The Lessons We Learn

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The Lessons We Learn

• PACS in the Fraser Health

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Lets be clear!

• This is not about PACS, but achieving the vision
  of an integrated electronic health record!

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Bills list of why we need the EHR

• There is no choice digital information
  management is a necessity System capacity
• Effective clinical management is predicated on
  timely and comprehensive data sets - Quality.
• Clinical information must be available anywhere,
  anytime, any place to those who need it,
  including the patient - Access.

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PACS Picture Archive Communication System

• Vision any image, anywhere, anytime
• Transform radiology images from film to digital
  format.
• Store these images
• Allow for the distribution and integration of the
  images to the patient EHR.

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The Puzzle..
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So what did we want to do?

• Convert 12 acute care sites to digital management
  system. 98 less film!
• Integrate 12 sites to a central database/single
  MPI/standardize work processes.
• Provide images across the entire enterprise.
• Provide web access for external viewing of
  images.

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Project Status May 12th

• 10 sites of 12 are up on PACS.
• 8 sites have achieved 98 film less targets
• Last go-live is schedule October 05.
• Software upgrade scheduled for June 05

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It takes lots of experts

• Canada Health Infoway - thankyou
• General Electric PACS vendor
• EMC storage
• Telus bandwidth
• Meditech RIS integration

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Going in we thought

• Existing facility infrastructure was reasonably
  adequate.
• We knew what change management was all about.
• Physicians would embrace this technology

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Facility Infrastructure

• In some facilities it appeared like we were
  replacing the whole building.
• We went from being dependent on film processors
  to digital networks.
• On-going investment is critical, resp. for must
  be clearly identified

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Change Management

• Project is a revolution in information management
  and service delivery.
• Key leadership roles required on the PACS team.
• Implementation plan built up from as-is
  workflow mapping.

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Change Management Strategies

• Imaging team took ownership of workflow mapping.
• Local ownership external expertise
• Priority to develop expertise in-house
• Lessons learned embedded in project plan and
  put to action!!

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Strategies cont

• Assessment of change requirements are monitored-
  continual engagement!!
• Physicians provided an advocate
• VP chairs steering committee, participates in
  con-call with vendor
• Encourage new communities/leverage region size

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Physician Adoption

• Success of EHR is predicated on physician
  adoption strategies.
• Force is unlikely to be successful - i.e. admin
  cannot prescribe.
• 2 general issues workflow, technology, manage
  expectations

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Physician adoption cont.

• Workflow changing how a physician works with
  their patients is a profound exercise.
• Technology new system must work! Every
  physician office is unique and network security a
  major challenge.
• Manage Expectations everyone is an expert! Be
  clear on deliverables.

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Physician Adoption Strategies

• External partnership leader sought the champions
• Pilot projects initiated- high volume, high need
• Look at who really needs the images - data.
• Radiologists are key ambassadors
• Communicate, communicate, communicate

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Emerging stuff.

• Sustainability
• System performance and monitoring do not assume
  quality!!!!
• Future capital investment who manages?
• Continuous improvement
• Its the people!!!!
• Physician adoption
• BCMA and fee schedule, needs provincial focus?
• What is the value proposition? Then do it!
• Film replaced with CD!!

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Cont..

• Clarity of benefit!
• Can we explain this in clear terms?
• Juggling distribution vs. security
• Its all about access but

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Cont..

• New information management roles/skills required
• The interface between information and clinical
  practice delivery is the system opportunity!
• We need in-house experts to decipher and define
  work processes this ties to sustainability!!
• Technical/clinical expert combined.

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Top Five!!

• Facility assessment is a big first step and make
  no assumptions.
• Workflow mapping must be owned by those who do
  the work.
• Executive support -ownership/visibility/clear
  vision
• Project team development must link to system
  improvement and sustainability.
• Think clinical service delivery, not IT
  implementation total customer focus. This will
  also engage physician groups more effectively.

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Thank You