EHR Implementation from an Acute Hospital Perspective

1. EHR Implementation from an Acute Hospital Perspective Michael Strachan EHR Program Manager

2. Mater Health Services Brisbane • Not for profit, privately owned company by the Sisters of Mercy • 7 Hospitals – 972 Beds • Mater Adult Public Hospital – 205 Beds • Mater Mothers’ Public Hospital – 102 Beds • Mater Mothers’ Private Hospital – 93 Beds • Mater Children's Public Hospital – 141 Beds • Mater Children's Private Hospital – 37 Beds • Mater Private Hospital South Brisbane – 323 Beds • Mater Private Redlands – 71 Beds

3. Mater Footprint

4. Mater Patient Activity

5. Queensland Context • Queensland Health (QH) is a major partner of Mater • Mater Public Health Services Act 2008 passed in November 2008 • Paves the way for better connectivity • QH E-Health strategy under development • Not bound by E-Health strategy • Collaboration re client index etc important

6. Background

7. EHR Strategy Chronology • Early 2003 – Commenced EHR strategy sponsored by CEO • Mid 2003 – Conducted market EOI • Mid to late 2003 – Vendor investigation • Early 2004 - International site visits • Mid 2004 – CIO commenced • 2004 – 2007 • Building better IT service capability • Replacing PAS & consolidating PMI

8. A Strategic Framework ? • Vision: • A whole of Mater patient medical record electronically accessible anywhere, anytime. • Goal: • The Mater’s EHR program will deliver a web based single point of access for clinicians to access clinical information at the point of care/ decision making across the enterprise from both inside and outside the organisation.

9. In Hindsight….

10. Lessons Learnt • Strategic approach was fundamental – long range journey – not big bang • Research more than just vendor demonstrations • Site visits were critical • Gartner, HIMSS analytics valuable • Organisational readiness is critical • Staged approach to implementation

11. Engaging & Empowering Clinicians

12. Understand Clinical Attitudes • Plenty of war stories about failed EHRs • Clinicians unconvinced an EHR can deliver benefits • Competition for the scarce capital dollars ie Clinical equipment • Use of clinical systems in specialist and GP practices is more prevalent – driving expectation hospitals should too!

13. Understand Benefits • Patient safety a major benefit • ie system for follow-up of results • Clinical workflow efficiency • Silos of clinical information • Incomplete, missing, unwieldy paper record • $2-3 million per annum on maintaining a paper based record

14. Many Disparate Systems… Radiology Results Obstetric System Emergency System Pathology Results Oncology System Clinical Letters External Results Pharmacy System Patient Administration Data Digital Radiology Images Obstetric U/Sound Report Electronic Discharge Summary

15. Clinical Portal – the solution? Radiology Results Electronic Discharge Summary Patient Administration Data Emergency System Obstetric System Single Point of Access to all Mater Clinical Information – a beginning only… Oncology System Clinical Letters Pharmacy System Digital Radiology Images External Results Pathology Results Obstetric U/Sound Report

16. Empower your clinicians • Traditional IT solution procurement methodology not suitable • Live proof of concept critical to empowering Mater clinicians • Consistent with the clinical trial or scientific methodology which clinicians understand

17. Verdi - A Solution for Mater ? • Commercialised software solution originally developed by Peter MacCallum Institute for clinicians • Mater is the first site to pilot this solution outside Peter Mac • It is a low cost, unique solution which can be implemented within a relatively short space of time

18. Verdi – Clinical Trial • 6 month trial with three clinical teams or 60 users • Replaced existing information systems & practices • External Private Results – S&N / QML (Mother’s only) • Access to patient attendance data in the PAS • Emergency = EDIS, Obstetrics = Matrix, Oncology = Charm, Discharge Summary = Discharge Summary System (DSS), Medications = Merlin • Access to outpatient clinical letters • Pilot group has reached 200 users • Successful clinical trail methodology branded Verdi as a helpful tool for clinicians – not a hindrance • Good design methodology – iterative / rapid development

