All Hands on Deck: IT Involvement in EDIS Implementation

1. All Hands on Deck: IT Involvement in EDIS Implementation 13th Annual National Emergency Department Information System Symposium December 10-13, 2007 New Orleans, Louisiana Catherine Glenz, RN, BSN Consultant – Glenz IMAP Consulting L. Albert Villarin, MD FACEP CMIO – Albert Einstein Healthcare Network

2. Outline • Assist with finding vendors • Make initial contact with vendors • Ask about functional requirements • Assist with RFI/FRP • Explain current IT strategies • Discover integration needs • Assign resources for implementation

3. Outline Continued • Review network needs • Ask about budget responsibilities • Review contract • Attend product demonstrations • Attend site visits • Assist with project plan • Determine support hierarchy

4. Outline Continued • Assist with application build • Assist with interface build • Application testing • Integrated testing • Set up training environment • Attend training sessions • Parallel systems • Be present for “Go Live” support • Assume liaison role for trouble shooting

5. Real Quotes From Vendors What is said What it means “We don't know where we're going, but we're moving full steam ahead.” “We just hired three guys... We'll let them kick it around for a while.” “We threw the whole thing out and are starting from scratch.” • “A number of different approaches are being tried.” • “An extensive report is being prepared on a fresh approach to the problem.” • “Modifications are underway to correct certain minor difficulties.”

6. Real Quotes From Vendors What is said What it means We haven't started this job yet, but we've got to say something. The only guy who understood the thing just quit. Let's spread the responsibility for this Prior COO was fired and this person is supposed to pick up the pieces • “The design will be finalized in the next reporting period.” • “The entire concept is unworkable.” • “We need close project coordination.” • “Let me introduce you to our new COO”

7. Assist With Finding Vendors • You know the technology. • Let your users know what will or will not interface with your systems • Explain the WHY, not just the WHAT • Legacy vs. New Systems • Remote Hosting vs. Local Hosting • Speak up about resources!

8. Make Initial Contact With Vendors • Use your professional contacts: • Phone, email, onsite • Evaluated multiple site of SAMEvendor • Personal experiences • Careful of ‘Hear-say’ and ‘Heresy’

9. Ask About Functional Requirements • What will it take once its purchased? • Deployment – “soup to nuts” • Up-front and long term • Maintenance • Problem reconciliation

10. "Computers make very fast, very accurate mistakes."

11. Assist With RFI/RFP • Be the voice of reason: • Edit specifics to tailor to your needs • Take part initially AND when its received • Follow up on vendor claims • Call or Email ALL clarifications • GET IT IN THE CONTRACT

12. Explain Current IT Strategies • Take time to look in the mirror…. • Where have we been • Past mistakes, problems, issues • Where are we now • Currents state – stable? – “Best of Breed”? • Where are we going? • Costs, budget, ongoing current platforms • Phase out of legacy

13. Discover Integration Needs • What will WE have to do? • Support from vendor • Complete – Partial – On Demand • Cost? – per event / per period of time • Partnership or Leadership • FTP or ON SITE • Time expectations – in contract? • GET IT IN THE CONTRACT

14. Assign Resources For Implementation • Personnel • Tech, Nurse, Doc, Admin • Financial • Overtime, FTE supplements • Schedule • Expect it to take longer than what’s in print • Parallel efforts • Maintain legacy • Support new platform • Cost of License fee of BOTH

15. Review Network Needs • Network Vision: • Who, in IT is on board? • IT subcommittee • COO - CIO – CNIO - CMIO – VP(s) • Financial – IT money or ED money? • Medical Staff Board – all ED campuses • Physician Leadership • Nursing Leadership

16. Ask About Budget Responsibilities • Cost of Ownership: • Purchase / Time in Years • Administrators aware of market? • IT leadership aware of • Local / National IT trends? • Initial cost / Maintenance? • Operations • FTE – backfill (“What is IT’s Role”?) • Super User / Trainers / Training • Hardware / Software – RHO vs. CHO

