hugo e Huddle 3 Healthcare Undergoing Optimization hugo

hugo e. Huddle #3 Healthcare Undergoing Optimization

hugo will transform our world “We do not need magic to transform our world. We carry all of the power we need inside ourselves already. ” - J. K. Rowling Healthcare Undergoing Optimization

Participating Hospitals Healthcare Undergoing Optimization

What is HUGO? Healthcare Undergoing Optimization … optimizing patient safety and supporting continuous quality improvement. There are four elements to HUGO: 1. Computerized Provider Order Entry (CPOE) 2. Electronic Medication Administration Record (e. MAR) 3. Closed Loop Medication Administration (CLMA) 4. Electronic Medication Reconciliation (e Med Rec) Healthcare Undergoing Optimization

HUGO benefits Improved Access through decreased turn around time Improved outcomes through standardized evidence-based care Decrease medication errors Meet ROP Accreditation Standards Improved compliance with medication reconciliation Reduction in duplicate orders Improved communication Improved antibiotic therapy Improved trending and reporting of quality indicators Healthcare Undergoing Optimization Reduced HSMR

Agenda • October in Review • HUGO Events – System Review and Design Review – Key Dates • • HUGO Leads/SMEs Engagement Order Set Update Devices Update Q&A Healthcare Undergoing Optimization

October in review • Clinical workflows: Clinical areas, which were engaged throughout the summer month, wrapped up documentation of current state work flows. • Physician “shadowing” studies conducted across HUGO hospitals to better understand physician current workflow and will continue • Physician information sessions continue at HUGO hospitals. • Vendor transition to Cerner leveraging 2012 code • Benefit Evaluation Framework and metrics in progress Healthcare Undergoing Optimization

Agenda • October in Review • HUGO Events – System Review and Design Review – Key Dates • • HUGO Leads/SMEs Engagement Order Set Update Devices Update Q&A Healthcare Undergoing Optimization

System Review Event 150 – 230 attendees each day Healthcare Undergoing Optimization

System Review Event At the System Review Event Nov 6 – 8, we began the clinical integration design work! Objectives: • • • Demonstrate solutions using Cerner demo environments Provide initial application education Review our progress to date Establish context for information gathering materials Identify and discuss clinical workflow integration topics Organize assignments and discuss next steps Healthcare Undergoing Optimization

What we learned… • Clearly define who should be at the event – Skill set – Previous participation • Do not forward/delegate appointments – We need to manage numbers/logistics • Provide dates as far in advance as possible – Have all dates until go live • Save the Date – Meeting details will be ~ 8 weeks ahead • Refine participation list Healthcare Undergoing Optimization

System Review: Comment “Just finished up the HUGO system review and my head is actually spinning with all the possibilities!! … seemingly very simple functions that we (the lab) will be able to use in conjunction with CPOE to make our lives, the physicians’ lives much better, and most of all the patients’ lives will be safer. ” “A useful feature is that the lab can in fact send a comment directly to the physician’s message centre. So if we have a test result that we think may be a false positive … we can simply put our concerns directly into the most appropriate message centre. ” Healthcare Undergoing Optimization

What’s Next: Design Review event will be held January 15 - 17 with a focus on: • Automating the workflows (Provider, Clinician Pharmacy, Ambulatory etc. ) • Integrated design sessions • Completing the design for each workflow Healthcare Undergoing Optimization

Key HUGO Dates Event Date Avg. Duration October, 2012 30 days Project Review / System Review 11/5/2012 3 -5 days Remembrance Day US Thanksgiving 11/12/2012 11/22/2012 HUGO project Transition Order Set Workshop 11/26/2012 3 -5 days Meds Process Workshop 12/10/2012 3 -5 days US & Canadian Christmas Canadian Boxing Day New Year's Day Design Review Device Fair Leading Strategic Change 12/24/2012 - 12/25/2012 12/26/2012 1/1/2013 1/14/2013 3 -5 days Early - Mid February 2 -4 days 2/11/2013 2 days Family Day 2/18/2013 Workflow Localization - Nursing/Ancillary 3/4/2013 March break Workflow Localization - Provider Easter & Easter Monday 3 -5 days 3/11/2013 -3/16/2013 3/18/2013 3 -5 days 3/29/2013 - 4/1/2013 14

