Implementing a Clinical Information System The Role of

Implementing a Clinical Information System – The Role of Informatics Nurses Helen Edwards RN MN Carol Warren RN November 24, 2009

Outline a. Evolution of Computerization at Sick. Kids b. Building a Nursing Informatics Portfolio c. Implementing a Clinical Information System a. Design b. Communication c. Education d. Go-Live e. Post Go-Live d. Key Success Factors e. Lessons Learned

Sick. Kids Hospital Grand Total Planned Beds 274 Clinic Visits 73, 907 Medical Day Care Visits 28, 971 Day Surgery Visits 5, 146 Inpatient Surgical Visits 6, 238 Emergency Visits 54, 580 Discharges 13, 803 Average LOS 7. 3 Patient Days 100, 332 Average Daily Census 274. 9

Evolution of Computerization a. Complex infrastructure - comprises diverse platforms, applications, client devices • Complex and dynamic technological environment with >140 information technology systems/applications in use

Evolution of Computerization cont’d a. 1980 s first clinical information system – home grown system (functionalities included laboratory order entry / results retrieval and dietary order entry) • 1989 Poison Control Centre switches from microfiche to electronic database (electronic charting 1997)

Evolution of Computerization cont’d a. 1992/1993 DOS based system (Kidcom) – ADT, CPOE, e. MAR, some clinical documentation • 1996 Telemedicine launched • 2000 - ICUs – all clinical documentation except CPOE

Evolution of Computerization cont’d a. Other common systems a. PACS b. Scanned historical paper chart c. Schedule Book d. Transcription and Dictation System e. Ambulatory Referral Management System f. e. CHN – EHR g. Surgical Information System h. Emergency Department Information System

Evolution of Computerization cont’d a. 2005 –Kid. Care Phase I (transitioning Kidcom to Windows based system) a. Patient Lists b. Results retrieval b. 2008 – Kid. Care Phase II (transitioning remaining functions) a. CPOE b. e. MAR c. Clinical Documentation (e. g. Admission Assessment, LOA, Discharge Summary)

Our Vision a. Fully electronic patient chart across the inpatient and ambulatory areas a. Progress Notes b. Flow Sheets c. Consents d. Diagrams/Photographs, b. Universal Workstations a. Single Sign-on b. Multiple form factors etc.

Building a Nursing Informatics Portfolio a. Prior to 2003 a. Variety of titles b. Variety of responsibilities c. Variety of compensation strategies d. Little opportunity for specialist-specific professional development b. 2003 a. First Director of Nursing Informatics b. Mandate – build a portfolio

Building a Nursing Informatics Portfolio a. 2007/2008 a. Informatics Nurse – common job description and ranking a. Informatics Nurse – Application Specialist b. Informatics Nurse – Education Specialist c. Informatics Nurse – Workload Specialist b. Currently a. Monthly business/professional development meetings b. Bi-monthly hospital CIT Forum

C. I. T. Matrix Organizational Chart Chief Information Officer Chief – Inter-Professional Practice and Chief Nurse Executive Directors – Clinical Programs Directors/Managers - IS IS a. Mgr – Informatics Education • IN – Application Specialists • IN – Education Specialists Director – Clinical Informatics and Technology Centre for Nursing a. IN – Workload Specialists • IN – Application Specialists • Clinical Technology PM Managers – Clinical Programs a. IN – Application Specialists Direct Reports Matrix Reports

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

Design a. Application and Education Specialists a. Knowledge of practices and processes b. Consultation with clinical departments/ areas and IS staff c. Advocacy / Liaison d. Theoretical perspectives e. Testing – unit, functional, integrated f. Reports

Communication a. Hospital-wide engagement/profile • Steering Committee o o Executive Sponsor Physician Leadership Nursing Leadership Professional Services • Project Team o Diverse membership - Application and Education Specialists – IS and Clinical Programs

