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We Didn’t Know What We Didn’t Know

We Didn’t Know What We Didn’t Know. Presented by Sarah Foster, RN, BSN, SANE-A. April 22, 2013. Define change and how transition is a vital component Compare this change process to other examples Review the process of changing to a new Electronic Health Record (EHR)

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We Didn’t Know What We Didn’t Know

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  1. We Didn’t Know What We Didn’t Know Presented by Sarah Foster, RN, BSN, SANE-A April 22, 2013

  2. Define change and how transition is a vital component • Compare this change process to other examples • Review the process of changing to a new Electronic Health Record (EHR) • Discuss what we didn’t know • Discuss the impacts to end users • Questions and answers

  3. How to identify the need for a New EHR • Establish criteria to evaluate success of new selection • Identify and acknowledge what we didn’t know • Identify steps to continue successful forward movement

  4. Changevs. Transition Change vs. Transition What Do We Want in a New EHR? Change Transition • External Process • Situational • Internal Process • Occurs within Change Phases: • Let go of the Old • Neutral Zone • A New Beginning

  5. Multiple campuses, multiple organizations, multiple departments, and multiple stakeholders Multiple charting IT systems throughout organization and campuses Multiple complex and non-integrating workflows Pre-Change Status

  6. What Do We Want in a New EHR? Primary Reasons: • Increase patient safety • Increase quality patient care • Monetary returns from meaningful use Other Benefits: • Discrete data elements • Patient integration and increased • continuity of care • Increased readable and precise • documentation

  7. Vendor Selection November 2010 – Vendor announced • Expedited Roll Out • Ambulatory go-live May 2012 • Hospital Inpatient go-live August 2012 • Timeline over 5 Phases • Planning • Validation • Building • Testing • Go Live

  8. Phase 1 - Planning • Finalize scope • Vendor breaks program into applications • Recruit project champions, Core Team (Analysts and Trainers), Subject Matter Experts • Committees formed with representatives from all entities – TNMC, UNMC Physicians, BMC, Private Practice Associates

  9. { Guiding Principles • Patient First • No compromising Quality and Patient Safety • Adhere to Model System • Standardize Practice (evidence based and best practice • Standardize Data • Computerized Physician Order Entry • Ease of Use • Interoperation and availability of data with a common enterprise work process • Patient care, Education & Research

  10. What We Didn’t Know • How fast 18 months can fly by • How many workflow Visio’s would need to be created and modified • How to direct people to start visualizing a new product different from their known and what impact that would have on so many

  11. Phase 2 - Validation • Breakout sessions with specific applications to look at specific workflows • Create interdisciplinary/inter-affiliate task groups to help recommend decisions in alignment with guiding principles • Certification of core team in the vendor’s product • Contract with outside consulting group to help with Order Sets, Care Plans and Patient Education

  12. What We Didn’t Know • How hard it is to get all affected parties from different campuses all in the same room at the same time (literally or by conference phones) • How hard it is to visualize a new workflow that we are conceptualizing with a computer system many still know little about • How many times Visio’s would circle around and have to be recreated and revalidated

  13. Phase 3 - Building • Build/Modify necessary components from model system • Hardware analysis, reports • Training plan solidified • Branding – One Chart

  14. What We Didn’t Know • One Chart – It Changes Everything! • How hard it would be to keep deadlines • The 80-20 rule does not fit all – especially when you have a team of high achievers and you work in healthcare • How many moving pieces there are and how people cannot “silo” themselves in applications

  15. Phase 4 – Testing and Training • Go-live Readiness Assessments • Interim Workflows • Credentialed Trainers chosen for the Outpatient applications • Operational Dress Rehearsals (ODRs)

  16. What We Didn’t Know • ODR’s – It matters who is in the room • Training – one size does not fit all

  17. Phase 5 – Go Live & Optimization • A New Beginning • Outpatient Ambulatory First • Inpatient 3 months later • Support • Tickets, Tickets and More Tickets • Post Live Feedback • Information Management Structure

  18. What We Didn’t Know X • Olympic Torches have a flame for a reason • Post live feedback • The New Look of IT • How to say Good bye to the old X

  19. Phase 6 – Optimization and Rollout • New Faces • New Projects • More Change

  20. What We Didn’t Know • How long the marathon really is • How many components of a new leadership structure are necessary

  21. What We Have Learned • Perfection is the enemy of good enough • Go Live is not the final step • A new language of Healthcare • It is not always easy to do the right thing, but that is what we are here to do

  22. How Did We Impact End Users

  23. Questions?

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