Xerox & Faxton St. Luke’s Healthcare System

A Partnership in Clinical Documentation

Anil A. Bapat, M.S. PMP

Our Journey Patient Education Log (Oct – Dec 2012) KBC/Clinical Documentation (Jan – June 2013) Staff Augmentation & Support (July – Dec 2013) Knowledge Transfer (Jan – June 2014)

Patient Education Log

Oct – Dec 2012

Patient Education Log

Our Challenge:Patient Education is scattered in multiple areas of the chart. We need a central location where all clinicians can go to see what education has been given to the patient and when.

Solution:Implement the Patient Education Log in Allscripts.

Our Approach: Load Core Modules into the system Design Meetings with Project Sponsor Rapid Prototyping (Build) Stakeholder Meetings to Review Prototypes User Training/Education Go Live/Activation Support

Patient Education Log

Load Core Modules into the system: Loaded by Allscripts System Engineer (SE) Validation of load by Xerox/Faxton. Confirmation of Patient Education Log licensure. Webex Q&A session with Allscripts Subject Matter Expert.

Patient Education Log

Design Meetings with Project Sponsor: Initial Design Template created and reviewed with Faxton Project

Sponsor Key Design Decisions included:

Integration with Exit Care module? Names of Document Categories Names of Documents Mappings of Documents to Categories

Patient Education Log

Rapid Prototyping (Build): Iterative Development Reviewed with the Faxton Project Sponsor at regular intervals prior

to presenting to the Stakeholders (Clinicians)

Patient Education Log

Stakeholder Meetings to Review Prototypes: System Wide Meetings were scheduled with the Clinicians to

present the content developed by our teams: Meeting #1: Review Initial Prototype Meeting #2: Make Revisions from Initial Meeting & Demo the

Final Build for Signoff

Patient Education Log

User Training/Education: Education Packets created for ‘Train the Trainer’ sessions. Workflow Diagrams Live Classroom Training Sessions with the Clinicians.

Patient Education Log

Go Live/Activation Support: Load Patient Education Log content to Production environment Post Load Manual Build work Activation – Dec 18th Post Go Live Support/Chart Audits

Patient Education Log

Accomplishments: Establishment of a clear Project Plan w/timelines and milestones for

implementation.

Development of a Prototype Signoff Process to validate requirements.

A savings of 80 hours of manual build work through use of automation tools to move content between environments.

Patient Education Log

Knowledge Based Charting (KBC/Clin Doc)

Jan – June 2013

Knowledge Based Charting

Our Challenge:Clinical Documentation is scattered and fragmented within the system. Clinicians seem to work in silos and there are no guidelines or standards for documentation within the Electronic Health Record.

Solution:Implement Knowledge Based Charting (KBC) to establish best practices in documentation.

Our Approach: GAP Analysis Design/Configuration *BUILD FREEZE – Load content to TEST/TRAIN Document Testing/End User Training Load content to PROD/Activation Post Go Live Support/Chart Audits

Knowledge Based Charting

GAP Analysis: Compared site’s current build to KBC content. Analysis was done by document and discipline (Nursing, Rehab, ….) Goal was to adopt as much of KBC as possible with minimal

customization.

Knowledge Based Charting

Design/Configuration: Reviewed GAP Analysis with Clinicians Built necessary customizations into KBC documents Validation/Signoff of each document

Knowledge Based Charting

BUILD FREEZE – Load content to TEST/TRAIN: BUILD FREEZE – May 10th

KBC content was unloaded from DEV and loaded to the TEST and TRAIN environments.

Validation of loads was performed by Xerox and Faxton teams.

Knowledge Based Charting

Document Testing/End User Training: Testing/Training activities were performed for next 3 weeks Issue Log was used to record defects uncovered in testing Tip sheets were created to help resolve training/workflow questions. “Mock” Go Live test runs were staged to simulate downtime process.

