Presentation Transcript

1. e-Health 2013 Challenges & Opportunities TEC Talk

   Service Interrupted…AHS Experience with IT Major Incidents& Clinical Involvement Wendy Tegart, Provincial Director Service Management Jill Robert, IT Strategic Partner
2. Faculty/Presenter Disclosure Faculty: Wendy Tegart & Jill Robert Relationships with commercial interests: Grants/Research Support: Not applicable Speakers Bureau/Honoraria: Not applicable Consulting Fees: Not applicable Other: Employees of Alberta Health Services Nothing to Disclose
3. Agenda Alberta Health Services Overview 1 2 Major Incident Process 3 Major Incident Roles 4 Communication Approach 5 Clinical Involvement 6 Next Steps 7 Questions
4. Alberta Health Service Overview Alberta Health Services (AHS) Responsible for delivering health services to the 3.8 million people living in Alberta, over 661,848 square kilometers served Annual Service Volumes (2011-12) Acute Care 2,029,191 Emergency Department Visits 376,115 Hospital Discharges 2,602,384 Total Hospital Days 50,099 Births 99 Acute care hospitals and 5 stand-alone psychiatric facilities Primary Care 104,704 Home Care Clients 766,146 Health Link calls 393,964 EMS Calls/Events
5. Alberta Health Service Overview AHS Scale of Effort Largest Employer in Alberta, 5th largest in Canada 100,000 employees 7,000 physicians 120,000 network IDs Scope of AHS-IT 1,514 production apps (163 critical) 34 data centers 4,721 servers (physical and virtual) 75,000 workstations 48,000 tickets generated monthly 550 concurrent users in ITSM tool 1,300 IT Staff (+ outsourced partners)
6. Major Incident Process Context to Current Realities Complexities of Electronic Health Record in Alberta Local vs Provincial IT service delivery Given the complexities of the AHS IT landscape, aging and varied technical infrastructure and critical service requirements to support patient care... “Downtimes happen...” How do we minimize organizational and clinical impact and provide robust support when the technology fails?
7. Major Incident Process Super Bowl 2013 – infamous power outage
8. Major Incident Process What is a Major Incident (MI)? IT has a provincial Incident Management Process to manage all Incidents. When an Incident is of a certain scale, scope, or impact, a “Major” Incident is launched. The goal of the Incident process is to return an IT Service to operational status. Throughout AHS-IT, we employ this common process to ensure that major IT service issues are quickly identified and appropriately responded to. The purpose of the MI process is to supplement the Incident process with additional resources, escalation, communication and record keeping.
9. Major Incident Process Is this a “Critical” Incident? Urgency and Impact must both be High to create a critical incident. Critical Incidents must be escalated to the IROC immediately. Critical incidents are: a major outage affecting a large number of customers an essential service and/or a business unit where there is no available resolution or work around to provide a return to business operations Must also consider: Patient safety may be at risk or reduced effectiveness of patient care The safety of AHS staff and personnel Impact to confidentiality of data, or reliability of data Degradation of a service including data, applications, or infrastructure. A Senior Admin from the business is requesting a Major Incident be declared (requires immediate escalation to IROC)
10. Major Incident Process Is this a “Critical” Incident? Urgency
11. Major Incident Process Is this a “Critical” Incident? Impact
12. Major Incident Process Priority
13. Major Incident Process Major Incidents by Month
14. Major Incident Roles IT Major Incident Roles An IT service Incident is typically managed by the IT Service Desk and/or a specific IT Service team. When an MI is initiated, some additional resources brought in include: IT Incident Response On Call (IROC) This is a group of IT Directors who share an On Call responsibility for MI’s. Once contacted, the IROC is responsible for managing the MI Process so the Service Desk and Service team can concentrate on resolving the Incident. IT Security & Compliance On Call On Call IT Security staff to respond to MI’s with a security component. IT Senior Leader On Call This group of IT senior leaders is available to provide additional guidance and authority if/as required by the particular MI. Problem Manager Chair and facilitate communication bridge meetings. Notify IT staff of updates.
15. Major Incident Roles Clinical Roles Not all MIs require the engagement of clinical experts, but when required these roles provide context to clinical impact and urgency Clinical Informatics This is a group of Physicians and non-physicians Clinical Operations Administrator On-call On Call AHS leaders including Executive Directors and Site Administrators. May provide front line resources to support in downtime and reconciliation efforts Senior Leadership On-call This group of AHS Senior leaders include Facility Medical directors and VPS Health Information Management Health Record Management experts with data and record integrity expertise Zonal Emergency Operations Centres (ZEOCs) Tied into Emergency Preparedness
16. Communication Approach Bridges Types (conference calls) Technical Bridge Part of the Incident Management process, as is initiated independently of MI process Opened when collaboration by several parties is required during incident resolution activities Communications Bridge Launched by IROC to bring the right stakeholders together to identify the problem and direct its resolution. Problem manager assists by recording chronology, participants, decisions and results Directs communications within IT and the user community Clinical Bridge Usually chaired by a Clinical Informatics physician
17. Communication Approach MI Heads Up Notification
18. Communication Approach Communications to Customers
19. Communication Approach MI Root Cause Code Definitions
20. Clinical Involvement Clinical Support During a MI Transparency Communication Understanding and translating the clinical impact Timely and frequent “clinical speak” communication about the incident and immediate risk mitigation measures Support Robust downtime procedures owned by clinical operations Bedside to boardroom engagement and support
21. Clinical Involvement More than clinical involvement...it’s about relationships, partnerships and supportingsafe patient care!
22. Next Steps Next Steps Continuous improvement per incident review Develop service improvement plans overall driven by business requirements Examine different scales of MIs and support requirements Leveraging the successes of the MI process to other risk areas Continually examine clinical business risk tolerance/value and architecture of information systems Simplify – application consolidation, migration to a provincial patient care platform and large scale reliability/redundancy Higdon’s Law Good judgement comes from bad experience. Experience comes from bad judgement.
23. Questions? Comments / Questions Insanity: Doing the same thing over and over again and expecting different results. ~ Albert Einstein Jill.Robert@albertahealthservices.ca Wendy.Tegart@albertahealthservices.ca