Key HUGO Dates Event Date Avg. Duration System Validation 4/8/2013 3 -5 days Test Script Writing (Unit, System, Integration) 4/15/2013 4 weeks Unit Test 5/6/2013 4 weeks Victoria Day US Memorial Day 5/20/2013 5/27/2013 Trainer Go-Live Prep 6/3/2013 3 -5 days System Test 6/10/2013 6 weeks 15

Key HUGO Dates Date Avg. Duration (days) Maintenance Training 6/24/2013 3 -5 days Canada Day US Independence Day 7/1/2013 7/4/2013 Internal Integration Test 7/22/2013 5 days Integration Testing #1 7/29/2013 5 days Canada Civic Holiday Labor Day 8/5/2013 9/2/2013 Internal RDDS Integration Test #2 9/9/2013 5 days Integration Testing #2 9/16/2013 5 days Canada Thanksgiving 10/14/2013 Go-Live #1: St. Thomas Elgin General Hospital 10/21/2013 Event 5 days 16

Agenda • October in Review • HUGO Events – System Review and Design Review – Key Dates • • HUGO Leads/SMEs Engagement Order Set Update Devices Update Q&A Healthcare Undergoing Optimization

Local HUGO Leads/SMEs Engagement • What will continue: – HUGO Core Team supports and engages HUGO Leads/SMEs on regular basis: • Participating and giving feedback on design and risks • Providing data to HUGO team on a timely basis • Workflow, testing, training localization – HUGO Core Team supports and gives due dates for deliverables • What will be new: – Terminology will change – DDM (Design Decision Matrix), DCW (Data Collection Workbooks) etc. – Communication and meetings set around key events, milestones and deliverable dates Healthcare Undergoing Optimization

Local HUGO Leads / SMEs Engagement Month Activities December • Wrap up any incomplete current state work • Open House training and test scripts • Review decisions related to DDMs and assist with DCWs as requested by HUGO team • Assist with set up of Order Sets Orientation and Preparation • Information email on device selection will be sent out including preliminary device estimates January • • Continue with Open House scripts, DDMs and DCWs Assist with Order Sets development as needed Share information on devices and educate team Work with Change Consultant to develop and implement influence strategies for increasing engagement in work to be done Healthcare Undergoing Optimization

Local HUGO Leads / SMEs Engagement Month Activities February • Continue with DDMs and DCWs, Order Sets as needed • Participate in Device Fairs and share information • Continue work on implementing influence strategies March • Workflow Localization Workshops • Continue with DDMs, DCWs and Order sets as needed • Start device walkthroughs April • • Continue workflow localization activities System validation Device walkthroughs Identify influence strategies for system adoption Healthcare Undergoing Optimization

A Word on Backfill in London For System Review and Order Sets Workshop: • Submit request for backfill by December 10 to Andrea Kemps (Funding will apply for direct care providers only and would not apply for NPs, educators, etc. who do not require backfill) • At LHSC approved time will be coded to HUGO cost centre (HUGO will provide cost centre to operational unit) • At St. Joseph’s staff will paid by their operational cost centre and finance will reimburse the operational cost centre (HUGO will submit approved names to finance) For future events such as Design Review: • Each site will have a defined number of eligible funded positions • Attendees eligible for backfill will be defined in advance Healthcare Undergoing Optimization

Agenda • October in Review • HUGO Events – System Review and Design Review – Key Dates • • HUGO Leads/SMEs Engagement Order Set Update Devices Update Q&A Healthcare Undergoing Optimization

hugo Order Set Process Healthcare Undergoing Optimization

Order Set Design • • Order Set Build Team in place Following a 7 -step Order Set Process About 150 order sets to be built in CPOE for launch Common order sets will be assigned to individual hospitals to lead the review of existing order sets and gaps and prepare draft order set • All hospitals, all clinicians and physicians, will have opportunity to review draft order sets before finalizing • 80% to be built in Zynx by early March 2013 Healthcare Undergoing Optimization

