Presented by Sarah Foster, RN, BSN, SANE-A April 22, 2013 We Didn’t Know What We Didn’t Know

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 2 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 ChangeTransition Change vs. Transition What 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 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 X X

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?