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Roadmap to Clinical Computing Using Clinical Transformation Tools
Beverly Bell, RN, MHAHealthlink Incorporated, An IBM Company
University of Maryland 2005Summer Institute Nursing Informatics
University of Maryland 2005Summer Institute Nursing Informatics
Beverly Bell, RN, MHA Beverly Bell, RN, MHA • Vice President, Healthlink Incorporated, An
IBM Company
• Adjunct Professor, Johns Hopkins University School of Nursing
• President, HIMSS Central and Southern Ohio Chapter, 2001-2002; Board Member, 1998-2003
• CPHIMS
• FHIMSS
• HIMSS Practice Standards Task Force
• Provided leadership on multiple clinical transformation projects at Integrated Delivery Networks
More: Better and FasterMore: Better and Faster
ObjectivesObjectives
To understand what is meant by clinical computing and clinical transformation
To understand the major activities that encompass clinical transformation
To recognize at least four (4) tools used in clinical transformation
Operational DefinitionsOperational Definitions
Clinical Computing Is…
• An integrated application and process strategy that ultimately automates the entire clinical process
• A strategy built around a core solution that may include – Patient Administrative
– Core Clinical (orders/results, clinical documentation, medication management)
– Clinical Ancillaries (Lab, Radiology, Pharmacy)
– Clinical Specialties such as OR, ED, ICU
Is Not…• A single vendor solution
• Computerized Provider/Physician Order Entry (CPOE)
Clinical Transformation A significant, substantial change in form, nature, and function of
how work is carried out and enabled by information technology, in the delivery and support of clinical care.
It’s About People!It’s About People!
Clinical Executive Steering Team
Clinical Project Work Group
Radiology Project Manager
Laboratory Project Manager
Existing Operational Department Committees
AncillaryProject
Manager
Project Executive Committee Facility
AdministrationTeam
Project Physician Council
Implementation Partner Project Director
Physician InitiativesManager
Vendor Project Director
Go Live Director
On Site SupportDirector
IS Clinical Project DirectorTesting Coordinator
Training Coordinator
Vendor Practice Director
Financial Project work Group
Financial Executive Steering Team
ERM Project Manager
Scheduling Project Manager
Surgery Project
Manager
IS Financial Project Director
ERM Project Manager
ERP HIPAA Project Manager
APC Grouping Project Manager
On Site Testing
Coordinator
Nursing Project Manager
Transformation Officer
Project Governance
Yellow is project
Blue is hospital
Project Decision Making AuthorityProject Decision Making Authority
Tactical Strategic
Ris
k/S
cop
e
JAD Teams & PM’s
JAD Teams & PM’s
CTO &ProjectDirector
CTO &ProjectDirector
Project Steering
Team
Project Steering
TeamProjectWorkGroup
ProjectWorkGroup
ExecutiveSteering
Team
ExecutiveSteering
Team
Implementation ApproachesImplementation Approaches
Process
Information Technology
UnsustainableChange
Automation Without Significant Benefit
Optimal Organizational
Change
Change Management
Organizational Change
Job design determines:• Roles, responsibilities, and
jobs that will change• Required vs. current skills• Performance
measurements
Training requirements determine:
• User learning preferences• Training program and plan
Change ManagementChange Management
Healthlink’s change management program consists of 6 initiatives to determine and manage the “people” dimension of change:
Change readiness assessment determines:
• Types of risks to be encountered
• Extent of change to perform job duties
• Strategies to manage resistance
Transition management framework determines:
• What to communicate when by whom
• How management and staff will provide support and leadership
• How change initiatives align with strategic goals
Change leadership determines:
• Leadership roles• Leadership skills and
abilities• Plan for leadership actions
Organization design determines:
• Governance• Processes and components
to be redesign• Risk and value of the new
design
Conduct Informational analysis Interview key stakeholders and leadership across the hospital
Observation of care delivery
Document current state• High-level process maps
• Process summary reports
• Red flags and gold stars report
High-level Process Map
Conduct Current StateConduct Current State
Executive Kickoff Meeting Project governance structure Charter approved Review current state findings
High Priority• Marginal development• Lack of existing infrastructure• High level of effort
Low Priority• Well developed• Solid infrastructure• Continue efforts
Medium Priority• Partially developed• Some infrastructure• Mid-level of effort
Legend
Readiness Assessment Summary
IT Training and Support
Coworker Technology Experiences
Medical and Surgical Physicians
Care Delivery
Culture
ReadinessCategory
Leadership InvolvementLeadership Involvement
Framing the FutureFraming the Future
Analyze Options, Scenarios, Key Decisions Identify areas of
opportunity (red flag)
Identify best practices observed during current state (gold star)
Conduct best practice research
Identify design principles
Finalize future state recommendations
Framing the FutureFraming the Future
“An alert screen appears indicating no allergy information has been documented in the system for Mr. Steel.”
Will allergy information be required prior to order placement?
