Clinical Informatics Its Our Time 2014 Clinical Informatics

Clinical Informatics: It’s Our Time! 2014 Clinical Informatics Academy Sponsored by DFW ANIA Chapter October 10 -11, 2014 We are Live…now what? Sustaining the EHR Barbara Carrizales, RN MS Managing Director, National Clinical Informatics Tenet Healthcare 1

Conflict of Interest Disclosure Barbara Carrizales, RN MS has no real or apparent conflicts of interest to report. 2

Session Objectives � Describe the post-live sustainment model used to maintain EHR adoption and provide care and feeding of the EHR � Present a sustainment measurement tool � Provide examples of successful use of sustainment approaches in the hospital setting 3

Tenet Spans 16 States in Many Settings Michigan 8 Hospitals 9 Outpatient Pro. Care Tennessee Illinois 12 Hospitals 36 Outpatient Golden State Health Plan 2 Hospitals 6 Outpatient 4 Hospitals 4 Outpatient Chicago Health Plan 2 Hospitals 3 Outpatient N. Carolina 2 Hospitals 3 Outpatient 2 Hospitals 4 Outpatient Arizona S. Carolina 5 Hospitals 10 Outpatient Georgia New Mexico 5 Hospitals 15 Outpatient 2 Outpatient Alabama Texas 197 Outpatient Centers 6 Health Plans 3 Hospitals 4 Outpatient Pennsylvania Missouri 80 Hospitals 4 Hospitals Massachusetts California 6 Hospitals 4 Outpatient Abrazo Advantage Health Plan Connecticut (LOI) 19 Hospitals 63 Outpatient Valley Baptist Health Plan 1 Hospital 5 Outpatient Mississippi Florida 10 Hospitals 28 Outpatient 1 Outpatient 4

Installation vs. Adoption Installation Adoption Focus on user training Focus on user adoption Focus on go-live event Focus on long term sustainment and value realization Focus on go-live success factors Focus on embedding new processes and work flows and continuous improvement Installation Go-Live Event Adoption and Sustainment Post Go-Live Benefits 5

Sustain Protocol: Elements and Outcomes � How does the hospital sustain and improve EHR benefits post-live? Sustain Protocol Elements Outcomes Roles & Responsibilities Ownership Governance & Committees Accountability Change Request Management System Usability Standardization Managers’ Toolkit Optimization 6

Roles and Responsibilities To Promote Ownership 7

Hospital Key Roles and Committees � � Roles ◦ Executive Sponsor (Steering Chair) ◦ Chief Nursing Officer (CPIC Chair) ◦ Clinical Informatics Director ◦ MU Coordinator ◦ Physician Champion Informaticist ◦ Information Systems Director ◦ Health Information Director (HIM) ◦ Training Lead ◦ Pharmacy Informaticist Committees ◦ Steering ◦ Clinical Process Improvement Committee (CPIC) ◦ Physician Advisory Group ◦ Meaningful Use Committee 8

Key Sustainment Roles and Objectives � IMPACT Hospital Sponsor ◦ Chairs Hospital Steering ◦ Chairs Meaningful Use Oversight Committee ◦ Consults CI Director and VP Applied Clinical Informatics on clinical system replacement, upgrades and new purchases ◦ Principal IMPACT communicator ◦ Allocates training resources for new hires, new physicians and system upgrades � Primary Objectives ◦ Achieve Meaning Use – Federal and Tenet targets ◦ Allocate resources to support ongoing IMPACT operations ◦ Provide visible support of IMPACT and Sustain Protocol 9

Key Sustainment Roles and Objectives � Chief Nursing Officer ◦ Chairs the Clinical Process Improvement Committee (CPIC) ◦ Communicates key advisory team decisions ◦ Participates in Hospital Steering and Meaningful Use Oversight Committee ◦ Establishes initiatives to improve Meaningful Use, quality metrics and process improvement ◦ Facilitates change request approvals � Primary Objectives ◦ Promotes interdisciplinary collaboration and alignment ◦ Ensures workflows, downtime and other policies and procedures are up-to-date ◦ Ensures department heads follow up on compliance issues ◦ Monitors continuous improvement action plans 10

Key Sustainment Roles and Objectives � Physician Champion ◦ Chairs Physician Advisory Group ◦ Serves as principal communicator and EHR advocate with physicians ◦ Increase physician adoption and utilization of EHR and CPOE ◦ Participates in Hospital Steering, CPIC, and Meaningful Use Oversight Committees � Primary Objectives ◦ Achieve physician adoption of technology ◦ Serve as the voice of physicians in system changes ◦ Engage physicians in ongoing order set evolution 11