Knowledge Based Charting

Go Live/Activation Support: Downtime/Cutover – June 10 – 11th 6PM – 7AM KBC content loaded to Production environment Post Load Manual Build work System Release – June 11th @7AM Post Go Live Support/Chart Audits

Knowledge Based Charting

Accomplishments: Establishment of a clear Project Plan w/timelines and milestones for

implementation.

Development of a Prototype Signoff Process to validate requirements.

Enforcement of a BUILD FREEZE date ensured delivery of stable documentation at Go Live.

Creation of new Interdisciplinary Flowsheets promoted standardized documentation

Knowledge Based Charting

Accomplishments: Clinical Summaries allowed for “1-stop shopping” view of patient chart

A 50% increase in documentation consistency was reported as an Initial Improvement post go live

Creation of “Pull Sets” allowed for Nursing Documentation to be pulled into Ancillary Department notes (Nutrition, Rehab)

Automation of Clinical Practice Guidelines (CPGs)

Greater sense of Participation and Ownership felt by departments in the Patient Care process.

Knowledge Based Charting

Staff Augmentation & Support

July – Dec 2013

Staff Augmentation & Support

Our Challenge:Now that the site is live on Knowledge Based Charting, we need to be able to sustain the momentum we’ve created with Interdisciplinary documentation.

We also need to be able to control requests for future changes to documents in the system.

Solution:Establish a formalized Change Control Process.

Approach: Identify key components of a Formalized Change Control Process Establish process for progressing builds through the environments in

the system

Staff Augmentation & Support

Change Control Process Components: Change Request form Change Control Spreadsheet Weekly Change Control Review Meetings Evaluate change for impact to other areas of the system Develop Initial Prototype Review Prototype with End User & Obtain Signoff

Staff Augmentation & Support

Environment Progression of Builds: Change Request does not leave DEV environment until signed off by

end user. Once approved, move to TEST and TRAIN environments. Extensive testing performed on Change Request in TEST environment

to ensure accurate outcomes. Conduct End User Training on changes, if necessary. Coordinate time with the end user to move Change Request into the

PRODUCTION environment Move the Change Request into PRODUCTION. Notify End User that request is complete.

Staff Augmentation & Support

Accomplishments: Better accounting of Change Requests

Easier Status Reporting on Change Requests

Improved focus on Higher Priority Change Requests

More accurate, reliable testing

Consistent Training

Easier Troubleshooting for Production Issues

Staff Augmentation & Support

Knowledge Transfer

Jan – June 2014

Knowledge Transfer

Our Challenge:We need to enable the site to support their Clinical Documentation after we roll off the Project.

Solution:Facilitate Knowledge Transfer and create a Formalized Training Program for new Faxton employees so they may support the system going forward.

Phase 1 – Foundation Concepts: Environment Overview Introduction to Change Control Process “Pre-Build” Work:

Create a “build spec” for each change request on paper before doing anything in the system.

Knowledge Transfer

Phase 2 – Basic Clinical Documentation Concepts: Introduction to lists, observations, sets Build Simple Change Requests:

List item additions Spelling corrections Add new observations Moving (positioning) items within a document and/or set

Knowledge Transfer

Phase 3 – Advanced Clinical Documentation Concepts: Introduction to Discriminants, Flowsheets, Structured Notes, MLMs, etc Build Advanced Change Requests:

Create a new Flowsheet or Structured Note Build Discriminants Calculations/Advanced Calculations Develop Clinical Summary Tiles/Views Pull sets Multi-Part/Faceted Change Requests (Ex/ Clinical Documentation

interfacing with Order Items, MLMs, Reports)

Knowledge Transfer

Phase 4 – Transition of Ownership:Faxton Resource now: Leads Weekly Change Control Meetings Builds Prototypes Develops plan for moving changes between environments.

Knowledge Transfer

Accomplishments: Instilled a good working knowledge of Clinical Documentation to

Faxton resource

Faxton resource is now able to conduct effective meetings and calls

Faxton resource is now able to effectively complete any build assignment asked of him or know where to go to get support

Knowledge Transfer

Questions?