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Maurer, C. (20121.Recuperado de la
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Project HUGO at LHSC:Leading Urgent Change In Healthcare.base de datos de Richard lvey Schoolof Business (041471)
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PROJEGT HUGO AT LHSC: LEADING URGENT CHANGE INHEALTHCARE
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On lhe moming of Se'ptanba 6, 201 l, Susaa lohsoa tmk a deep bred as she entercd &c @iqg lot ofthe l,ondon Hcalth Scieace C€ffio (LHSC]. StF bad just lsrrtrftod her children into a new school ycar.Johnson smiled as she rocalled the excitemcnt and tuticipnticr on dreir faces at their fiestr stryt bsck toschool. I{er smile lessend s her thougtts hrnd to the monumenal obange laadership task th layahead. Todry would hiag a public announcanent by the senior mranagcmd tqm &at'het''Pr,ojectHUGO would be live in all LHSC hospitab by Apr{I2013.
Jo'hrson was fre direcCIr of Pharriaoy Scrviccs at IJISC. Over tbc past y€ar, sbo hed bean planning forthp launch and implcmentation of Projec't IIUGO, an acrqnym for Healttnse Un&rgoing OptinizationHUCO would bc one of the nrost Gompl€x, ercpemive aod cballenging projccs wer undcrtakel by thchospihto in London and region. HUCO wsuld tusform the nay Garc was deliverc4 from parntregistratioa to pdient dischalge. Whcn fully implemcgbd, the physicians, nur!€6 md otha healthcar€provid€'ls rvould be using a fiilly eleefronic pstimt reoord (EPR) in place of tlie current pryer-basedeystEm d all Inndon horyihls and thp nine smallor regirmal bepials that paftered with LHSC.
Johnson knew that HUGO would ffig some opemtional sffioiemcy, but fts main ratisralc fm the projectwas to ensure patient saftty and grnliry of care. 'HUCiO was ultini&ly about prcveltring ntedical errorsand savrng lives. She also kncw tbat the implmetrtation of HUGO would bc very challcngrn& includingthe risks ofnmning over budg4 rnissingdeadlines and not getting,ev€ryone on lxxrd.
Jtst fte prcvious w€€k, in6e Hluray, slr had nm ino a plXnician whom *re had though wauld havebeen a suppor&r of HUGO. Yet, surpisingly, lhc Sysician had scated, "Susart" I believe that ws will haveelectronic order entry very soo& hrt you know, I will never entet my own ord€rs, My secretry will dothis for me. lon not a d& atry oledc"
Johnson knewtlrat divrrtirg thls process to clerical strfrwould dilqtr the geins in safgty. She also recalleda conversation witrr &e den of the medical school who hld stded unequivocdly thd by introducingelcctrsnic otdcr Grfiry, ln€dical sfud€ob uould not lann bow to p'r.cscribe ordqs and prop€rly care for
Fagq 2 9HIGO3E
patiens. *Thit is 'coo&book' medioiae,'the dea had sai4 "I trcat my pfu ar individuals.Standadimtion will not work!"
