HOW PATHOLOGY & RADIOLOGY

ORDERING & RESULTS

MANAGEMENT HAS BEEN

IMPROVED AT A 350 BED

CHILDREN'S HOSPITAL

Dr Andrew Blanch

Lead Clinical Champion, OERR project CHQ

14/03/2017

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How did we get to this point?

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• What led us to want to improve… Case Scenario

• About us – the organisational context…

• Orders Entry & Results Reporting project approach…

– Governance

– Leadership

– Clinical engagement

– Usability and workflow

– Training

– Patient safety

• Lessons learned…was it a success and would we do it again?

Overview

• 10yo presented to Emergency

after injuring her left ankle

playing netball

• X-rays of the ankle were taken

• Reviewed by a junior medical

officer and diagnosed with a

sprain

• Advised to attend LMO for

review if symptoms not

improving in 1 week

Rebecca’s case

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• Rebecca’s x-ray reviewed by paediatric radiologist 1 day

after ED presentation

– Non-displaced tibial fracture present

• 3 days after ED presentation paper report arrived in ED

• 4 days after ED presentation paper report reviewed and

parents contacted and advised to attend LCCH ED

– Cast applied and follow up arranged in Orthopaedic clinic

Parents asked why it took so long for the right diagnosis

and treatment to be started?

Rebecca’s case

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• Statewide build, single Cerner ieMR domain

• It is being rolled out in a phased approach

• ieMR is a commercial off the shelf system but with local

configuration.

– Bulk of configuration is at the state level.

• Children’s Health Queensland is one of 6 sites currently using

the ieMR

– Leading the development of the system for use in paediatric

patients

Where does CHQ fit… QHealth eMR Program

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CHQ ieMR Timeline

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• CHQ was initially pencilled in to implement broad range of

ieMR modules in 2016

• Central pool of resources became limited due to delays

related to other go-live sites

• Scope of the project was reduced

• Governance

• Leadership

• Clinical engagement

• Usability and workflow

• Training

• Patient safety

OERR Project Overview

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Governance

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Statewide Program Committee Representatives from all sites

Local Program Committee EDMS as chair, high level representation from across

organisation

Clinical Reference Groups Senior clinician reps from all areas

Regular reporting requirements

to ensure consistency

Delegated workflow and local

design issues to clinicians

Right information being shared at the right levels

• Divisional leadership

– owned the operational impacts on the business

– Readiness checklists (signed off by every service lead)

– Director General visits

• Clinical project staff

– Chosen from across the organisation

– Clinical staff involved in the project had quarantined time

– Subject matter experts were identified with the inclusion of

executive recommendations

o increased the trust and buy-in of executive

Leadership

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• Detailed stakeholder assessment included planning of needs

of each area

– Rigorous

– Performed very early in project informed change, training, and

adoption approach

– Resulted in 1 page summary for each clinical area (> 40 in total)

– Categorised each area regarding the complexity / change risk

o Change manager and subject matter experts allocated to each area

informed by these measures

Clinical Engagement and Communication

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• Tested in simulated scenarios / dress rehearsals driven by the

clinical areas themselves

• Clinical Practice Leads

Usability and Workflow

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• How do you train a large volume of staff quickly?

– Flexible approach – trainers on weekends and nights.

o Multiple training mediums

– Team training sessions

Training

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• Training dashboards

– Each service / division had visibility of how their team was

tracking regarding training

• The value of “at the elbow” training

– Many people had completed classroom training well before

go-live.

– Floor walkers were available 24 hours a day at go-live.

o someone could be available to support clinicians with

their first order.

Training

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• Need to be as honest as possible with clinicians about what

the solution is, and what it isn’t

• Stakeholder analysis

– proactively responded to risk areas

– able to provide additional support at go-live

• Roll out over 2 weeks assisted the team to effectively support

high risk areas and high volume areas

• Members of the local patient safety team were embedded

within the project go-live governance

Patient Safety

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• Rationalisation of committees

– Program Committee became

GOLD meetings

– On the floor support (Floor

Walkers) were supported

through the BRONZE

meetings

• Number of calls for assistance

much lower than planned for:

– Floor walkers were visible

and readily available

o Proactively solved potential

problems

Go Live

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• Nil clinical incidents related to the roll out.

• All teams across the organisation are using the system for all

pathology orders

– Within 1 week of go-live 90% of orders were within the

ieMR system

• Clinicians felt well supported and informed

• Clinicians like having access to pathology and radiology

results within the medical record

• During a recent planned downtime…we had trouble stopping

clinicians from using the electronic system (significant

hesitance in going back to the paper system)

Go Live and beyond

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• Resourcing

– Needs to be a mix of subject matter, project management

and technical expertise

– Specialist contractor resources were brought in as required

• Timelines

– Date of go-live was changed to ensure that it didn’t coincide

with school holidays

o However this limited post go-live support

• Hybrid release – Workarounds continue to be required

– Training was able to be focussed on a key eMR

functionality

– It should make the change easier for the next release

Other Lessons Learned

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• Improved Reliability

– 25% reduction in “No test” rate (unable to complete a

requested test)

o Improved culture of pathology and medical imaging

ordering / collection

– Improved result sign-off

o From less than 30% pre-go live to 90% currently

• The OERR project has tested the organisational readiness for

future releases and has sparked an enthusiasm for more.

– We are much readier for the “BIG” next step because of this

project

Was the pain of implementing OERR alone worth it?

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Questions…

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