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The Implementation of Advanced Clinical Documentation for Bariatric Services at University Health Network: Lessons From the Field Vicky Ramirez, Giuseppe Cammisa e-Health 2013: Accelerating Change May 27, 2013. UHN Fast Facts Canada’s leading research and academic hospital 4 Sites:
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The Implementation of Advanced Clinical Documentation for Bariatric Services at University Health Network: Lessons From the FieldVicky Ramirez, Giuseppe Cammisa e-Health 2013: Accelerating ChangeMay 27, 2013
UHN Fast Facts • Canada’s leading research and academic hospital • 4 Sites: • Toronto Western Hospital • Toronto General Hospital • Princess Margaret Cancer Centre • Toronto Rehab Institute • $1.8B revenue • 762 beds • 1,400 physicians • 12,000 employees • 966,000 amb visits • $265M in research • 4,465 OR visits 2
UHN Advanced Clinical Documentation Strategy
In support of UHN’s ACD strategic goals… UHN will be a global leader in reporting on patient outcomes Research hospital of the future road map will be developed and implemented 4
ACD IP EPR ACD OP EPR ACD Bariatric Assessment Notes 5
Nurse Practitioners Social Workers Registered Dietitians Surgeons Psychologists Psychiatrists Psychometrists Support Staff Data Analysts Internists Endocrinologists 7
Project Team Privacy The Team Clinicians Mobility Partner • Human Factors Security Technical Teams 9
Challenges • Patients repeatedly answering the same questions • Clinicians’ persistent difficulties locating charts or finding information in a chart • Other challenges: • Interdisciplinary rounds • Diminished productivity • Outcomes monitoring • Leveraging data for research 14
Where we started Mapping the data flow Focus on outcome indicators Device & usability assessment 18
Agile and responsive development iOS design driving clear, standard documentation Free-text to synoptic Function (Human Factors) vs. flash Multidisciplinary lens – enable the breakdown of care silos 20
Workflow: Before & After Early results: Summary report allows time at end of day to be used for other purposes The problem: Back to back assessments resulted in charting being stockpiled until the end of day ~30 minutes saved per clinician per day! 23
Measuring Success: An Outcomes Approach • Baseline surveys and observations • Post-implementation surveys and observations Improving the ability to monitor and report on: Pre-Surgery Post-Surgery Health Status Time to Care Patient Errors Health Sustainability Patient & Clinician Satisfaction Data Collection & Access Cost Measures 24
Start small → gather learnings → grow access The Bariatric Journey
Critical Success Factors Leading edge technology; the ‘fun’ factor End to end change management Rapid prototyping/Agile documentation Improving data collection & access Sustainability model (leveraging existing infrastructure, MDM strategy) 26