1. Implementing a Clinical Information System – Strategies for Success Helen Edwards RN MN January 26, 2012 PMI – SOC Professional Development Day

2. Outline Evolution of Computerization at SickKids Implementing a Clinical Information System –Design –Communication –Education –Go-Live –Post Go-Live Key Success Factors Lessons Learned

3. SickKids Hospital TOTAL Planned Beds 274 Ambulatory Visits217,707 Day Surgery Visits4,953 Inpatient Surgical Visits6,506 Emergency Visits57,561 Admissions14,590 Average LOS 6.9 Patient Days100,595 Average Daily Census276

4. Evolution of Computerization Complex infrastructure - comprises diverse platforms, applications, client devices Complex and dynamic technological environment with >200 information technology systems/applications in use main clinical apps patient management apps decision support apps interface technology apps scheduling and departmental systems personal productivity apps business services network/computing infrastructures communication apps

5. Evolution of Computerization cont’d 1980s first clinical information system – home grown system (functionalities included laboratory order entry / results retrieval and diet order entry) 1992/1993 DOS based system (Kidcom) – ADT, CPOE, eMAR, some clinical documentation 1996 Telemedicine launched 2000 - ICUs – all clinical documentation except CPOE

6. Evolution of Computerization cont’d Other common systems –PACS –Scanned historical paper chart –Schedule Book –Transcription and Dictation System –Ambulatory Referral Management System –eCHN – provincial paediatric EHR –Surgical Information System –Emergency Department Information System

7. Evolution of Computerization cont’d 2005 – KidCare Phase I (transitioning Kidcom to Windows based system) –Patient Lists –Results retrieval 2008 – KidCare Phase II (transitioning remaining functions) –CPOE –eMAR –Clinical Documentation (e.g. Admission Assessment, LOA, Discharge Summary)

8. Our Vision Fully electronic patient chart across the inpatient and ambulatory areas –Progress Notes –Flow Sheets –Consents –Diagrams/Photographs, etc. Universal Workstations –Single Sign-on –Multiple form factors

9. Implementing a Clinical Information System Design Communication Education Go-Live –Command Centre –Support Post Go-Live

10. Design Based on user input working with informatics clinicians –Reflect practices and processes –Engage clinical departments/areas – e.g. responsible for their order sets –Testing – (unit, functional, integrated) accomplished by users and informatics clinicians

11. Communication Hospital-wide engagement/profile Steering Committee –Executive Sponsor –Physician Leadership –Nursing Leadership –Professional Services Leadership Project Team –Diverse membership – IS, Clinical Programs, Other programs

12. Communication cont’d Built off of successes of KidCare Phase I User Groups - Nursing, Professional Services, Physicians, Others Super Users –Meetings –Emails Hospital publications –This Week (print) –Daily News (homepage) Website – KidCare; Countdown Key Leadership Forums – Executive, Directors, Managers, Educators, MDs

13. Informatics Education 3500+ staff 8 Weeks

14. Education and Support Pre-education Communication and Advertising for Education Blended Learning Approach Go-live Post Go-live Support

15. Pre - Education

16. Pre – Education Open Forums

17. Pre – Education Open House

20. Education and Support Pre-education Communication and Advertising for Education Blended Learning Approach Go-live Post Go-live Support

21. Communication and Advertising

24. Education and Support Pre-education Communication and Advertising for Education Blended Learning Approach Go-live Post Go-live Support

25. Blended Learning Approach Computer-based Tutorials (CBTs) –Mandatory pre-requisite –General/Basic information –Decreased in-classroom time –Staff themselves decided when and where Instructor Led Classes (ILC) –Complex process or changes in process/ concepts –To anchor knowledge – provide hands-on training

26. Super User Education Job Description –proficient at all functionality on legacy system and KidCare Phase I –recognized ability to lead and support all health care colleagues –availability to act as a SU during implementation Attend Super User training

27. Incentives

28. 3500+ staff 8 Weeks Original Goal Outcome: –Between Sep 4 th and Nov 4 th 3083 staff were trained 585 classes were held 88% of staff were trained by go-live 98% within 6 weeks of go-live

29. Education and Support Pre-education Communication and Advertising for Education Blended Learning Approach Go-live Post Go-live Support

30. Go-Live Command Centre

31. Command Center Help Desk

32. Immediate Assistance

33. Communication tools

34. External Support Staff and Super Users

36. Education and Support Pre-education Communication and Advertising for Education Blended Learning Approach Go-live Post Go-live Support

37. Post Go-Live Ongoing education Clinical Applications Resources and Education Support (CARES) Ongoing communication –Tips and Tricks –Website updates KidCare Duty Officer (KDO) Stabilize the system for a period of time before making any revisions

38. Key Success Factors Hospital engagement –Hospital-wide project – ownership –Go-live day was a “marked event” Communication mechanisms –Countdown –Posters –Clinical Managers, Directors, VPs Education –Model –Daily communication –CME Credits

39. Key Success Factors Go-Live Support Model –Command centre –Super Users –Informatics nurses –Hiring skilled activation support resources helped the front-line users tremendously throughout the activation process. Post Go-Live Support Model –Continuing training session –CARES

40. Sense of Humour Essential Lessons Learned

41. Application –Ensure sufficient resources for both the project team and support staff –Cross-train more of the project team members on system configuration –Changes to a legacy system should be restricted to only those that are critical – Printing should be tested earlier in the project

42. Lessons Learned Training –Ensure you have sufficient technical expertise to support training –No grab bags –Have an admin assistant –An LMS would help! –Regular debrief sessions

43. Lessons Learned Training –Create a mock training environment for informatics educators to practice –Create a practice database for staff to practice after attending training –Online Reference Material only – no paper

44. Lessons Learned Support – Extended activation support should be planned for and acquired (for example, contracted project team members should not be released shortly after activation)

45. Questions?

46. Helen Edwards RN MN Director – Clinical Informatics and Technology Assisted Programs Hospital for Sick Children (SickKids) helen.edwards@sickkids.ca Contact Information