THE GLOBAL HEALT}ICARE D{DU8TY AilD THE ]IEED FORC}IA}IGE
Tho glohal hoattkre idustry provkted heafthcare senices and producc, inchding mcdicel quipncent,snd bioteobnslory. Scrviceg could be brosdly &viOeO into noapiU astivitiss, moCicald dental practice; and other mcdical swice, such a those dcliverGd bV register€d diaicius and
optometisb' In mury cu.rntbs, hcalthca,e was ons of the largect industies and ofun one of lte mostineffisiqrL In mgsry cournrtes, bealthoare consurned.about l0 p* cent of grss domcstio prodtrct (GDp]
Although hml&carc spending abaoftcd nsre thn US$I.? biltioo pff ycat in the Unitsd Strbs aild morcthm C&S175 blllion in Cansda' prcnatrre rnortatiry in Nqth Anerica remained higher tan in mnyother &vcloped munties. Msst medical recsds were still stored on papor, whhh preeluded ltecoordination of care or routin€ measurencfi .of qrntity, ad oflea ted to crttical, ofteo fant, nedicalerron. Recsrt media reporb had highligbfcd the tragic corucqu€noes of,mdical erron:
, *D€a6s of 3 Babies in Indiana Spodight Mcdication Mix-ups" - Sasran Glabe, SWembq 23, 2006. lQuaids Sue Blood-thinncr Manufrctrer', - Lw Angeles ?ilnel, Dec S,?AO7. 'Heparia ovsdoses Hit Babi€s in To<as Hospital' - vau street Jaur.nal,July 9, 200g. "3 PhihdelphiaInfaGDicAftrMix-upatHospitalPhnmqy''- Phtlefuhia lryuir*,Jurw l9.ql0. *Iwo Die in Hospicl Dialpis Mu.-Up" -Natiorutlpast,
March 19, A004. *Hospibl Enor, Wonnaa Di€d'*rBC, Wedaesday, April 4,?ffi1
In addition to these alffsdng media reports, the asadomlo lit€ratue abo painbd a bleak picure. TbeInstinrte of Medieine published findings of widesproEd uediaal errors in ib r€po4 To En k Htrllprtt''fterWort sugge$ed that ss marry as 98,(n0 Ameeiens died erery yqt as a rcsrtt of mcdicd crnor. Asubsequcut Cansdian snre/ ectocd ttrcse fi'yrirug rcporting Ut"t-Z.S p€r 'c€trt of peierrts "d-itd tohmpital had exPeri€tnscd sn adve,rse evat Of those patients, 37 per cpnt rry€r€
-colsidercd to haw
otpedenced preventable ev€nts, and2.l perc€ot had dicd as oresult oftheh adversc ev€rits. Acroos key{ees in the medkdsa prooess, ditr€rerdt}"es of enors oosrrred with difraent ficqrrncics. Enors wereclassifitd into odering erron, tranccription erors, dispelrsing €rrers, and administation mon (seeExtribft 1).
BACKGROUND OH T}IE ORGA}IIZANOO{s
Insluded in the rruGO pmjoct werc a total of I I horyitals, all located in and arorurd lfirdon, Onbrio, insoutbrrestern Orfiariq Canada- firese bospitals included l"ondon Heatth Sciences Centre, SL Joseph'sH€alfh Cane London and nins small€r regional hospitats (sce Exhibit 2). In btal, HU@ u,ould atrectmore than 10,000 shffraembers acrms the diff€rcnt b$pitals and sies.
LHSC, one of Canada's largest aoute-care teaching hoqpitals, cared for the moat critically itl pationts andthe most medically cor4plex casoe in the region. In 2010, 150,000 patients visited the-emergcucydoparhcnts,700,000 patienb visited oubsti€nt derprhr*rnb aad 40,900 patients wele adniilsd. [HSCt &rs&rda d hbtHtp', To En tstlwran: Buitdima ffir lffi.ella Sya#n. N&d AenyFncs, !'.tdlludorl D.c..ts9t.z G. Rer &ab et 4., 'TiF &lnsd&l't ,d/vee tunb thfi4 frp tm:dern of,{da/se Erads azror4l r$gfid tu&,rils ilr@nadg.,' Tlp Can&n ltccfrp/ Asffin Jaurnd. m4" wt. lVA, ttc'. l l, g. I 6ltl ffi9.