Key Sustainment Roles and Objectives � Training Lead ◦ Keep training materials and collateral up-to-date ◦ Track delivery of training for new staff and physicians ◦ Manage training for system upgrades and releases ◦ Monitor training effectiveness ◦ Participates in CPIC ◦ Member of the super user group � Primary Objectives ◦ Ensure staff and providers are trained to perform their work using IMPACT 12

Governance & Committees To Promote Accountability 13

Key Sustainment Committees � In order to maintain visibility and awareness of EHR adoption, utilization of CPOE and compliance with Tenet Clinical Standards, the following committees are in place to communicate progress and opportunities for improvement and provide forums for interdisciplinary information exchange and organization decisionmaking ◦ ◦ ◦ Hospital Steering Committee Clinical Process Improvement Committee Meaningful Use Oversight Committee Physician Advisory Group Super User Group 14

Key Hospital Sustainment Committees � Hospital Steering Committee ◦ Ownership by hospital executives ◦ Resource allocation to support the EHR ◦ Attainment of MU and quality targets � Clinical Process Improvement Committee ◦ Clinical system change requests ◦ Actions to improve MU and quality compliance Meaningful Use Oversight Committee � Physician Advisory Group � ◦ Physician change requests ◦ Order set and decision support review and evolution � Super User Group ◦ Training new staff and supporting new releases and functionality 15

Change Request Management To Promote System Usability & Standardization 16

Clinical Application Change Request Management � Guiding Principle ◦ Changes are made system-wide (all hospitals) � Vetting ◦ Clinical informatics director is the gatekeeper at the hospital ◦ Clinical Process Improvement Committee must approve (requires interdisciplinary review) ◦ Change requests reviewed regionally � Design and Approval ◦ “Standards” clinicians design change with end user input ◦ Clinical advisory teams and Change Control Board approve to implement � Implementation ◦ Change is built and scheduled for testing and moved to production with CI input 17

Tenet Manager Toolkit To Promote Optimization 18

Tenet Managers’ Toolkit � Role of the Manager Changes with Automation ◦ Tools employed in supporting the manager to drive behavior changes based on evidence and metrics � Application Tools Employed ◦ Standard Reports – examples: Census, Orders by Unit/Shift ◦ Report Writing Tools for ad hoc reporting – example: CPOE Utilization, Medication Reconciliation, Allergies � Metrics ◦ Examples: Barcoding for Medication Administration, Abnormal blood glucose levels, e. MAR overdue schedules � Monitoring and Feedback Mechanism ◦ Review at Clinical Process Improvement Meetings ◦ Review with individual end users as applicable 19

How it all fits together 20

The Sustainment Score Card Measuring Hospital Sustainment Health 21

Sustainment Score Card Questions Sample results shown for illustrative purposes for multi-facility organization 22

Sustainment Score Card Results Sample results shown for 10 hospitals 1 2 3 4 5 6 7 8 9 10 Green = 0 vacancies/deficiencies Orange = 1 - 2 deficiencies Red = 3 or more deficiencies 23

Remediation Actions � Regional Clinical Informatics Director discusses results with hospital sponsor and formulates remediation plan ◦ Leverage best practices from other hospitals ◦ ◦ �Visits �Mentoring from peers Allocate resources to fill vacancies Restart or re-energize committees Educate super users and managers Etc… 24

Lakewood Regional Medical Center � Steering and CPIC in place – keeps leaders engaged and informed ◦ CPIC maintained as decision-making and approval body ◦ Sub-groups employed to propose solutions ◦ Physician Champion active and engaged � Informatics Team centralized – CI, MU Coordinator, Pharmacy, Training Lead ◦ Promotes collaboration and open communications ◦ Provides a common place for issue presentation, discussion, and resolution for different departments 25

Lakewood Regional Medical Center � Strong working relationship with IT ◦ Issues management ◦ Trending � End Users are kept informed and supported ◦ At the elbow support ◦ Monthly night rounding ◦ IMPACT as standing agenda in staff meetings � Collaborative directors relationship with department ◦ Facilitates communication of new initiatives, issue resolution, and workflow changes 26

Contact Information � Barbara Carrizales, RN, MS ◦ Managing Director, National Clinical Informatics ◦ Tenet Healthcare ◦ Barbara. carrizales@tenethealth. com 27

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