing training session– CARES
Sense ofHumour
Essential
Lessons Learned
Lessons Learned
• Application
– Ensure sufficient resources for both the project team and support staff
– Cross-train more of the project team members on system configuration
– 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 training
– No grab bags
– Have an admin assistant
– An LMS would help!
– Regular debrief sessions
Lessons Learned
• Training
– Create a mock training environment for informatics educators to practice
– Create a practice database for staff to practice after attending training
– Online Reference Material only – no paper
Lessons Learned
• Support
– Extended activation support should be planned for and acquired (for example, contracted project team members should not be released shortly after activation)
Questions?
Helen Edwards RN MN
Director – Clinical Informatics and Technology Assisted Programs
Hospital for Sick Children (SickKids)
Contact Information
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