Pegc 3 9Blt0038
was the lqest mPloyer in London, wi& rnorc tran 2,200 dostors and medical studonb, alnost 3J00rurs€q 500 olinical str(such as pliararcists, ntfitionist and pnvsioucrrylsel ard 4p,roxim*oly 7,000other staff and voltmbers. It eacompssod S€ Sodh $teet Hospial, Utriversity ilotpitrl, Vi6rt"Ilospttal md Ctil&€n's llospitaf Byron Fanily M€dical Ccrt€ md VictoriaFmrily lrtodfu Ceuge, aodwas home to the FowlsKenncdy SportMedieine Cfnic, Canadian Surycsl fecUrotogies aqd AdvamcdRobotics (CSTAR), Lowssn tlealtt Res€s&h Institr*. Childrcn's Health Foun&tion iad Lonfon lleatrhSeienca Foundatiur-
St Joeepb'r l{€lth C,are London (st Jospht) r+rs a m4ior pciem catr, eaceiry and rtsca13h c€Ebe. ItryU{ 8L JosePh:s HolPilalr Parkwood Hospital, Mount Hope Centre for Lofu-rerm &re, RegionslMental Health Carc Londod ad RegionalMental Heslth Car-eSt Thomc. Annually, morc than 50O,OOO
PdiEilB vbitodthc cr@Lart clinics et SG Josephrs, fi,fl)0 surgerics ..rar petfotneO aod 41,000 111g*cslE css€s nr{minictspd. St Joeeph's uore e8a 5,000 ;aff ne;bers imtrUea almost l,SO0 ihysiciinqresidcrtr aqd medical studocilE aad 1,100 nursing,srd allicd health profcssionals.
Bo{h LHSC md St. Joseph's h8d rynly spFoiftpd chicf estecutive officers, wbo wcrs rcdcfiaiqg thcvision for thcir oqguizdiom (eec E!&ibit $. wUte tho organidions nsnp slgtUy difforcnt in smsways, borth orgeizdions werp sobscssod? with quality ofcarc-d,paticut saery.
-
Johcrson knew that. statr diftred md csutd be categorircd into physicienq muss and alliod healtlprofessionals. Becauso physicians were in@ndcnt md not reguhr drployo of thc bospial, h$pitaladnin5qcion rves permittcd only lirrired dircct influence over physiciansi wor*flow. phlrsicians rreremore likely lirn num€s or allied hedth professionals CI switc,h iroipiats seveml times in'their Gj1.ce6.Thgr_ofiel compared tho pcrftrrrance oftheir hoepitat wittr the perforrrurce of ofter hospitals in g116rioand Canada. Many pbysicias r€sisted chmge in &eir mfins
-nna res€ntsd purcly adniniemtive trsks.
Thls group valued rndenA$e 'TE, mn€y and professionat prestigc. ilri"iaor urcre ultim*elyrespoasible_for the patienr hcalthcarc thd wm ordcfed. Nursx rvete etnptJyws oftne Uospiat wlrerc they,t9** and_gpiaally r€maincd d ttre sarrre placc of work for a longer dr.rtion Oan pirysiAars. Theivalusd otellence in P$*t caq time efficiency asd oonsisHrt md ongotng emptoymini. Ttre agc anitenure'of runes ranged 'widely, with some senior nurses having Ueen employed Or sevoral decades. Tlrcgmup of atlied^h{tr proessionals tms the most diverse group-ofhospitai rtifi, i"cfudiqg sweral smallerSoups of professionals,
.such as phannacists, physiortrerapists, egcupsionl nrrryirq dieficios, 1abtechnisianq radio teclmioians and mmsage thr.rpfu" tesi pnofesionrls rrcre Aivin Ui fbeir afifiy rcProvidc sfe sd sffoctivc care frr pdeffi in m effisieni msnnei. T.hey wcre elso concerd withcommunic*ioos wi& bo& physicb and patieira. For all throe groups, tlrc abilry to rccpss pdientremrds from uywhcre in thc hcpitat aod bcfore sseing a pdient woutU signinearrly irrprovc *eirSility to provide higbauatity, e&ctivecare in aoefficient mann€r.