17. Review Contract • Careful here • Work with lawyers who are familiar with IT contracts • Get input from all administrators • CIO, CMIO, Project Team Leader • C-SUITE – CMO, COO, CNO • Be Picky – Its in the DETAILS

18. Attend Product Demonstrations • Invite vendor to your hospital • Support any needs for demo • Invite ALL clinical, IT, Admin services to participate and evaluate • Use a template: common scoring grid that evaluates key CIS aspects: • + those imperative to YOUR HOSPITAL

19. "Software suppliers are trying to make their software packages more user-friendly... Their best approach, so far, has been to take all the old brochures, and stamp the words, 'user-friendly' on the cover“ -Bill Gates

20. Attend Site Visits • Vendor ‘sponsored’ • Great time to ask questions of vendors • NON-Vendor ‘sponsored’ • Great time to ask questions of user(s) • Call their users or those equal to your position

21. Assist With Project Plan • Imperative to your survival • Plan the future of your department • Can we get this done? …on time/budget? • Do we have the support from everyone? • …what if? ….what if? …what if?....

22. Determine Support Hierarchy • Who is in CHARGE? • Who do we get help from? • Who can we NOT expect help from? • If there is an issue, who do we turn to for reconciliation?

23. Assist With Application/Infrastructure Build • …right from the start • Do NOT wait! • If there is interest – then start looking into potential snags with: • Infrastructure (Hardware / Software) • Wireless – COWS – Printers – etc • Legacy – Security – HIPPA – Single sign on • User Profiles

24. Assist With Interface Build • Focus on the REALITY! • Do not get distracted from what can or cannot be done • Prepare your team – NASA PARADIGM • Component ACCOUNTABILITY • Break down connectivity by system • Keep on track – schedule MILESTONES • Weekly progress / Scheduled monthly ‘decompression’ meetings

25. Application Testing • Emergency Department created scenarios • 12 patient types • Multiple patients • Admission • Death • Code • Special victims

26. Integrated Testing -Notify all departments: ‘Test patients in the wire’ • Most important for success of a CIS • Add to the patient by complexity • Laboratory • Radiology • Transfers • Know your current processes • Redesign and create new ones • All users must be involved: • Doc, Nurse, Pharmacist, Admin, Registration, Clerk

27. Set Up Training Environment • Be as close to reality as possible • Practice for the Game! • Warn against “work-arounds” • Treat / solve issues on the spot • IT / Vendor / Process – reassessment • Document with ‘Trouble Ticket’

28. Attend Training Sessions • Get involved • Ask questions • See users’ reactions live (Not Hear-Say) • Solve misunderstandings right away • These will lead to potential negative user sentiments at go-live • OR…even worse – “PRE LAUCH DYSFUNCTION”

29. Parallel Systems • Advise on pros and cons • Coordinate • Assist with decision making • Provide additional resources

30. Be Present For “Go Live” Support • Lead the way! • Be vocal and supportive • Assist new users • Support Super-Users • Do not show any negativity • Teamwork is the KEY! • ‘Sell’ your product by a unique name

31. Assume Liaison Role Trouble Shooting • Trouble shooting • Issue escalation • Upgrades • Contract renewal terms

32. Conclusions • Be involved and Stay involved! • Focus • Long hours – 24/7 availability • Duration – 5 years • Be flexible but persuasive • Know your limitations • Be ready to say “NO”: • Work arounds • Second best solutions • Inefficient utilization Evaluate – Discuss – Redirect - Succeed

33. Questions ? 13th Annual National Emergency Department Information System Symposium December 9 -13, 2007 New Orleans, Louisiana Catherine Glenz, RN, BSN Consultant – Glenz IMAP Consulting L. Albert Villarin, MD FACEP CMIO – Albert Einstein Healthcare Network