Implementing a Clinical Information System – Strategies for Success

Helen Edwards RN MN

January 26, 2012PMI – SOCProfessional Development Day

Outline• Evolution of Computerization at SickKids• Implementing a Clinical Information

System– Design– Communication– Education– Go-Live– Post Go-Live

• Key Success Factors• Lessons Learned

SickKids Hospital

TOTAL

Planned Beds 274

Ambulatory Visits 217,707

Day Surgery Visits 4,953

Inpatient Surgical Visits 6,506

Emergency Visits 57,561

Admissions 14,590

Average LOS 6.9

Patient Days 100,595

Average Daily Census 276

Evolution of Computerization• Complex infrastructure - comprises diverse platforms,

applications, client devices

• Complex and dynamic technological environment with >200 information technology systems/applications in use

• main clinical apps

• patient management apps

• decision support apps

• interface technology apps

• scheduling and departmental systems

• personal productivity apps

• business services

• network/computing infrastructures

• communication apps

Evolution of Computerization cont’d

• 1980s first clinical information system – home grown system (functionalities included laboratory order entry / results retrieval and diet order entry)

• 1992/1993 DOS based system (Kidcom) – ADT, CPOE, eMAR, some clinical documentation

• 1996 Telemedicine launched

• 2000 - ICUs – all clinical documentation except CPOE

Evolution of Computerization cont’d

• Other common systems– PACS– Scanned historical paper chart– Schedule Book– Transcription and Dictation System– Ambulatory Referral Management System– eCHN – provincial paediatric EHR– Surgical Information System– Emergency Department Information

System

Evolution of Computerization cont’d

• 2005 – KidCare Phase I (transitioning Kidcom to Windows based system)– Patient Lists– Results retrieval

• 2008 – KidCare Phase II (transitioning remaining functions)– CPOE– eMAR– Clinical Documentation (e.g. Admission

Assessment, LOA, Discharge Summary)

Our Vision• Fully electronic patient chart across

the inpatient and ambulatory areas– Progress Notes– Flow Sheets– Consents– Diagrams/Photographs, etc.

• Universal Workstations– Single Sign-on– Multiple form factors

Implementing a Clinical Information System

• Design

• Communication

• Education

• Go-Live– Command Centre– Support

• Post Go-Live

Design

• Based on user input working with informatics clinicians– Reflect practices and processes– Engage clinical departments/areas – e.g.

responsible for their order sets– Testing – (unit, functional, integrated)

accomplished by users and informatics clinicians

Communication

• Hospital-wide engagement/profile• Steering Committee

– Executive Sponsor– Physician Leadership– Nursing Leadership– Professional Services Leadership

• Project Team– Diverse membership – IS, Clinical

Programs, Other programs

Communication cont’d

• Built off of successes of KidCare Phase I• User Groups - Nursing, Professional

Services, Physicians, Others• Super Users

– Meetings– Emails

• Hospital publications– This Week (print)– Daily News (homepage)

• Website – KidCare; Countdown • Key Leadership Forums – Executive,

Directors, Managers, Educators, MDs

Informatics Education

3500+ staff

8 Weeks

Education and Support

Pre-education

Communication

and Advertising

for Education

Blended Learning Approach

Go-live Post Go-live Support

Pre - Education

Pre – Education Open Forums

Pre – Education Open House

Pre – Education Open House

Pre – Education Open House

Education and Support

Pre-education

Communication

and Advertising

for Education

Blended Learning Approach

Go-live Post Go-live Support

Communication and Advertising

Communication and Advertising

Communication and Advertising

Education and Support

Pre-education

Communication

and Advertising

for Education

Blended Learning Approach

Go-live Post Go-live Support

Blended Learning Approach

• Computer-based Tutorials (CBTs)– Mandatory pre-requisite – General/Basic information– Decreased in-classroom time– Staff themselves decided when and

where

• Instructor Led Classes (ILC)– Complex process or changes in process/

concepts– To anchor knowledge – provide

hands-on training

Super User Education• Job Description

– proficient at all functionality on legacy system and KidCare Phase I

– recognized ability to lead and support all health care colleagues

– availability to act as a SU during implementation

• Attend Super User training

Incentives

3500+ staff

8 Weeks

Original Goal

• Outcome:– Between Sep 4th and Nov 4th

3083 staff were trained

585 classes were held

88% of staff were trained by go-live

98% within 6 weeks of go-live

Education and Support

Pre-education

Communication

and Advertising

for Education

Blended Learning Approach

Go-live Post Go-live Support

Go-Live Command Centre

Command Center Help Desk

Immediate Assistance

Communication tools

External Support Staff and Super Users

Education and Support

Pre-education

Communication

and Advertising

for Education

Blended Learning Approach

Go-live Post Go-live Support

Post Go-Live

• Ongoing education

• Clinical Applications Resources and Education Support (CARES)

• Ongoing communication– Tips and Tricks– Website updates

• KidCare Duty Officer (KDO)

• Stabilize the system for a period of time before making any revisions

Key Success Factors

• Hospital engagement– Hospital-wide project – ownership– Go-live day was a “marked event”

• Communication mechanisms– Countdown– Posters– Clinical Managers, Directors, VPs

• Education – Model– Daily communication– CME Credits

Key Success Factors

• Go-Live Support Model– Command centre– Super Users– Informatics nurses– Hiring skilled activation support

resources helped the front-line users tremendously throughout the activation process.

• Post Go-Live Support Model– Continuing training session– CARES

Sense ofHumour

Essential

Lessons Learned

Lessons Learned

•  Application

– Ensure sufficient resources for both the project team and support staff

– Cross-train more of the project team members on system configuration

– Changes to a legacy system should be restricted to only those that are critical

–  Printing should be tested earlier in the project

  

Lessons Learned

•  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

•  Training

– Create a mock training environment for informatics educators to practice

– Create a practice database for staff to practice after attending training

– Online Reference Material only – no paper 

Lessons Learned

• Support

–  Extended activation support should be planned for and acquired (for example, contracted project team members should not be released shortly after activation)

 

Questions?

Helen Edwards RN MN

Director – Clinical Informatics and Technology Assisted Programs

Hospital for Sick Children (SickKids)

helen.edwards@sickkids.ca

Contact Information