Barbara Carrizales, RN MS Managing Director, National Clinical Informatics Tenet Healthcare 1 Clinical Informatics: It’s Our Time! 2014 Clinical Informatics Academy Sponsored by DFW ANIA Chapter October 10-11, 2014

Conflict of Interest Disclosure Barbara Carrizales, RN MS has no real or apparent conflicts of interest to report. 2

 Describe the post-live sustainment model used to maintain EHR adoption and provide care and feeding of the EHR  Present a sustainment measurement tool  Provide examples of successful use of sustainment approaches in the hospital setting 3

80 Hospitals 197 Outpatient Centers 12 Hospitals 36 Outpatient Golden State Health Plan California Arizona 6 Hospitals 4 Outpatient Abrazo Advantage Health Plan Texas 19 Hospitals 63 Outpatient Valley Baptist Health Plan Alabama 1 Hospital 5 Outpatient 10 Hospitals 28 Outpatient Florida 5 Hospitals 15 Outpatient Georgia 5 Hospitals 10 Outpatient S. Carolina 2 Hospitals 4 Outpatient N. Carolina 2 Hospitals 3 Outpatient Pennsylvania Massachusetts 3 Hospitals 4 Outpatient Connecticut (LOI) 4 Hospitals Tennessee 2 Hospitals 6 Outpatient Michigan 8 Hospitals 9 Outpatient ProCare Illinois 4 Hospitals 4 Outpatient Chicago Health Plan Missouri 2 Hospitals 3 Outpatient Mississippi 1 Outpatient New Mexico 2 Outpatient 6 Health Plans 4

InstallationAdoption Focus on user trainingFocus on user adoption Focus on go-live eventFocus on long term sustainment and value realization Focus on go-live success factors Focus on embedding new processes and work flows and continuous improvement Go-Live Event Installation Post Go-Live Benefits Adoption and Sustainment 5

 How does the hospital sustain and improve EHR benefits post-live? 6 Sustain Protocol ElementsOutcomes Roles & ResponsibilitiesOwnership Governance & CommitteesAccountability Change Request ManagementSystem Usability Standardization Managers’ ToolkitOptimization

To Promote Ownership 7

 Roles ◦ Executive Sponsor (Steering Chair) ◦ Chief Nursing Officer (CPIC Chair) ◦ Clinical Informatics Director ◦ MU Coordinator ◦ Physician Champion Informaticist ◦ Information Systems Director ◦ Health Information Director (HIM) ◦ Training Lead ◦ Pharmacy Informaticist  Committees ◦ Steering ◦ Clinical Process Improvement Committee (CPIC) ◦ Physician Advisory Group ◦ Meaningful Use Committee 8

 IMPACT Hospital Sponsor ◦ Chairs Hospital Steering ◦ Chairs Meaningful Use Oversight Committee ◦ Consults CI Director and VP Applied Clinical Informatics on clinical system replacement, upgrades and new purchases ◦ Principal IMPACT communicator ◦ Allocates training resources for new hires, new physicians and system upgrades  Primary Objectives ◦ Achieve Meaning Use – Federal and Tenet targets ◦ Allocate resources to support ongoing IMPACT operations ◦ Provide visible support of IMPACT and Sustain Protocol 9

 Chief Nursing Officer ◦ Chairs the Clinical Process Improvement Committee (CPIC) ◦ Communicates key advisory team decisions ◦ Participates in Hospital Steering and Meaningful Use Oversight Committee ◦ Establishes initiatives to improve Meaningful Use, quality metrics and process improvement ◦ Facilitates change request approvals  Primary Objectives ◦ Promotes interdisciplinary collaboration and alignment ◦ Ensures workflows, downtime and other policies and procedures are up-to-date ◦ Ensures department heads follow up on compliance issues ◦ Monitors continuous improvement action plans 10