$u9A1t JoHilsot{
Susan Johnson hsd ta*ur orrfte role as dirEctor of Pbarmacy at LHSC six mordlrs eadier. She had been
I-"ttd as a clinical phamacist and had gained rclatcd experience in muttiple artas over alnost ZO y"roShs bd practiced clinicd pbermacy in pediairic sp€cialty aras, general sr4ery, gai6oifficstigalnedicine, infectious disas€ aod adult intensiv€€r€ plograms. Additioiully, sle naA spenitrro years as apharmacist inatoaching&mily medicire clinic, pmviding phirmaoantic"t ca* to an amtulatory ptiurtpopulatio& In 21F0, Johroa becamelhe cosrdinatsr ofPhrrracy Operations d St. Jos€ph's Heatn Carein Londo'ni Ontado. [q lhis dminietrdive role, she had played a keyrote in the implementation of smartinfirsion systerm' apurcbring systmr ard a phannspy information system.
Pegn 4 sttc038
In 200t, Jo&ns& hsd esfiSlisM lhc new trledic*ion Srfety Oep6@nt d St J6c?tr's ltrcaltb C.r! aadM bccn i6 ooordinalor frr 19 )€8ls. In tbis mlc' sh had furylac d wveral mcdicci'm safrtyinitietivsq induding lvlsdic*kn Recmailicion, a higb-alut nedicatim saety pcogre and hadfuroducod en ind4cmdctr &rl&'c.bck sysM" In 20@, $e hd gsrbli$ed {he nc\r Deparffi ofClinicat Infunatics d London Horhh Scitrccs C6tre md St Joacpb'r Hcdlh C,ae. Ov€r tb two ycmth Jobnson was dirpcbr, this d€Frtrw f had grmm to a s'bffofz0 ftll-titrc equival€oc.
Prcviously, slrc hrd reecivcd hcr bacMor of ssisrcc dcgrae in pharmacy from ths Univcrsity of Tmoloxrd hcr ne's dogrc in hcalth strdcs $-Gedcr*rip) fom Athahsca Univenig.
HTSTORYOF EI,BCTR(rI|G PATIEITT RECORS AT LHAC
HUGO uas LHSC's seoond smptto imptrcnrcnf raelec*ronis pcient rcoord (EPR) systcin. Fmm 2003to ?I)05, a maumatal etrlrt trad becn undcrbkcn to irnplaffirt ooryrmitd ptrovidcr ore s$y(CFOE) ad cllnical doqrucrmtion" Inforrnation er,hnology sffi, not clinicst gtafi, had &ivea this
Frojecl Sevsmlconsutaab S,omfrs Urdt€dStEFs bdbeeq{pars,h$od in*btltcorgetz*mbbuildtlc systEm- In ttc spriry of 2@5, t$c FNCiect was ovrr{ndgrt and M &ilod b tDcd bf dlincs"Clinicims had coqsidersd fu sysEm eumbcrsmre ud rruupprtive of patient mte. Hspe, they wercfrustnfd by tre eystm bofore it had wen been larnclrs4 and drcy had clarly itrdicelGd tbey wouldre.yerusc ir ?lE projec-t nas put on idcfinie tnld ad bd nmaired dornad umil2009; horrcter, ttcorganidional mclnory of the frilod dqnpt b isboduae EPR hod stayod alivo in the minds ofthc nnryshffudto bad rcmained at tba hospitat
In 2009, rder Johnson'r ladership, a naw trm was forn€4 fr. Clinical Infmaics Team. This tcowas staftd with olinicians, includiilg nuscq phnrnmlsh and nufritimisfs, and v*as taskd with lhedcsig& imptemerilation, educdion urd Saining of the clinical systcrns. Thb tem a#d u advocales forthc clinigat stafflnd fq the r:sc of tcobnologl to cnhanc€ qrnlity of oare and petient saftSy. Th€y akoplayed kcy roles a; ffi$latorc bctwecn thc infurm*iqn e$enobgr staff and clinical stafr, t$o grorye &*o*enused very di&rent lff€uage.
