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The EMR: InformationThe EMR: InformationWhere You Need ItWhere You Need ItWhen You Want ItWhen You Want It
Presented by:Jim Cato, RN, CRNA, MHS, MSNEVP Of Clinical Operations and Chief Nursing Officer NCH Healthcare SystemNaples, [email protected]
Learning ObjectivesLearning ObjectivesIdentify how information technology improves clinical effectivenessDescribe how information technology improves employee and patient satisfactionDevise a strategy for reducing medical errorsGain insight from an experienced user of point of care devices
Background InformationBackground Information
DemographicsVision and Mission Business Drivers Information Systems Strategic Plan
Information Technology Background
Information Technology Information Technology BackgroundBackground
Best of Breed (Legacy) 1988Integrated System 1996
Project CycleProject Cycle
Identified Need/Operational InitiativesExecutive Support and SponsorshipJustification/Return on InvestmentApprovalsRoles and Responsibilities
Project CycleProject CycleTeam SelectionScope/Phasing & TimingProject MethodologyEducation EventsSuccess FactorsEvaluation/Results
Roles and ResponsibilitiesRoles and Responsibilities
Executive Management TeamExecutive SponsorProject Management– Clinical Team– Technology Team– Vendor Support Team– Subject Matter Experts
Project OrganizationProject Organization
End Users:Nurses,
Physicians,Clinical and Support Staff
CareNet Project Team
CIS Review Committee
HIS Steering Committee
MultidisciplinarySubject Matter
Experts
ClinicalAdvisory
Task Force
Technology Committee
ImplementationTeam
PhysicianAdvisory
Board
SecurityTask Force
Ad hocTask Forces
Vision for Vision for Clinical Information SystemClinical Information System
Seamless flow of informationReal time chartingNurses back to bedside
Standardize Nursing DocumentationReduce RedundancyImprove Nursing Visibility to Patients
Clinical GoalsClinical Goals
Improve Nursing Visibility to Improve Nursing Visibility to PatientsPatients
Point of Care Devices– Device Fair – Criteria
– Clinical– Technical
Other devices– 60 Wyse Devices– 700 PC’s
Marketing Marketing
ELMR –electronic medical record– Mascot– Newsletter– Proof of concept
demonstrations
Training and EducationTraining and Education
Train the Trainers –Key Trainers–End Users–Administrators
GoGo--Live ExperienceLive Experience
September 6, 2001– Big Bang– Administrative support– Staff acceptance/resistance– Episodic downtime– Documentation off-line November to
January
Design DecisionsDesign Decisions
Determining what to automateRequired FieldsAutomatic TriggersReference TextProcess Driven
Technical Vision and GoalsTechnical Vision and Goals
Provide reliable systems to support clinical application“No Downtime” through redundant systemsAnticipate hardware needs and have in place prior to go-live
ResultsResultsImproved charting complianceImproved safetyReduced LOSImproved patient and staff satisfactionReduced turnover (state and national)Improved patient confidentiality
Improved SafetyImproved SafetyCombined Health System Patient Falls Rate
Combined 2001-2002 To Date
5.76
4.685.37
6.22
3.96
6.06 6.02
4.855.76
54.53
5.44 5.17 4.83 4.644.23 4.44 4.7
5.76
4.68
5.37
6.22
3.96
6.06 6.02
4.85
5.76
5
4.53
5.44
5.17
4.83
4.64
4.23
4.44
4.7
Jan.
, 200
1
Feb.
, 200
1
Mar
., 20
01
Apr
., 20
01
May
., 20
01
Jun.
, 200
1
Jul.,
200
1
Aug
, 200
1
Sep,
200
1
Oct
, 200
1
Nov
, 200
1
Dec
, 200
1
Jan,
200
2
Feb,
200
2
Mar
, 200
2
Apr
, 200
2
May
, 200
2
Jun,
200
20
1
2
3
4
5
6
7
Trend
Reduced Length of StayReduced Length of Stay
00.5
11.5
22.5
33.5
44.5
5
Oct
. 01
Nov
. 01
Dec
. 01
Jan.
02
Feb.
02
Mar
. 02
Apr.
02
May
. 02
Jun.
02
Jul.
02
Aug.
02
Sep.
02
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
Oct
. 00
Nov
. 00
Dec
. 00
Jan.
01
Feb.
01
Mar
. 01
Apr.
01
May
. 01
Jun.
01
Jul.
01
Aug.
01
Sep.
01
NCH
North Collier
Trend
FY 2001FY 2002
Improved Patient SatisfactionImproved Patient SatisfactionInpatient Customer Satisfaction-NCH Healthcare System
0
5
10
15
20
25
30
35
40
45
50
Jul-01 Aug-01 Sep-01 Oct-01 Nov-01 Dec-01 Jan-02 Feb-02 Mar-02 Apr-02 May-02 Jun-02 Jul-02
Perc
entil
e Ra
nkin
g
Series1 30 23 37 16 31 27 34 26 16 29 43 46 31
Jul-01 Aug-01 Sep-01 Oct-01 Nov-01 Dec-01 Jan-02 Feb-02 Mar-02 Apr-02 May-02 Jun-02 Jul-02
Improved Patient Improved Patient ConfidentialityConfidentiality
Levels of securityAudit trailsKey fobs
What’s Next?What’s Next?Pharmacy with medication integration, ADEPhysician order entryDigital radiologyEmergency Department IntegrationSurgical Services IntegrationEnterprise wide schedulingCritical care equipment interface
Goal: PAPERLESS system
Thoughtful Design
Testing
Executive OversightThe monthly/quarterly participation of the Executive Management Team is essential to ensure that the project is in line with theCorporate goals and that the benefits that are identified are achieved
Sufficient End-user involvement in the Process Design and Product Design will ensure that the new processes and systems meet the needs to the areas being automated
Adequate Unit, System and Integration Testing ultimately shortens the duration of any project and guarantees a smooth conversion
Project Organization and Staffing Appropriate client and vendor staffing from the inception of the project is critical to meeting aggressive time frames
Success FactorsSuccess Factors
Learning Strategies Vendor transfers knowledge to the Client Project Team and End-users through documentation, workshops and informal day-to-day interactions
Change Management
Change Control
Issue Management
Assessing the implications of processes being altered by the implementation and developing appropriate communication and training plans will make sure that there are no surprises
A systematic process where the Client and Vendor jointly identify and solve problems that will inevitably surface during the project
Tight controls for code and database changes must be in place from the start so that the "Left Hand" always knows what the "Right Hand" is doing
Success FactorsSuccess Factors
Scope Management Monitoring the project closely to ensure that changes to functionality, timelines, or budget are minimized and agreed to in advance
And...
Learning Objectives Summary Learning Objectives Summary
Identify how information technology improves clinical effectivenessDescribe how information technology improves employee and patient satisfactionDevise a strategy for reducing medical errorsGain insight from an experienced user of point of care devices
QUESTIONS?QUESTIONS?
