Transcript PREPARING FOR AN E.H.R SYSTEM

PREPARING FOR AN
EHR SYSTEM
Carol Sainsbery Project Director
Leanne Cox
Medical Records Manager
Scanning @ Southern
“One small step for man;
one giant leap for mankind”
(Neil Armstrong, 20.07.1969).
Southern Health Vital Signs
• Acute, Sub-acute, Mental Health, Aged &
Community
• Service area of 2800 square kms and 750,000
people
• 12,000 staff
• Annual turnover of $700 million
Southern Health Vital Signs
• 110,000 inpatient attendances
• 700,000 outpatient attendances
• 1.8 Million PMI entries
• 2.4 million MR location moves annually
Scanning @ Southern
From this…..
Typical paper based
medical records
department;
To this…..
Casey Hospital medical records department
following the removal of shelving and
installation of scanning workstations
Preparing for an EHR System
How does a Health Service start?
An EHR is a journey,
not a destination
WHAT?
Activity One
• Group Activity
• Key Stakeholder Groups
• Brainstorming EHR
WHAT do you want to achieve?
• Paperless Medical Record
• Electronic diagnostics
• Direct entry forms
• Wireless tablets
• Integration between different systems
WHAT do you want to achieve?
• E-Prescribing
• Direct Pathology and Radiology order entry
• Remote access
• Document Management / Archiving
WHAT do you want to achieve?
If you don’t know where
you are going,
you surely won’t get
there!
WHY?
WHY do you want to do this?
Which would you prefer?
WHY do you want to do this?
• Clinical Care / Continuum of Care
• Timeliness and Accessibility
• Access by multiple users
• Reduces physical storage space
• Reduces the clerical EFT in HIS
WHY do you want to do this?
• Record Transportation – Network record issues
• Decreased record consumables
• HIS Information Systems ‘get smart’
• Quality Management / Auditing
HOW?
HOW will you achieve this?
Think BIG …. Start Small
HOW will you achieve this?
What is available?
• Scanning
• Direct entry
• Voice recognition
• Archiving systems
• e-Pens
• In house or Out house
How will these support your WHAT & WHY?
HOW will you achieve this?
How will you get your chosen product to work?
• Working party & steering committee of stakeholders:
- IT
- HIMS
- Clinicians
- Project Team – Ownership and direction
- Vendor
What are the expectations of your stakeholders?
• Are they aligned, realistic and achievable?
HOW will you achieve this?
Process Redesign
• Challenge everything you know about medical records management
Implementing into an existing site
• Managing the dual world between paper and scanned records
• Individual sites – transition “hump” but it is manageable
• Networked records – messy and resource intensive
HOW will you achieve this?
How do we do it?
• Ensure chosen solution reflects the look of the paper record
- Minimise the impact in the hospital
- Consider containing the change to HIS for a short time
- Scan on discharge
- Decrease reliance on past paper history
- Centralised and decentralised scanning areas
HOW will you achieve this?
Forms – Top Priority
• Forms inventory – Which stay and which go?
• Forms register – Standardise across your service
• Barcode all forms – Document mapping file
• Control forms in one central location
Activity Two
• Medical Record Sample
• Analysis of Content
• Comparison with Scanned Record
Activity Two
Backscanning is a dirty word!
• Consider the pros and cons
• All or nothing or segmented approach?
• Pick a start date – “old” records then become static
• Consider impact on throughput of current records
• What is to be gained – what are current recall rates?
WHO?
WHO should be involved?
• Organisations Executives / Board
• Clinicians / NUMS / Key Clinical Stakeholders
• Steering Committee
• HIMS
• Project Team
• Working Party
• IT / Computer Services
• Forms Co-ordinator / Materials Management / Printer
• HIS Clerks / Scanners
WHO should be involved?
Project
Steering
Committee
Executive
Clinicians
EHR
H.I.S
Vendor
Project
Team
Computer
Services
WHEN?
WHEN?
When do you want it?
When can you do it?
What are the known barriers?
• Hardware / software
• IT Infrastructure
Impact on organisation whilst doing it?
• Who will be affected
• Staffing required to provide ongoing services
Staged or Big Bang?
• Department based or whole of organisation
It’s not going away!
Moving to an EHR is not
an alternative. It is not
an IF, it is a WHEN!
Don’t get left behind, the
planning starts NOW!
HOW MUCH?
HOW MUCH and who pays?
• Funded by the Health Service
• Government / Department funding
• Consortium or partnership arrangement
• Hub & Spoke
• What is the projected return on investment?
Paper Vs Scanning…Some costs
Paper Department EFT =
$23.04 per separation
Scanned Department EFT =
$11.40 per separation
51% reduction
Tracking in a paper dept =
$1.17 per move
Tracking in a scanned dept =
$0.58 per move
51% reduction
Paper Record Construction =
$1.62 per record
Scanned Record Construction =
$0.00 per record
100% reduction
Casey KPIs
Days
Scanning Completion Times
10
9
8
7
6
5
4
3
2
1
0
Days
Outstanding
1
2
3
4
Week
5
Activity Three
• Sample Business Case
• Group Activity
• Brainstorming Business Case Development
Project Management Methodology
Methodology controls the flow of the Project
•
•
•
•
•
•
Project Start-up
Directing a Project
Initiating a Project
Controlling a Stage
Managing Delivery
Closing a Project
Project Management Methodology
Clinical Record Information Scanning Project (CRiSP)
Project Vital Signs
People 80%
Product 20%
Project Warning Signs
In Scope
• Application
- Deployment
- Interfacing
- Integration
Out of Scope
• Mapping / translating
data tools
• Direct & order entry
• Process re-engineering
• Legal compliance
• Acceptance testing
• Archiving
• ……
Change Management
PROJECT
• Define the purpose
PEOPLE
• Who to engage
• Stakeholder analysis
• Manage HR / IR issues
• Manage the risks
• Consult / Communicate
• Develop evaluation
strategies
• Develop change agent
skills
Change Management
WORKFORCE PLANNING
• Reconsider recruitment
• Natural attrition rather than retention
• Plan to reach the projected EFT in your business case
TRAINING
• Paper MR clerk @ 8 weeks =
$6,271
• Scanning MR clerk @ 1 week = $785
Training costs significantly reduced in scanning environment
Quality Plan
Project
• Customers quality expectations
• Acceptance testing
• Quality responsibilities
• Applicable standards
Scanning Solution
• Quality of finished product at
scanning and scanned stages
• Record Maintenance – Before,
during and after scanning
• Regular scanning audits –
Retraining and feedback
• Metadata and audit trails
• Quality control and audit
processes
WHAT IF…?
WHAT IF….?
The most important question a Project Manager must ask
hundreds of times each day is
WHAT IF…?
• Clinicians / stakeholders don’t buy in?
• The Unions get involved?
• The system goes down?
• You have poor organisational support?
Also need to confirm your state’s legal position on EHR
The Project Life Cycle
DEFINE the Project
PLAN the Project
EHR is in reality a project
portfolio that is a
collection of projects
that must be
co-managed
simultaneously
IMPLEMENT
MONITOR
ADJUST
EVALUATE
CELEBRATE
Laws of Project Management