Which Hospital, Which Order Set? Order sets will be assigned to HUGO hospitals • Based on existing order sets, eg PPOs in place, • Based also on specialties, eg cardiology Lead hospital task: • Put together small team 3 – 5 people (eg. Pharmacist, physician, labs, DI, NP, RN, Allied Health, frontline leader, etc. ) using checklist from tool kit to guide membership • Review current order sets from all ten participating hospitals (will be provided) • Identify gaps • Prepare order set draft for HUGO Build Team (paper format is ok) Healthcare Undergoing Optimization

Getting Started The order set build team is currently reviewing all order sets to be developed by specialty. The build team will contact HUGO leads at the appropriate unit and hospital to assign order sets. You can expect to hear by Dec. 14, 2012 Healthcare Undergoing Optimization

HUGO Build Team is here to help • Will be reaching out to all teams and hospitals • Will provide order set toolkit and orientation • Will provide guidance as you work through process Ready to start but haven’t met with Build Team? Contact Andrew Nemirovsky 519 -685 -8500 ext. 64094 Healthcare Undergoing Optimization

Order Set Design Process: 7 Steps Step 1 Order Set Orientation for Lead Hospital with HUGO Build Team • Review current order sets and other source materials • Identify gaps • Prioritize order sets for development • Develop action plan to meet timelines Step 2 Interdisciplinary preparation of common order sets by Lead Hospital • Clinicians agree on program’s order sets scope • Collaborate with other programs where order set development overlaps • Utilize order set guiding principles • Use checklist to ensure stakeholder engagement • Prepare order set draft for HUGO Build Team Healthcare Undergoing Optimization

Order Set Design Process: 7 Steps • Initial build by HUGO Build Team based on order set information provided in Step 2 • Consider updated evidence (Zynx, Health Sciences Libraries, RNAO Best Practice Guildelines) • HUGO Build Team incorporates opportunities for standardization Step 4 • Interdisciplinary/interorganization review of first Stakeholder review draft order sets posted to View. Space of order sets by ALL • Provide feedback to HUGO Build Team within hospitals specified time period Step 3 Order set: First Draft Step 5 Order set: Second draft • Content experts and HUGO Build Team review feedback • Consider updated evidence (Zynx) • Finalize second draft order sets Healthcare Undergoing Optimization

Order Set Design Process: 7 Steps Step 6 • Pharmacy (P&T/DTCs), Labs/DI, and Order set finalized & Professional Practice validate second draft clinical validation order sets • Physician and Clinician Advisory Committees review and provide final feedback to HUGO Build Team for common and admission orders (i. e. linkable modules used across all facilities) • HUGO Build Team finalizes order sets for approval process Step 7 Approval process (unique by organization) • Order set ratified by Physician Advisory Committee (including appropriate MAC advisory/subcommittees) • Recommendation for approval forwarded to MAC and the Thames Valley Chiefs of Staff Healthcare Undergoing Optimization

Order Set Tools • Orientation to order set design and toolkit by HUGO Build Team • We’ll be posting list of hospitals and their order sets work to our HUGO website later this month. • Zynx Health contains a repository of over 1, 000 order sets and supports the development of evidence-based order sets Healthcare Undergoing Optimization

Agenda • October in Review • HUGO Events – System Review and Design Review – Key Dates • • HUGO Leads/SMEs Engagement Order Set Update Devices Update Q&A Healthcare Undergoing Optimization

What’s next: Device Strategy • RFP for Workstation on Wheels (WOWs), hand held devices, and wall mount devices posted mid November. Responses due from proponents by Dec. 10. • Windows desktops, laptops and tablets will be considered using our existing vendor agreement. • Watch for Device Fair in February. • Detailed device validation walk through activities will occur after the device fair and workflow localization beginning in March/April 2013. Healthcare Undergoing Optimization

Questions? ? ? Healthcare Undergoing Optimization

For more information HUGO Executive Sponsor: Robin Walker, MD HUGO Project Sponsor: Heather Tales, RN, MN HUGO Program Manager: Heather Pilkington, Ph. D. , P. Eng HUGO Regional Program Manager: Marg Kampers, PMP, CHIM HUGO website: link from intranet homepage E-mail HUGO: hugo@lhsc. on. ca Healthcare Undergoing Optimization