* Yeah, It kinda feels like this….
* Healthcare Reform – Meaningful Use
* Decreasing Volumes
* Increasing Financial Pressures
* Increasing Reporting Needs
* Replacing the Core Information System * Used for 25 Years
Soarian Conversion
January 14, 2012
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* 7 Hospital System (5 campuses) * Clinical Partner to UMass
Medical School * 13,500 employees * 3,000 registered nurses * Approximately 1,700
physicians * 1,111 beds * $2.2b in Annual Revenue * ~70,000 inpatient visits * ~1,600,000 outpatient visits
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* Only Academic Medical Center (AMC) in Massachusetts without a clinical Electronic Medical Record (EMR) and Computerized Provider Order Entry (CPOE) * Only AMC in the country running Meditech as its core
information system * Clinical and Financial limitations of the system * Focused on back-end remediation vs. front-end data
capture * We knew we had to upgrade/replace our core system
* Under pressure to move quickly – short time to implement change
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* Initiate Enterprise Master Patient Index
* GE Centricity (IDX) * Ambulatory Scheduling and Physician Billing
* Allscripts * Ambulatory EHR
* Siemens Soarian * Hospital/Acute Care EHR and Hospital Billing
* Pharmacy
* GE Imagecast (RIS) Philips PACS
* Meditech Laboratory
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PCHIS
PowerScribe
ForwardAdvantage
Metrico
IDX
Cardiology
R4Ob US IBEX
ED
PACS
TSI
PCI
Laboratory
Cycle
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R4
Ob US
IBEX
ED
PACS
IDX
TSI
EMPI
G
M B
BizcomdbMotion
MeditechLab
M
o
PCI
Meditech
Siemens Soarian
Allscripts / IDX
University
Memorial Hahnemann
Clinton Hospital
HealthAlliance Hospital
Wing Memorial Hospital
Medical Group
Marlborough Hospital
Private Medical Practice
Private Medical Practice
Private Medical Practice / Affiliate
Hospitals
Current Information Systems as of January 2012
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Health Alliance has been running a separate instance of Soarian since 2005
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* HIM Repository and Remote Coding/Abstracting * Transition of Care Automation * Ambulatory Meaningful Use ($10M) * Combining E-Mail Systems * Wireless Device Expansion * Virtual Desktop/Device Independence * Single Sign-On * Application Linking/Switching * Single Patient ID/IDX Active Registration * Soarian/IDX 2-Way Interface * ePSI Financial Planning System * Ambulatory Dashboard * eICU Expansion * Salar Inpatient Physician Documantation * MedCPU/ NLP
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* The Conversion * Replacement of the core system used for 25 years * Largest Soarian implementation to date * Multi-entity implementation * Financials AND Clinicals – touched EVERY process at once * Significant changes in practice/workflow * “Big Bang” conversion of 5 campuses * Over 20,000 users converted * 3.9 million patient records converted * 300,000 scheduled future appointments moved * 284 new interfaces built and implemented * Introduced Virtual Desktop Technology, Wallaroos,
Workstations on Wheels
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* Conversion Week * 4 Hospital Operation Command Centers * 7 Soarian Support Centers * Open 3-4 weeks 24/7
* The First Three Weeks * 300,000 results into Soarian * 250,000 non-med orders * 17,000 hours working on Soarian within IT
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1/14/12 12:00 am Conversions begin Hospitals on Downtime Procedures
1/14/12 11:00 am Meditech Conversion Complete
1/14/12 4:00 pm Interface Conversions Complete
1/15/12 6:00 am Interface Backloads Complete
1/15/12 6:00 am Soarian Financials Live Patient Access
1/17/12 8:00 am Business Offices Live Revenue Management
1/18/12 7:00 am Clinton and Marlborough Hospitals Live Soarian Clinicals
1/19/12 7:00 am Memorial Campus Live Orders
1/20/12 7:00 am University Campus Live Orders
1/23/12 7:00 am Memorial and University Campuses Live Nursing Documentation
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* Unforeseen * 4 Power Failures in our Soarian Support Center
* Network Switch Failure on Lakeside A
* Lower Census did not materialize
* We should have foreseen…… * Security Issues * Effect of SSO (Single Sign-On) introduction with Soarian
* Problems with Role-Based Access
* Limitations of Siemens Security Tool
* Downtime backlog * Design of downtime forms based on issues with backload
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* Spread support resources throughout hospital
* Eliminated Single Sign On with Soarian
* Established a Security “swat” team
* Relaxed Role-based access requirements
* Staged phased introduction to orders and documentation