In 2010, witl6s Clinical Infsnnstics Term oo 6s Sound dd trc Tocmto horyitals rcpctiag swcescftlCPTOE implerrenatioqs, the Lonilos hospitsls e:cpcrieircod rcneupd intgr€st in a scod uy *implmcfing CPOE. A rcport was rplcread that oorrpcod Cangdian hospitals' dopd@ of ncwtocbmhgr. I,ondoq typically s nstimal l€sdor, uns sbrtirg to ftll behfud mrrci smslla Canadiaohospitats. In addltion, mporB wem emerghg from wory rnqior organization regerdfutg tb trernsdottsgaim in pdiqrt saftry b€ing reatized as a r€$rtr of the irnplonrntatim of aa ohcursric psticctt r€6d.Utrdcr President Obarm, &e U.S. adninistruion had &rvestsd billiqrs of dolhrs in U.S. bcpials forclec,tronlc pdi€nt rpordc. Ercpoce-d to follow suit was Ceade Hsalth lnfoway, a Sdcrally funddgowrnmont orpnizstcn creed to foeilcr ud accelerstc adoption and implemcrrrion of ekctronichsd& rccffds.
PRN'E T HU@
Senior leadership st tbs hocpihl bd ssk€d fohnson to deermire u&at it would uke O larmch a fullelecbonic petient record project d I SC. In resporoc, # had caarpleed an ercEnsiye rmlysis of the
clrangp sftrt r€quircd, tho human ad phCIrsical re r)rrc€s tr€€dsd atd tto ptoposed roll-ors plaa. Tlsestimatod ccst of HUGO was mor€ &an $25 million. Part of this cost uns tbc tochology thd wag new,
Prg! 5 33tte$0
soenis*ara aad arposiva tha soo'pe of hjoct HUGO was mrsivg considsriag tto nmbcr ofhspiials ed shtr involvod. The anont of d& rbd wqrld be poeesod €loctrodcslly insd ofrnarudly was dso shggsingly higb Information on approrirnealy ssvon millior pdieot vbib wasalrGody ol4 dcwisfurrdimsd{dbaddod quic*ln &ctorryidlyiscaaingbea
Prg.8 0a1{o03t
lives ia e €mergr&? si$dim fu qucciom n€cd to bc arutercd quickly durhg tb cmergcncydoci;rion-mokitg proc6ss. F'or rxmrplg duriag su& eqic ovents a$ 9/ll and Hunicano K$ina, thbeocfit of *clronic rcood kccplry wtar bighlt&d The injud wGr€ rurc @ily trcdod *nd maybaveH bffiqgcomlf lhgn thoco wbm pepareoords had bscndostroycd-
Dsspitu fu st$grriry cofb sod thc manitrdc of 6is ugurizdionsl c;harge chlloogc, &c seniorledcrship Eiln bad dccidod thrt tbe potcotid ggins io quality of pdicdt sc ud estic'trt safcfy wero toogr€dto delay any fi$thcr, aod henao, had rccnily apprcvedProjcstHuc0.
A SOSII CHAilCE
While ,IohnsEn knew tftat gEtiing HUCO offtbe grorrtd was a ms'nrnnantrl dntloge sle also lnctil thatfu rEsrdB srqff bG *ell wordr thc eftre Sfts hsdspent rnuch of the last for yeers rccearching fucauses of msdi$tion ensE ad advocating for chargx to ths sys&m. Sls lcn€{r fu HUCO wagn't fuitefficiac,y or saving monoy; it was about savirg live She tlnught about thc modia bcsdlhes thet ulutburnod into her mamory f6wrr. Shs hDelrl thirt dl of tlmcs tag€dies could have beeo pwatd !ysystcms likeHUCO.
Y€t Johm *as dso mnly arwu oftts mrry &aors &d could tuve a s€dow nqilivo impart ou tho
adoptio of fiis pmjcct $hs "lso tnew thst ltlc od& of $rwss were st in her ftvour, with t4 to 50 porccart of CPOE p,roject tlryicatly &iline kuse of ruitu fiwt clinicians" Shc rcmcmborcd Eadingsbort C€tus Sinai Horylat in Celiforni& ln 2W2" tts orgrniztisn had bm forad to sanp a $ilmillion s),stem when pbysiqisnc bad *wslked orf of tte hopital and rcfirseil to work lmtil the c)rst€fit
was rcmovcd-{ Many rcasms had booa noted for wbf EPR systams hd fiild (sec Extrtbit 9).