Communication cont’d a. Built off of successes of Kid. Care Phase I • User Groups o Nursing, Professional Services, Physicians, Others • Super Users o o Meetings Emails

Communication cont’d a. Hospital publications a. This Week (print) b. Daily News (homepage) • Website o o Kid. Care Countdown

Communication cont’d a. Clinical Program Director meetings • Clinical Program Manager meetings • Nurse Educator meetings • Division/Department meetings o o Medical Professional Services

Informatics Education 3500+ staff 8 Weeks

Education Design a. 3 team leads a. Nursing b. Physician c. Professional Services and Administration • Instructor led class curriculum • Reference material

Education

Pre - Education

Pre – Education Open Forums

Pre – Education Open House

Pre – Education Open House

Communication and Advertising

Communication and Advertising

Communication and Advertising

Communication and Advertising

Communication and Advertising

Communication and Advertising a. Leadership • Nursing • Physician • Professional Services and Administration

Communication and Advertising

Blended Learning Approach a. Computer-based Tutorials (CBTs) a. Mandatory pre-requisite b. General/Basic information c. Decreased in-classroom time d. Staff themselves decided when and where b. Instructor Lead Classes (ILC) a. Complex process or changes in process/ concepts b. To anchor knowledge – provide c. hands-on training

CBTs a. 5 modules a. General b. Order Overview Entry c. Documentation d. e. MAR e. Task Viewer

CBT Agreement Form

Super User Education a. Job Description a. proficient at all functionality on legacy system and Kid. Care Phase I b. recognized ability to lead and support all health care colleagues c. availability to act as a SU during implementation b. Attend Super User training

Original Goal 3500+ staff 8 Weeks a. Outcome: a. Between Sep 4 th and Nov 4 th 3083 staff were trained 585 classes were held 88% of staff were trained by go-live

Go-Live a. Education continued through go-live a. 3 Informatics Educators a. Scheduled and adhoc training b. Ongoing education for existing clinical systems b. 4 Informatics Educators a. Go-live support b. Reference material

Go-Live Command Centre

Command Center Help Desk

Informatics Nurses

Communication tools

External Support Staff and Super Users

Go-Live cont’d a. Daily meetings at 1300 with all clinical managers – get a sense of how staff were doing • Tips and Tricks

Post Go-Live a. Ongoing education • Clinical Applications Resources and Education Support (CARES) • Ongoing communication o o Tips and Tricks Website updates • Kid. Care Duty Officer (KDO) • Stabilize the system for a period of time before making any revisions

Key Success Factors a. Hospital engagement a. Hospital-wide project – ownership b. Go-live day was a “marked event” b. Communication mechanisms a. Countdown b. Posters c. Clinical Managers, Directors, VPs c. Education a. Model b. Daily communication c. CME Credits

Key Success Factors a. Go-Live Support Model a. Command centre b. Super Users c. Informatics nurses d. Hiring skilled activation support resources helped the front-line users tremendously throughout the activation process. b. Post Go-Live Support Model a. Continuing b. CARES training session

Lessons Learned a. Application • Ensure sufficient resources for both the project team and support staff • Cross-train more of the project team members on system configuration • Having one consistent vendor project manager is necessary for continuity

Lessons Learned a. Application a. Changes to a legacy system should be restricted to only those that are critical b. Printing should be tested earlier in the Project

Lessons Learned a. 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 a. Training • Create a mock training environment for educators to practice • Create a practice database for staff to practice after attending training

Lessons Learned a. Communication • Communicate project scope to the users – functionality • Communication mechanism to all relevant project team members re changes and decisions

Lessons Learned a. Support a. Extended activation support should be planned for and acquired (for example, contracted project team members should not be released shortly after activation)

Contact Information Helen Edwards RN MN Director – Clinical Informatics and Technology Centre for Nursing Hospital for Sick Children (Sick. Kids) helen. edwards@sickkids. ca Carol Warren RN Manager – Informatics Education Information Services carol. warren@sickkids. ca