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* Training * Planning and executing initial training program * Flashes during transition * Downtime Planning * Dedicated Activation Project Manager * Engaged Emergency Preparedness Coordinator * Support Centers * Definition, logistics, scheduling, metrics/dashboard tools * Communications with Operational Command Centers * Flexible and scalable during the transition * MPI Conversion * Integration cutover * Meditech conversion * Room Renumbering deployment
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* Operational and clinical buy-in * Created Applications for Operations Committee (SKTT)
* Communications: * More vehicles, more frequently
* Transparency
* Using the experience gained by HealthAlliance
* Timeline * Engage activation manager and operations sooner
* Live date changes (10/1/11, 12/1/11, 1/14/12) constrained transition planning
* Testing: more workflow and reports
* Incorporate QA and reports development team in future design
* Technology * Mock cutover
* Simulation testing
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* Consider pilot go-live then big bang * Staging a rapid roll-out * Assign a dedicated communications manager * Link support center network
* Provide ability to leverage more tools (blogs, Twitter, Facebook, etc.)
* SWEEPS work; will keep for subsequent activations * Do not underestimate the space and other accommodations needed for
you support staff * Can not overemphasize training and training * Establish a formal coaching program * Formal commitment; long term
* Invest in temporary support staff * Internal and external
* More training sooner * Plan to include internal staff in testing efforts as an education opportunity
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Organizational Culture and Governance
Clinical Adoption
Technical Build
• Discuss Lessons Learned • Share the discussion between technical
and clinical • Provide successes and challenges
• There is no magic here • The key tenets of successful
implementations remain • Planning • Communication • Detailed Workflow • Testing • Training • Support
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* Replacing Meditech rather then implementing a “new” approach * Long term Meditech client
* Customized the application significantly * PDI
* Provider Dictionary
* Patient instructions
* Bulletin Board
* Reports
* Workflow was primarily paper * Little standardized work
* Complicated areas * Dialysis
* ED
* Outpatient
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* "Thank you, thank you. I will get you a huge bag of chocolate! I am so happy now I have access to the forms and reports I need and they work since the folks in the support center spent time with me…”
* "I can't believe how much easier Soarian has made my job…”
* “This system is much more user friendly than Meditech”
* “Slowly learning and I will be an expert soon”
* "Don't quote me but this is kind of fun"
* “…We love this! We get credit for what we do!"
* “I never thought I'd say this but this is easier.”
* "You know what I like about Soarian? The target behaviors page. Boom.- there it is!"
* “…love it love it love it took 4 hour class, left crying but it turns out Soarian is really easy to use and intuitive”
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* Stabilization and Enhancement * Allscripts Expansion * Order Entry/Results Verification * Population Health Management * Patient Portal
* Wing Memorial * Soarian & Allscripts
* Electronic (Bar Coded) Med Administration * Computerized Provider Order Entry
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* No definitive formulation – each attempt at creating a solution changes understanding of the problem * No stopping rule – since you cant define, you can’t tell when it is resolved.
Problem solving ends when resources are depleted. * Solutions are not true/false but good/bad – no unambiguous set of criteria for
solution – what is “good enough” * No immediate or ultimate test of a solution – impossible to know how all
consequences will play out * Every implemented solution has consequences – you can’t reverse, it’s one way…. * No well described set of potential solutions – all stakeholders have differing views
of acceptable solutions * Every problem is essentially unique – no “classes” of solutions * Every problem can be considered a symptom of another problem – interlocking
issues and constraints that change over time * Causes can be explained in numerous ways – many stakeholders with varying and
changing ideas about the problem, its cause and potential solutions * Planner/designer has no right to be wrong – scientific method does not apply
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