No major project is ever installed on time, within budget
and with the same staff that started it. Yours will not be
the first.

When things are going well, something will go wrong.
When things can’t get any worse, they will. When
things appear to be going better you have overlooked
something.

Project teams detest project reporting because it so
vividly manifests the lack of progress.

A carelessly planned project will take three times longer
to complete than expected. A carefully planned project
will take only twice as long.
Key Project Features
• Assess the Environment
Who are the key players, who has the power and impact?
• Identify the goals of the key players
What are their professional goals or hidden agendas?
• Know yourself
What are your own strengths and weaknesses? How are
you perceived by others?
• Define the problems
What are all the relevant facts? What is the real situation?
Key Project Features
• Develop solutions that work
Avoid premature solutions that don’t consider the previous
four points
• Test and refine the solutions
Initial solutions are rough, they need testing and refining.
• Political Reality
A solution that does not take political realities into account is
superficial and naïve.
• Failing to plan is planning to fail
The Five Keys to Project Success
1.
Don’t be an accidental Manager
Project management is a discipline, understand the
process to achieve the goal.
2.
Get it right the first time
Doing things right requires time and effort but it is much
more expensive to do it again later.
3.
Anticipate inevitable problems
Conflict and problems are built into the concepts of
projects, plan ahead to improve your ability to cope.
The Five Keys to Project Success
4.
Dig deep to find the real solution
Never accept a project at face value, you must go
beneath the surface to discover the real project
objective.
5.
Be flexible
Projects are full of surprises, an overly rigid system is
bound to fail.
Advocate Clarity, Avoid Ambiguity
This is what the
organisation
conceptualised….
Advocate Clarity, Avoid Ambiguity
This is what the
engineers designed…..
Advocate Clarity, Avoid Ambiguity
This is what the
manufacturer built….
Advocate Clarity, Avoid Ambiguity
This is how the builder
installed it….
Advocate Clarity, Avoid Ambiguity
This is what the user
really wanted….
Remember….
• Be brave, be determined,
be resolute!
• What may seem
impossible today, may be
the norm tomorrow!