 Physician Champion ◦ Chairs Physician Advisory Group ◦ Serves as principal communicator and EHR advocate with physicians ◦ Increase physician adoption and utilization of EHR and CPOE ◦ Participates in Hospital Steering, CPIC, and Meaningful Use Oversight Committees  Primary Objectives ◦ Achieve physician adoption of technology ◦ Serve as the voice of physicians in system changes ◦ Engage physicians in ongoing order set evolution 11

 Training Lead ◦ Keep training materials and collateral up-to-date ◦ Track delivery of training for new staff and physicians ◦ Manage training for system upgrades and releases ◦ Monitor training effectiveness ◦ Participates in CPIC ◦ Member of the super user group  Primary Objectives ◦ Ensure staff and providers are trained to perform their work using IMPACT 12

To Promote Accountability 13

 In order to maintain visibility and awareness of EHR adoption, utilization of CPOE and compliance with Tenet Clinical Standards, the following committees are in place to communicate progress and opportunities for improvement and provide forums for interdisciplinary information exchange and organization decision- making ◦ Hospital Steering Committee ◦ Clinical Process Improvement Committee ◦ Meaningful Use Oversight Committee ◦ Physician Advisory Group ◦ Super User Group 14

 Hospital Steering Committee ◦ Ownership by hospital executives ◦ Resource allocation to support the EHR ◦ Attainment of MU and quality targets  Clinical Process Improvement Committee ◦ Clinical system change requests ◦ Actions to improve MU and quality compliance  Meaningful Use Oversight Committee  Physician Advisory Group ◦ Physician change requests ◦ Order set and decision support review and evolution  Super User Group ◦ Training new staff and supporting new releases and functionality 15

To Promote System Usability & Standardization 16

 Guiding Principle ◦ Changes are made system-wide (all hospitals)  Vetting ◦ Clinical informatics director is the gatekeeper at the hospital ◦ Clinical Process Improvement Committee must approve (requires interdisciplinary review) ◦ Change requests reviewed regionally  Design and Approval ◦ “Standards” clinicians design change with end user input ◦ Clinical advisory teams and Change Control Board approve to implement  Implementation ◦ Change is built and scheduled for testing and moved to production with CI input 17

To Promote Optimization 18

 Role of the Manager Changes with Automation ◦ Tools employed in supporting the manager to drive behavior changes based on evidence and metrics  Application Tools Employed ◦ Standard Reports – examples: Census, Orders by Unit/Shift ◦ Report Writing Tools for ad hoc reporting – example: CPOE Utilization, Medication Reconciliation, Allergies  Metrics ◦ Examples: Barcoding for Medication Administration, Abnormal blood glucose levels, eMAR overdue schedules  Monitoring and Feedback Mechanism ◦ Review at Clinical Process Improvement Meetings ◦ Review with individual end users as applicable 19

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Measuring Hospital Sustainment Health 21

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23 Green = 0 vacancies/deficiencies Orange = deficiencies Red = 3 or more deficiencies

 Regional Clinical Informatics Director discusses results with hospital sponsor and formulates remediation plan ◦ Leverage best practices from other hospitals  Visits  Mentoring from peers ◦ Allocate resources to fill vacancies ◦ Restart or re-energize committees ◦ Educate super users and managers ◦ Etc… 24

 Steering and CPIC in place – keeps leaders engaged and informed ◦ CPIC maintained as decision-making and approval body ◦ Sub-groups employed to propose solutions ◦ Physician Champion active and engaged  Informatics Team centralized – CI, MU Coordinator, Pharmacy, Training Lead ◦ Promotes collaboration and open communications ◦ Provides a common place for issue presentation, discussion, and resolution for different departments 25

 Strong working relationship with IT ◦ Issues management ◦ Trending  End Users are kept informed and supported ◦ At the elbow support ◦ Monthly night rounding ◦ IMPACT as standing agenda in staff meetings  Collaborative relationship with department directors ◦ Facilitates communication of new initiatives, issue resolution, and workflow changes 26

27  Barbara Carrizales, RN, MS ◦ Managing Director, National Clinical Informatics ◦ Tenet Healthcare ◦

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