Benefits:• Improve patient safety
• Enable interaction checking
• Meet JCAHO requirement for access to patient information
• Streamline communication
• Decrease turnaround time
• Improve patient outcomes
• Potential health-system annual savings of $1.3 million
Implications:• Process for entry,
update and verification
• Clarify “unknown” and
free text information
• Standardize drop down selections / alerts
• Training / education
• ED perceptions take along time
• Address exceptions
Cost:• Negligible
Cultural Change:• Additional allergy
information required
• Proactive approach
• Prompts utilized
• Menu driven selection
• Real time alerts
Framing the FutureFraming the Future
Designing the FutureDesigning the Future
What is JAD? Joint Application Design session
Why use JAD approach? Embraces team concept Focuses on quality and productivity Embraces shift from technology to business Focuses on Business Process
Redesign (BPR) Supports rapid design
JAD Team Members Executive sponsor Scribe/Timekeeper Facilitator
Attendees Subject matter experts IT/IS staff Vendor Consulting partner
Change ManagementChange Management
Change management team will:
Introduce change:• Develop hospital specific communication plan
• Communicate key decisions made and major process changes
• Review how success will be measured (metrics)
Assess readiness:• Assess staff, physical facility readiness including network, furniture,
hardware, remodeling, etc.
Risk assessment
Mitigation plan
Executive action plan
Change ManagementChange Management
Change management team will: Distribute information on…
• How the world will change– Processes, Policies, Procedures, Roles, Job Descriptions
• Capturing baseline metrics
• Training plans and expectations
• Activation strategy
Prepare for change• Begin preparation of detailed go-live plan
• Begin communication and training on downtime procedures
• Conduct informational meetings with departments, physicians and administration
• Order, install and test network and equipment
Industry awareness
Project awareness
Current state and future state Monthly topic
What is going on in other departments
Policy and procedure changes
Job description and role changes
Go live Hospital responsibilities
Preparation
Go live night/day activity
Post go live
Communicate, Communicate, CommunicateCommunicate, Communicate, Communicate
Pharmacy
Project Objectives
Major Design Decision
Metric Pre Go Live
Baseline
How Data captured Pre and Post Go Live
Expected Outcome
Frequency of Measurement
Responsible
Right resources Pyxis and PharmNet interface
Dollar amount of charges posted daily
Revenue & Usage Statements HQ/Nomad/Lawson viewed thru COOL
Maintain or exceed pre-conversion numbers.
Daily X 4 weeks then monthly
Pharmacy
Right information Pharmacy dept will enter all Pharmacy orders into PharmNet
Volume posted daily Revenue & Usage Statements HQ/Nomad/Lawson viewed thru COOL
Number of actions stays consistent with the volume of orders received from nursing unit.
Daily x 4 weeks then monthly
Pharmacy
Right resources Pyxis and PharmNet interface
Average cost per key indicator
Revenue & Usage Statements HQ/Nomad/Lawson viewed thru COOL
Number of actions stays consistent with the volume of orders received from nursing unit.
Daily x 4 weeks then monthly
Pharmacy
Radiology
Project Objectives
Major Design Decision
Metric Pre Go Live
Baseline
How Data captured Pre and Post Go Live
Expected Outcome
Frequency of Measurement
Responsible
Right resources Radiology charge on status at completion of exam
Dollar amount of charges posted combined for all cost centers
Revenue & Usage Statements HQ/Nomad/Lawson viewed thru COOL
Maintain or exceed pre-conversion numbers
Daily X 4 weeks then monthly
Radiology
Right information Radiology dept will receive and status orders into Radnet
Volume Posted daily Revenue & Usage Statements HQ/Nomad/Lawson viewed thru COOL
Maintain or exceed pre conversion numbers
Daily x 4 weeks then monthly
Radiology
Project Metrics
Start/Stop/ContinuePolicy and Procedures and Job DescriptionsStart/Stop/ContinuePolicy and Procedures and Job Descriptions
Ref # Process # &
Name
Process Step Date/ Time Start Stop Date/ Time Continue Questions Report Needed
RNRe
hab US Re
sp MDRa
diolog
yTra
nspo
rter
Comments
2 Communication
Making shift assignments.
12/9/2004 Charge Nurse will start making shift assignments in PowerChart.
Charge Nurses will stop making assignments based on room location only, if that is current practice.
The previous shift Charge Nurse will make assignments for the next shift. The oncoming Charge Nurse will review these and make adjustments as necessary.
X
Making Shift Assignments Flow
Testing, Training and SupportTesting, Training and Support
Testing Include processes Recreate care delivery areas
Training Include policies, procedures, role changes
Support Specifically delineate between process from ‘how to
technology’ questions Red coats/caps on floor ‘Stand up’ or ‘Drop by’ times
NursingAdoption
Change
Managem
ent Future State Process Design
Test
ing,
Tra
inin
g
and
Sup
port Leadership
Frames the
Future
ProjectGovernance
Clin
icia
ns
Def
ine
Clin
ical
Con
tent
Clinical Transformation Strategy for Clinical ComputingClinical Transformation Strategy for Clinical Computing
Wouldn’t It Be Nice If….Wouldn’t It Be Nice If….
Clinical Transformation Requires Clinician ParticipationClinical Transformation Requires Clinician Participation
