AHRQ 2006 Annual Conference on Patient Safety and Health IT

1. AHRQ 2006 Annual Conference on Patient Safety and Health IT Socio-Technical Approach to Planning and Assessing Redesign Huron Hospital CPOE Implementation June 5, 2006 Greg Kall, CPHIMS Regional Vice President, Information Technology

2. Huron Hospital • 211-bed, acute care, urban hospital • Located in East Cleveland, Ohio • 361 member voluntary medical staff • 52 residents in Medicine and Surgery • Level II Trauma Center, Obstetrics, Community Health Center • Part of 4 hospital CCHS East Region

3. Components Live at Huron • Electronic Medical Record (EMR) • Patient Lists • Clinical Results Review • Clinical Documentation • Electronic Medication Administration Record (eMAR) • On-line Discharge Process • Computerized Physician Order Entry (CPOE) • Clinical Decision Support (Rules and Alerts) • Order Sets • Electronic Signature • Strong Authentication • Remote Access

4. Implementation Facts • Go-Live in July of 2004 • Phase I: Psych Unit and OB Unit • Phase II: ICU • Phase III: Remainder of hospital • 1,000,000 eOrders processed to date • CPOE utilization rates • Residents: 94% • Overall: 75% Two WeeksBetween

5. Organization Strategy • Inclusive • All 4 hospitals in CCHS East Region participated from the start • Multidisciplinary • Physicians, Nurses, Ancillaries, IT • Together from the very beginning • Implementation Team • Clinically Focused - More Clinicians than IT! • Pharmacists, Nurses, Laboratory • Ongoing/Active Management • Multi-year project • Simultaneous phasing activities • Design, Implementation, Maintenance

6. Executive Sponsors Steering Committee • Regional and Hospital Executives • Monthly Status Reports • Remove Barriers • Executive-level Support Project Organization Project Management Office Physician Advisory Committee Clinical Informatics Council Patient Care Advisory Committee • Regional CMO, Hospital Chiefs of Staff, Hospital Physician, Advisors, Director Medical Education • CPOE Design • Medical Staff Bylaws and Policies • Order Sets and Other Clinical Content • Physician process redesign • Regional CMO, Physician Advisors, Hospital CNOs, Project Staff • Collaborative clinical decision-making • Regional and Hospital Executives and Managers of Nursing, ED, Ancillary, Clinical Services, and Quality Departments • CPOE Design • Hospital and Department Policies and Procedures Implementation Team • Team Members • 4 Physician Advisors • 1 Pharmacist • 3 Nurses • 1 Medical Technologist • 1 HR Trainer • 1 Project Manager • 1 Interface Engine Analyst • 1 Report Writer • 1 ADT/Charge Master Analyst • Functions • Planning • Analysis • System Design • Application Build • Interfaces • Testing • Implementation • Support Four Hospital Physician Advisory Groups Task Forces Communication Process Redesign Training Security • Develop and Execute Plan • Develop and Execute Plan • Standard Flows • Unit Review • Custom content • Develop and Execute Plan Nursing Process HIS Process Pharmacy Process

7. Design Strategy Patient Care Advisory Committee • Learn the software • Identify processes likely to be impacted • By policies and procedures • By function • By department • Form workgroups, including front-line staff • Flowchart existing processes • Correlate the process to the software • Identify where changes may occur • Flowchart new and revised processes

8. Nursing Workflow Redesign Examples

9. Design Strategy • Validate new workflows • Design Endorsement Sessions to demo workflows • Audience includes physicians, nurses, pharmacists, ancillary departments • Structured scenarios with written participant evaluations • Iterative process • Revise policies and procedures to support new workflows • Conduct unit-specific workflow review sessions to identify exceptions • End-user training must include workflow changes and new Policies &Procedures DES

10. Design Strategy Physician Advisory Committee • Establish clinical priorities • Create and modify policies and by-laws • Review and approve design • Review workflows and process • Create and manage order sets • Create and manage rules and alerts Clinical Informatics Council • Where everything comes together! • Also provides ongoing post-live management

11. Feedback and Improvement Strategy Clinical Informatics Specialist • New position dedicated to supporting clinicians • One-on-one training (carries beeper) • Grand Rounds • Weekly resident meetings • Monthly User Group meetings Local Physician Advisor Group • Workflow feedback • Data/performance review

12. Performance Tracking Examples

13. Survey Instrument

14. Technology-based perspectives Social Perspectives Task-Technology Fit Fit with technology, User evaluation, Relative advantage Cognitive Processes, Information quality, Bounded rationality Information overload Task EMR Adoption & Ongoing use IT Acceptance Model Perceived usefulness, Ease of use, Attitudes, Behavioral intention Organizational Imperative Power and control, Information politics User Survey Dimensions