Tbinking bqck o hcr prior convecsdims with physicians, Johnson knevy tht ttp clinicirns Se hadlno*Ed with on a daily basis hsd fuir or'n peisoml ncasffi for Fsisting HUGO. Atd it was ad justptr;rsiciae tb.qJotrcmhad b€ad &omwlilc wo'rkingon&e HUCO propos,el. Nutos *sr6 slso vocal intheir oppositim. Tby hd carcd for pdc6 f.u many years using pen and pryer (ofun weu just a pertorvcl), r*ic'h tley fclt bd wo*sd jnet fire. Thesc nurses chirncd tr* mistrlses did lot htppen to lh€Nrl
beerse thoy had pcrfeced tbe nanual pmcesscs. Johnson was rsmindd of r repsfit from a hospinl tbetnoted ir tbe firsf sk mootLs a$er the irnplenrentatftn of barcodd msdioation afuioiete$oo' a total of746 medicatim errolB had b@6n evoidsd- Most of ttese ffion r,rould bave gonc unrmticed by nursingsuJf, Bvcn Johrgon's orm pharnacy strff md othcr allicd health providen bad lcse,rmtims sborfHUGO. Moot sdbelievcd+ltet tlp ph5rsicimr r*ould find a cfiy to defloct order entry rusponsibility o aphannacir$ or nrnse ard thus rqs,tt€d the W€@d inspse in ftoir workload.
'tesistroc€ hchngc isnornal,"JohmthghL brssbc cotrld nothelpbutwq&rnrhs$erlhetieingffis rishtb srrbar& on HU@. Wiftin thp stinical ar€6& staffwss dlalfog with pressing ictu€s. Infectiootransnission of antibiatic-rcsistant organisr$ lvas at an all-tims hi8h, esd staff feil $cy wue btfngblamed for poor infegtion pordr,ol practicc. Wait timcs in the anergcnry deparErcffi ntrt much longerthan in any orthsr hospial in Canada; patiorrs werc waiting r4 to trree days br a bed a$cr a phpician'sdecigionO gdmil 6€Nrlr Ia addition, tbo informatioo tecblogy (IT) scrrricc lwt bsing ou8ottttod to tbUritcd Statsf and many of &c €r(p€rtlschnical $atredLHSC nepdd to re$ on hd bcst laid ofr, SoIf&rorrghouttb€ qgmidian ws cxhnstod, morals at an all timc lory and siek timo qru at rccord lsvels.
' Gedap-Sfnd Ooctur o&lg to tun aN tupq, by Ud Coruroily, l$rp1r}n&l-frgl" 2M ,Nch 21. z06t W Ntl.
Prgr7 gBtlCtXtE
Hdrro IAKE HUcoruORl( {JA||D SrFR
Johm wu well arruc of lho mgnindc of ttc oreeizdisrat clwrgc challagc fu sbo ftod- She
knc*' 6s ec implenron ion of an EFR ws lils a hrriostrG wltipping fuoqgh m oqeniuioaEvcrything thsl staffonse brp wotrld changp.
