From Go-Live to HIMSS Level 6 in 10 months The Royal Childrens - - PowerPoint PPT Presentation

From Go-Live to HIMSS Level 6 in 10 months The Royal Children’s Hospital EMR experience

Lauren Andrew, Matthew Thatcher, Jackie McLeod, Mike South, Jennifer White, Adrian Hutchison

9th August 2017

Royal Children’s Hospital

RCH cannot aspire to be a GREAT children's hospital, leading the way, if it continues to rely on paper-based records and antiquated systems for communications and patient care transactions.

Why Epic?

Most advanced software (KLAS reports) Best vendor partner model Most suited for academic paediatric hospital Extensive background investigation Our staff chose Epic:

• Over 250 staff attended tender demonstrations
• Over 70 staff, formal tender evaluation process

Tender evaluation: Clinical 50% Technical 17.5% Implementation 17.5% Tenderer Capability 10% Contract 5%

What was in scope?

Device integration

220 fixed bedside monitors Ventilators NICU / PICU

Point of Care equipment

Computer On Wheels Hand held android device - Rover Mounting solutions iPads Laptops at home services – car charges 23’ screens Label printers – medications Barcode scanners Desktop printers Touch screens anaesthetics

Portals – patient & family

See & Request changes to appointments See allergies / immunisations See medications and request repeats See test results (8 day auto release) See clinic notes / correspondence Self scheduling – pilot commenced Messaging clinicians – coming soon Questionnaires – coming soon

Sharing care

22 interfaces Internal & External Systems JCAPS – integration engine HL7 2.4.1

Integration

Subject identification / recruitment Research coordinator notification Routine & study data collection Family portal data collection Embedded analytics Data warehouse

Research

Why big bang?

Why big bang?

Patient safety focus

• Clear cutover plan from paper to EMR for current

inpatients

• All documentation to be completed in the EMR
• All clinical documentation available in one place

EMR Workflows were built to support patient flow across all areas

Why big bang?

• From an organisational perspective
• Organisation focus for one period
• More efficient to concentrate support to one

period of time, not two

• Reduce fatigue for the project team.
• It was more cost effective

What does it take to deliver?

• 30 clinical systems replaced or integrated
• Millions of records migrated from legacy systems
• 2600 computers checked prior to go live
• 3,785 staff trained with over 20,000 hours of training delivered
• 100+ Epic experts at go live from the RCH EMR team & Epic staff
• 400+ super users all from RCH staff volunteering to take shifts to help
• ut their colleagues

Success factors - methodology

EMR team

Many analysts were RCH clinicians External recruits to fill skill gaps Emphasis on training – mandatory

The RCH team

Governance committees Clinical decision making Management team Recruitment to EMR advisors (Drs), trainers, super users positions

Success factors - team

Vendor support team Strong onsite support from Epic Strong support model from Verona

Success factors - governance

• Strong internal governance structure
• Commitment from all levels
• Executive leadership
• Managers program
• Focus on EMR project

Go live readiness program

• 30, 60, 90, 120 day

Go live checklists for managers Technical and clinical dress rehearsals

Success factors – readiness

The system:

24/7 support for 4 weeks EMR Command Centre

• EMR and IT Help Desk co-

located

• 4206 Help Desk jobs logged
• 95% resolution rate
• Focus on addressing

technical issues

For staff:

24/7 support for 5 weeks Super user support centre

• Staffed by EMR trainers
• 400 super users – connected to

EMR by WhatsApp

19,000 messages in first 5 weeks Support from Epic and Stanford Children’s Health Reduced activity in outpatients and theatres

Success factors – go-live

Go live supports

• Top 10 @ 10 with Executive team
• Executive rounding
• Daily Patient Safety Meetings
• Monitored all reported incidents
• Quality and Safety dashboards

2012 2017

HIMSS

Information all in one place

• Fast
• Easy to find
• Clear overview of whole patient
• Specialty level customisation

One logon/password Remote access – PC / iPad / phone

Benefits - clinicians

Benefits - productivity

2015/2016 2016/2017 Variance Number of multiday stay patients 21322 21062

• 1.23%

Number of same day patients 23357 27593 15.35% Average LOS 2.64 2.56

• 3.12%

Number of outpatients 184705 193679 4.6%

Reduction in testing

2015/2016 2016/2017 Variance Total pathology tests completed 1235500 1228732

• 5.50%

Total medical imaging examinations 88406 85992

• 2.80%

Quality & Safety - examples

• Improved patient identification through barcode scanning
• Improvement in completion of transfusion consent
• Improved management of specialist clinic wait list
• Improved compliance in state government CPE (bacteria)

screening guidelines

Financial benefits

• 87% reduction in transcription and costs
• Savings from ‘sunsetted’ software
• 32% reduction in pre-printed form costs
• 6.3% reduction in senior medical recall
• Increased revenue due to improved compliance – PBS scripts, MBS

referrals

• 8.3% increase private patient revenue
• 12.4% increase in prosthetic revenue
• 4.6% increase in outpatient revenue

• Adherence to standardised care

– Review data on variance from CPG for diagnoses

• Increase sophistication of Best Practice Advisories
• Guide use of Criteria Led Discharge
• Full closed loop medication and unit dose dispensing
• Implement additional Epic applications

Future Benefits

Thank You

Contact: matt.thatcher@rch.org.au