EHR Implementation from an Acute Hospital Perspective

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EHR Implementation from an Acute Hospital
Perspective

• Michael Strachan
• EHR Program Manager

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Mater Health Services Brisbane

• Not for profit, privately owned company by the
  Sisters of Mercy
• 7 Hospitals 972 Beds
• Mater Adult Public Hospital 205 Beds
• Mater Mothers Public Hospital 102 Beds
• Mater Mothers Private Hospital 93 Beds
• Mater Children's Public Hospital 141 Beds
• Mater Children's Private Hospital 37 Beds
• Mater Private Hospital South Brisbane 323 Beds
• Mater Private Redlands 71 Beds

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Mater Footprint
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Mater Patient Activity
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Queensland Context

• Queensland Health (QH) is a major partner of
  Mater
• Mater Public Health Services Act 2008 passed in
  November 2008
• Paves the way for better connectivity
• QH E-Health strategy under development
• Not bound by E-Health strategy
• Collaboration re client index etc important

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Background
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EHR Strategy Chronology

• Early 2003 Commenced EHR strategy sponsored by
  CEO
• Mid 2003 Conducted market EOI
• Mid to late 2003 Vendor investigation
• Early 2004 - International site visits
• Mid 2004 CIO commenced
• 2004 2007
• Building better IT service capability
• Replacing PAS consolidating PMI

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A Strategic Framework ?

• Vision
• A whole of Mater patient medical record
  electronically accessible anywhere, anytime.
• Goal
• The Maters EHR program will deliver a web based
  single point of access for clinicians to access
  clinical information at the point of care/
  decision making across the enterprise from both
  inside and outside the organisation.

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In Hindsight.
Organisational readiness is critical 2003 2007
Affordability At the time organisation just meeting bottom line. Yes - but still fierce competition for scarce capital dollars
Executive sponsorship CEO sponsored EHR strategy CIO and wider executive support
Clinical champions and readiness Good champions but unconvinced of benefit Shoulder to the wheel
Benefits understanding Not clear at first Evidence suggest failed implementations in acute sector Clear case for patient safety and clinical efficiency
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Lessons Learnt

• Strategic approach was fundamental long range
  journey not big bang
• Research more than just vendor demonstrations
• Site visits were critical
• Gartner, HIMSS analytics valuable
• Organisational readiness is critical
• Staged approach to implementation

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Engaging Empowering Clinicians
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Understand Clinical Attitudes

• Plenty of war stories about failed EHRs
• Clinicians unconvinced an EHR can deliver
  benefits
• Competition for the scarce capital dollars ie
  Clinical equipment
• Use of clinical systems in specialist and GP
  practices is more prevalent driving expectation
  hospitals should too!

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Understand Benefits

• Patient safety a major benefit
• ie system for follow-up of results
• Clinical workflow efficiency
• Silos of clinical information
• Incomplete, missing, unwieldy paper record
• 2-3 million per annum on maintaining a paper
  based record

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Many Disparate Systems
Radiology Results
Obstetric System
Emergency System
Pathology Results
Oncology System
Clinical Letters
Pharmacy System
Patient Administration Data
External Results
Digital Radiology Images
Obstetric U/Sound Report
Electronic Discharge Summary
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Clinical Portal the solution?
Radiology Results
Electronic Discharge Summary
Patient Administration Data
Emergency System
Obstetric System
Single Point of Access to all Mater Clinical
Information a beginning only
Oncology System
Clinical Letters
Pharmacy System
Digital Radiology Images
Pathology Results
External Results
Obstetric U/Sound Report
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Empower your clinicians

• Traditional IT solution procurement methodology
  not suitable
• Live proof of concept critical to empowering
  Mater clinicians
• Consistent with the clinical trial or scientific
  methodology which clinicians understand

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Verdi - A Solution for Mater ?

• Commercialised software solution originally
  developed by Peter MacCallum Institute for
  clinicians
• Mater is the first site to pilot this solution
  outside Peter Mac
• It is a low cost, unique solution which can be
  implemented within a relatively short space of
  time

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Verdi Clinical Trial

• 6 month trial with three clinical teams or 60
  users
• Replaced existing information systems practices
  
• External Private Results SN / QML (Mothers
  only)
• Access to patient attendance data in the PAS
• Emergency EDIS, Obstetrics Matrix, Oncology
  Charm, Discharge Summary Discharge Summary
  System (DSS), Medications Merlin
• Access to outpatient clinical letters
• Pilot group has reached 200 users
• Successful clinical trail methodology branded
  Verdi as a helpful tool for clinicians not a
  hindrance
• Good design methodology iterative / rapid
  development

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Governance Execution of the Maters EHR
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The Maters EHR Program