'Thchappy orcitmt brthc rcw soblyear thdny childra ftcl could rctbe more diftrtntfronthcnot so joyous rnticiprim of HUC0 for hoepitrl ctsff, Jahnson fbsttgtl
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EFFEST OF HEALTH NFORTATPII TECI{ilOLOCVAT KEY gTAGE9IiI THE Prc|CESS OFTEDIGATIoTI USE
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SUNTARYOF HOAFfTALS IIIVOLYED Iil PRE'ECT HUGO
IrondonIlcdtlSdencccCcntre
Acnto-crrcbmH4rndrtccrrchhotpfrrl
t98 Phsvtdcs tbe bmodest mrrge of paliem scrvioes of any lbspttal in et&io(offcri4 carc in 5l ditrera* ryccidfties)
Pnsvidpd carc b more thsp I million paticats in thc past ycar, includiog themo$ medioally conplem and criticdly ill pdienb io tbc rgion
Home to South $hect ltospital, Unive-rsiS Hospital Vimia Hospial,Gildren's Hospiblr Byron Faryily lvlodical Ciltre, Victdis Farnily MtdicalCcmc London R€gional koer Progam, FowletKennedy Sport MedicincClinic CSTAR (Canadiar Surgical Tcchnologies & Advanccd Rotodcs)srd Lswso*r Hslth Rcscarch Institute
SL JoacphtrIlcltthCrrc
Meior prdentcrrqtcrctiryrnd roorrchccotre
r27E Prwides a broad r6ngp of peti€nt cam, inc'ltdkg ou$atieng bng-tcrm'r€ionsl mentd heal$r,rclrabiliatbn, pallixiv€, v€Frns and ryecislizedge&tric servicrs
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r In tbc pryer world, rnany policles andprocessGs arc not adrred to,puticdady if thq re n* pcrmired bystafrto bc importad" For omplc"medicatimr mu* be a&niqisrs$dwithin onc hour of the ti'netlcy aro dre.This tlmc roquircd i! not trcckedcarcfirlly ia apaper worldand norcpertussiogr rpsult wben a dose is
Intheefemnic$d!4 6currse will rcceive a nr nrirguftea adosc is late or er$. tfthe dosc fu-notgiven, anindd€nt r€port is gEosttcd,leodiagto m Grglsnation b€hgfesuir€d by the aurse.
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3. Ldofvisibleleademhlp support
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5. ll/o'rtflowmdpmc€sscs slendoscrrady andoompleefnrped rndunder*ood"
Orgmietions do nd fully apprecioetbeonplex$ of emed uoddow ptoocases.
susis otui tcr4ted b siqly Isctd€eeirpqslmmual pmcesscs in tr€cloctmicrrryld.
The org8nization musi conddcr &e totd costs of,
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6. Valuc u users notappdrnt
Cliniciens musi undeisrd tbe valueproposition Cliniciras cannst s thcCPOEas clericgl r+o*.
Usc decision*upport and crridencstssed or&s€{s,
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7. Pmjcctnungem€ntmcfho&logr ismtfollowod to Edreccspcod b knplcrnsrt Ttemisrahbelid6arhosp,itals can do it on theirom!
Rcquircs very tigbt pmjsct mgdlgctn€ot atdacountrbi$ty
Bnd$f ircltded for seoior projlct nungls.Rccruilrred critcrh will includ. qpqiw wi&CFOBiuphcaador
xrewill cnpgsCeocr!o assi* hqtrinplenenulion - drcy heve nrcccssful$colvcrted J3 CPOE projlcts srd lulrc aorc tfintr CFOE onoiecls in sorres$.
8. Tcchnologr Cmsidcr ussbility, qyebm pcrfomuacgsigrr oo, cficta. Dwicefuloyrn€$tand80eGs;
Slgr-on sffiegr will be in placc bc$atgo.live.
Clinical inftrmdcc IT *ltralrd clinieiaos willdeatgo intcrfrces !o ensurc usability. Plauing ontqn deviccs ocrourge!
9. Training and supportrsrovedtoosom
Rcquirc qlbcr bdp at thc clbow. Will have 24f support on site br6 rrtcks{Flrtrned}.
Will hEvp soeific rhvsicisn tplp line.
10, Ncoptiniztliorpntoc[is
Noed a plan for rrpid action asdchmgcsfter$e go-live {de b &l wiftunocpocred irwcs. Ncod aptnn to o$imizethesy$EoMonfto&ack
IT staff will suppon fu sY$€m Un aftr heg*,live dab. For ongoirg opimialioa issues an
e+uggpsttotr bo( wilt be inplam. ClinislInftilmstics team uvl[ be dcployd b in&rsEtwith t€dns.