19. Governance & Execution of the Mater’s EHR

20. The Mater’s EHR Program • Approved by Mater Board March 2008 • Governance, facilitation of the work program of projects to transition the Mater to an Electronic Health Record • Steering committee to govern & determine priorities – senior clinical directors / executive representation all hospitals

21. Why Program Management • Program framework ideal for ensuring EHR implementation can be broken down into more manageable projects • A coordinated approach for managing project schedules, dependencies, issues and risks • Implement systems for managing change management, budget control, benefits management etc for stage 1 & 2

22. HIMSS Analytics Adoption Model

23. Mater’s EHR Program Priorities

24. Clinical Portal (Verdi) Single point of access to all Mater clinical information systems including: Path, Rad, PAS(attendances/bookings), DSS, Clinical Letters, PACS images (DICOM viewer), Private path/rad, Scanned referral, Pharmacy,EDIS, Matrix, etc (over time) Results acknowledgement of all Mater pathology / radiology results Clinical documentation (VNotes)

25. EHR Infrastructure Patient Master Index (PMI). Develop a technical solution between iPM and third party clinical information systems for enforcing the iPM PMI as the source of truth Health Practitioner Directory (HPD). Develop Mater’s existing HPD to facilitate consistency & synchronisation of Mater internal practitioners among all clinical information systems. Partner with GP Qld to develop a real time update of external providers.

26. Document Imaging Solution Investigation of a document imaging solution for scanning of health records including key documents such as referral and external correspondence for access within the Clinical Portal as an electronic view of the paper record.

27. Shared EHR Project Provider Portal GPs access generally and specifically to support for shared care models i.e. Maternity, Diabetes etc. VMO access to their patients Mater records Queensland Health access for interflow patients Patient Portal development of patient access to views of their health record e.g. Maternity hand-held record Transactional capabilities such as checking upcoming appointments, bill payments, online preadmission etc

28. Electronic Health Record Program Structure EHR Stage 1 Projects Program Office Support

29. Benefits Management Approach • Benefits identified in the funding submission will be evaluated and reported to the Mater board • Evaluation of existing business processes will be undertaken to formally baseline benefits • Change manager will oversee identification, recording, tracking and reporting of benefits

30. Change & Communication Mgt • Stakeholder engagement and analysis is critical • Must reach a balance between focus groups, one on one approach to engaging • Engaging coal face staff critical • Business process review is critical to identify benefits • Including enterprise and local functionality important for clinical buy-in in a hospital environment

31. Change & Communication Mgt • Implementation is incremental to maintain momentum • Use of piloting and rapid prototyping essential change technique & to ensure effective design • Scheduling needs to consider other organisational or project change initiatives that are in progress • Resourcing & recognising the change management function in EHR project is critical to success

32. Change & Communication Mgt • Significant expectations around implementing an EHR – differing perceptions • Must manage expectations of key stakeholders and not rely on mass forms of communication ie Group email does not work • Chief Medical Information Officer is critical to maintaining effective engagement, change and communication with Mater clinical stakeholders

33. Challenges & Issues • Data quality in source systems – PMI data • Device access particularly in inpatient areas • Delivering short wins for clinicians – do not allow long elongated project timeframes • Scope creep for bells and whistles as opposed to meat and potatoes functions • Infrastructure readiness ie reliability of wireless network

34. Current & Future State

35. EHR Stage 1 Status

36. 5 Years from now… • One stop shop clinical portal + scanned paper record • Eliminate reliance on paper record & overhead • Better system data quality & information architecture • Paperless in ambulatory areas • Integration with Mater’s partner providers using national identifier and messaging standards • Patient Portal significantly utilised to improve the patient experience • Order entry and medication management system implementation well under way • Enterprise clinical documentation with decision support staged rollout