Implementing a Clinical Information System – Strategies for Success

1. Implementing a Clinical Information System – Strategies for Success Helen Edwards RN MN January 26, 2012 PMI – SOC Professional Development Day

2. Outline • Evolution of Computerization at SickKids • Implementing a Clinical Information System • Design • Communication • Education • Go-Live • Post Go-Live • Key Success Factors • Lessons Learned

3. SickKids Hospital

4. Evolution of Computerization • Complex infrastructure - comprises diverse platforms, applications, client devices • Complex and dynamic technological environment with >200 information technology systems/applications in use

5. 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

6. 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

7. 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)

8. 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

9. Implementing a Clinical Information System • Design • Communication • Education • Go-Live • Command Centre • Support • Post Go-Live

10. 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

11. 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

12. 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

13. Informatics Education 3500+ staff 8 Weeks

14. Education and Support

15. Pre - Education

16. Pre – Education Open Forums

17. Pre – Education Open House

18. Pre – Education Open House

19. Pre – Education Open House

20. Education and Support

21. Communication and Advertising

22. Communication and Advertising

23. Communication and Advertising

24. Education and Support

25. 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

26. 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

27. Incentives

28. Original Goal 3500+ staff 8 Weeks • 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

29. Education and Support

30. Go-Live Command Centre

31. Command Center Help Desk

32. Immediate Assistance

33. Communication tools

34. External Support Staff and Super Users

36. Education and Support

37. 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

38. 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

39. 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

40. Lessons Learned Sense ofHumour Essential

41. 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

42. 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

43. 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

44. 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)

45. Questions?

46. Helen Edwards RN MN Director – Clinical Informatics and Technology Assisted Programs Hospital for Sick Children (SickKids) helen.edwards@sickkids.ca • Contact Information