Presented by Sarah Foster, RN, BSN, SANE-A

April 22, 2013

We Didn’t Know What We Didn’t Know

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• Define change and how transition is a vital component

• Compare this change process to other examples

• Review the process of changing to a new Electronic Health

Record (EHR)

• Discuss what we didn’t know

• Discuss the impacts to end users

• Questions and answers

Agenda

• How to identify the need for a New EHR

• Establish criteria to evaluate success of new selection

• Identify and acknowledge what we didn’t know

• Identify steps to continue successful forward movement

Objectives

• External Process

• Situational

• Internal Process

• Occurs within Change Phases:

• Let go of the Old

• Neutral Zone

• A New Beginning

Change Transition

Change vs. TransitionWhat Do We Want in a New EHR?Change vs. Transition

• Multiple campuses, multiple organizations, multiple departments, and multiple stakeholders

• Multiple charting IT systems throughout organization and campuses

• Multiple complex and non-integrating workflows

Pre-Change Status

Primary Reasons:• Increase patient safety• Increase quality patient care• Monetary returns from

meaningful use

Other Benefits:• Discrete data elements• Patient integration and increased continuity of care• Increased readable and precise documentation

What Do We Want in a New EHR?

November 2010 – Vendor announced

Timeline over 5 Phases• Planning• Validation• Building• Testing• Go Live

Expedited Roll Out• Ambulatory go-live May 2012• Hospital Inpatient go-live August 2012

Vendor Selection

• Finalize scope

• Vendor breaks program into applications

• Recruit project champions, Core Team (Analysts and Trainers),

Subject Matter Experts

• Committees formed with representatives from all entities – TNMC,

UNMC Physicians, BMC, Private Practice Associates

Phase 1 - Planning

• Patient First• No compromising Quality and Patient Safety• Adhere to Model System• Standardize Practice (evidence based and best practice• Standardize Data• Computerized Physician Order Entry• Ease of Use• Interoperation and availability of data with a common

enterprise work process• Patient care, Education & Research{

Guiding Principles

• How fast 18 months can fly by

• How many workflow Visio’s would need to be created and modified

• How to direct people to start visualizing a new product different from their known and what impact that would have on so many

What We Didn’t Know

• Breakout sessions with specific applications to look at specific workflows • Create interdisciplinary/inter-affiliate task groups to help recommend

decisions in alignment with guiding principles

• Certification of core team in the vendor’s product

• Contract with outside consulting group to help with Order Sets, Care Plans and Patient Education

Phase 2 - Validation

• How hard it is to get all affected parties from different campuses all in the same room at the same time (literally or by conference phones)

• How hard it is to visualize a new workflow that we are conceptualizing with a computer system many still know little about

• How many times Visio’s would circle around and have to be recreated and revalidated

What We Didn’t Know

• Build/Modify necessary components from model system

• Hardware analysis, reports

• Training plan solidified

• Branding – One Chart

Phase 3 - Building

• One Chart – It Changes Everything!

• How hard it would be to keep deadlines

• The 80-20 rule does not fit all – especially when you have a team of high achievers and you work in healthcare

• How many moving pieces there are and how people cannot “silo” themselves in applications

What We Didn’t Know

• Go-live Readiness Assessments

• Interim Workflows

• Credentialed Trainers chosen for the Outpatient applications

• Operational Dress Rehearsals (ODRs)

Phase 4 – Testing and Training

• ODR’s – It matters who is in the room• Training – one size does not fit all

What We Didn’t Know

• A New Beginning

• Outpatient Ambulatory First

• Inpatient 3 months later

• Support

• Tickets, Tickets and More Tickets

• Post Live Feedback

• Information Management Structure

Phase 5 – Go Live & Optimization

• Olympic Torches have a flame for a reason• Post live feedback• The New Look of IT• How to say Good bye to the old

What We Didn’t Know

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• New Faces• New Projects• More Change

Phase 6 – Optimization and Rollout

• How long the marathon really is

• How many components of a new leadership structure are necessary

What We Didn’t Know

• Perfection is the enemy of good enough• Go Live is not the final step• A new language of Healthcare• It is not always easy to do the right thing, but that is what we are here to

do

What We Have Learned

How Did We Impact End Users

Questions?