• Approved by Mater Board March 2008
• Governance, facilitation of the work program of
  projects to transition the Mater to an Electronic
  Health Record
• Steering committee to govern determine
  priorities senior clinical directors /
  executive representation all hospitals

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Why Program Management

• Program framework ideal for ensuring EHR
  implementation can be broken down into more
  manageable projects
• A coordinated approach for managing project
  schedules, dependencies, issues and risks
• Implement systems for managing change management,
  budget control, benefits management etc for stage
  1 2

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HIMSS Analytics Adoption Model
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Maters EHR Program Priorities
Priority Key Initiatives Stage
1 Clinical Portal (Verdi) 1
2 EHR Infrastructure 1
3 Document Imaging Solution (feasibility) 1
4 Shared EHR Project 1
5 Clinician Order Entry with decision support 2
6 Clinical Documentation Phase II 2
7 E-Prescribing / Medication Management 2
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Clinical Portal (Verdi)

• Single point of access to all Mater clinical
  information systems including
• Path, Rad, PAS(attendances/bookings), DSS,
  Clinical Letters, PACS images (DICOM viewer),
  Private path/rad, Scanned referral,
  Pharmacy,EDIS, Matrix, etc (over time)
• Results acknowledgement of all Mater pathology /
  radiology results
• Clinical documentation (VNotes)

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EHR Infrastructure

• Patient Master Index (PMI). Develop a technical
  solution between iPM and third party clinical
  information systems for enforcing the iPM PMI as
  the source of truth
• Health Practitioner Directory (HPD). Develop
  Maters existing HPD to facilitate consistency
  synchronisation of Mater internal practitioners
  among all clinical information systems. Partner
  with GP Qld to develop a real time update of
  external providers.

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Document Imaging Solution

• Investigation of a document imaging solution for
  scanning of health records including key
  documents such as referral and external
  correspondence for access within the Clinical
  Portal as an electronic view of the paper record.

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Shared EHR Project

• Provider Portal
• GPs access generally and specifically to support
  for shared care models i.e. Maternity, Diabetes
  etc.
• VMO access to their patients Mater records
• Queensland Health access for interflow patients
• Patient Portal
• development of patient access to views of their
  health record e.g. Maternity hand-held record
• Transactional capabilities such as checking
  upcoming appointments, bill payments, online
  preadmission etc

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Electronic Health Record Program Structure
EHR Stage 1 Projects
Program Office Support
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Benefits Management Approach

• Benefits identified in the funding submission
  will be evaluated and reported to the Mater board
• Evaluation of existing business processes will be
  undertaken to formally baseline benefits
• Change manager will oversee identification,
  recording, tracking and reporting of benefits

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Change Communication Mgt

• Stakeholder engagement and analysis is critical
• Must reach a balance between focus groups, one on
  one approach to engaging
• Engaging coal face staff critical
• Business process review is critical to identify
  benefits
• Including enterprise and local functionality
  important for clinical buy-in in a hospital
  environment

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Change Communication Mgt

• Implementation is incremental to maintain
  momentum
• Use of piloting and rapid prototyping essential
  change technique to ensure effective design
• Scheduling needs to consider other organisational
  or project change initiatives that are in
  progress
• Resourcing recognising the change management
  function in EHR project is critical to success

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Change Communication Mgt

• Significant expectations around implementing an
  EHR differing perceptions
• Must manage expectations of key stakeholders and
  not rely on mass forms of communication ie Group
  email does not work
• Chief Medical Information Officer is critical to
  maintaining effective engagement, change and
  communication with Mater clinical stakeholders

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Challenges Issues

• Data quality in source systems PMI data
• Device access particularly in inpatient areas
• Delivering short wins for clinicians do not
  allow long elongated project timeframes
• Scope creep for bells and whistles as opposed to
  meat and potatoes functions
• Infrastructure readiness ie reliability of
  wireless network

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Current Future State
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EHR Stage 1 Status
EHR Project Status
Clinical Portal (Verdi) Commenced October 2008 Due for completion 2010
Patient Master Index Commenced December 2008 Scoping / Schedule in progress
Health Practitioner Database Commenced December 2008 Scoping / Schedule in progress
Document Imaging Solution (feasibility) Commencement due in March 2009
Shared EHR Portals Commenced December 2008 Scoping / Schedule in progress
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5 Years from now

• One stop shop clinical portal scanned paper
  record
• Eliminate reliance on paper record overhead
• Better system data quality information
  architecture
• Paperless in ambulatory areas
• Integration with Maters partner providers using
  national identifier and messaging standards
• Patient Portal significantly utilised to improve
  the patient experience
• Order entry and medication management system
  implementation well under way
• Enterprise clinical documentation with decision
  support staged rollout

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