Post Go Live Issue Management - PowerPoint PPT Presentation

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Post Go Live Issue Management

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Title: Post Go Live Issue Management


1
Post Go Live Issue Management
  • New Build, Maintenance, Enhancements etc.

2
Evanston Northwestern HealthcareWho we are . . .









Evanston Hospital 420 beds

Glenbrook Hospital 126 beds










Highland Park Hospital 240 beds

65 Medical Group offices

3
ENH Statistics
  • Admissions (Including Births) ?
  • Patient Days ?
  • Deliveries ?
  • Outpatient Visits (Excluding ER) ?
  • Total ER Visits ?
  • Employees ?
  • Physicians (Professional Staff) ?
  • ENH Medical Group ?
  • House Staff ?

42,000
195,000
5,700
454,000
88,500
7,500
1,700
500
150
4
Our Focus
  • EpicCare Inpatient HOV
  • Medical Informatics its role in work and issue
    management
  • Work and issue management in an integrated
    product
  • Evolution of the current process
  • Issues
  • Request For Service
  • Projects

5
ENHs Portfolio of EPIC Products
PatientData
HOV
ICU
ADT HIM Hospital Billing
Oncology
6
Evolution of Epicare IP and HOV at ENH
  • Implementation
  • First Hospital Clin. Doc 03/2003
  • First Hospital CPOE 05/2003
  • Second hospital Clin. Doc 06/2003
  • Second hospital CPOE 11/2003
  • Third Hospital Clin. Doc 12/2003
  • Third Hospital CPOE 04/2004
  • ICU 06/2005
  • Beacon 08/2006
  • Stork 03/2008
  • Upgrades
  • MU3, MU4, MU5, MU6, Fall 04, Spring 05, Fall 05,
    Spring 06, Spring 07 Spring 08,ADT,HIM,and
    Hospital Billing

7
Evolution of Medical Informatics
  • 2001 - Operations Sr. VP led an IP application
    group
  • 2002 - Formalization of a Medical Informatics
    Department
  • Lead by Sr.VP of Medical Informatics Reporting
    to the COO
  • 4 Sr. Directors (IP, HOV, Ambulatory and
    Business)
  • Facilitated all meetings between IS and
    Operations
  • 2007 - Medical Informatics moved under
    operations
  • Maintain Sr. Director Structure (IP, HOV, and
    Ambulatory)
  • Added Project Manager positions
  • Added a Director Systems Integration and
    Development

8
Collecting the Work!
  • Prior to Go Live Fit testing Database-one avenue
    for reporting issues
  • During Go Live Avenues for reporting issues
    expanded and excel spreadsheets proliferated
  • Post Implementation Issue management was
    fragmented and decentralized
  • Maintenance Added Help Desk and Epic Help
    button

9
Epic Help Button
10
Controlling the Wild Beast!
  • Fit testing exported into Excel Issues List - all
    teams add their spread sheets to the Issue List.
  • Spreadsheets proliferated again as a place to
    enter and track end-user requests
  • Pivotal event
  • Change management process was needed.
  • Calendar was created where all changes to
    production needed to be scheduled
  • Weekly call to review changes for impact on other
    applications.
  • Still not enough!

11
Birth of the RFS
  • Requests needed to be centralized
  • Implemented the use of an existing Request For
    Service (RFS) system
  • Direct entry by end users
  • Entry by MI IS

12
We feel we are in control - Just
  • ENH Spreadsheet issues list
  • Managed by IS Team
  • Weekly call with Epic
  • RFS database
  • User requests Enhancements, New build,
    Maintenance
  • Strange little collection of issues
  • Projects

13
It is Not the Perfect Solution!
  • RFS perceived as Black Void
  • Within Medical Informatics User request process
    differed
  • Inpatient requests came from multiple users,
    groups and administration
  • HOV came from Managers and Administrators
  • Design issues hindered RFS management
  • Inpatient team Database created
  • HOV Ring binder!
  • Double data entry
  • Weekly RFS calls

14
Mutiny!
  • Classified everything in the RFS system
  • Defined what went on the Issues List
  • Defined what would stay in the RFS
  • Required
  • Discretionary
  • Created a third category Projects
  • Made changes to the RFS System
  • Mapped out ideal RFS workflow

15
RFS Process Workflow
16
Projects
  • Lived on a spreadsheet
  • Worked on ad Hoc
  • Operational demand
  • Analyst availability
  • Available functionality
  • No dates or timelines
  • Things not getting done but perception of
    constant change
  • No operations ownership of projects

17
The Projects Project Plan
18
More Projects Project Plan
19
So.
  • We have
  • The Issues List
  • RFS System
  • The Project Plan
  • Now we need
  • Operational ownership
  • Communication
  • Prioritization

20
Ownership
  • ENH Issues List Spreadsheet
  • Managed by an IS team member
  • RFS System
  • MI review new requests and classify them
  • Project Plan
  • Steering Committee

21
Communication
  • ENH Issues List Spreadsheet
  • MI/IS biweekly call with Epic
  • RFS System
  • Monthly RFS Reports for discretionary requests
  • Project Plan
  • Monthly Score Card

22
Prioritization
  • ENH Issues List Spreadsheet
  • IS MI
  • RFS System
  • Essential to business moved into IS work queue
  • Patient Safety
  • Impacts Business
  • Regulatory
  • Enhancements assigned to operations VP for
    prioritization
  • Project Plan
  • MI IS review, estimate work hours, and schedule
  • Steering Committee

23
Current State
  • Shifting Project Plan
  • To meet Regulatory Requirements
  • Unanticipated changes in Projects
  • Refinement of RFS Workflow
  • Rules of Engagement for the RFS
  • Reclassification of Required

24
RFS Rules of Engagement
  • Types of RFS
  • Required - Services that have an immediate impact
    on patient safety, revenue or operations.
  • Discretionary - Enhancements that improve or
    increase efficiency.
  • The Modification Type - Assigned by Medical
    Informatics, in collaboration with Information
    Systems and/or the Requestor, as necessary.

25
Rules of Engagement
  1. Until the Modification Type is defined, the
    request should remain in the status of Request
    Received
  2. Status changed from Request Received to Approved
    by MI only after approval and prioritization from
    the designated VP or higher level administrator.
  3. IS and MI will collaborate on the order in which
    the prioritized Discretionary RFS are to be
    completed (Ex. If there are 10 1 priorities, the
    MI Sr. Director will determine order).
  4. Information Systems will assign Approved RFS to
    application coordinators
  5. Information Systems is responsible for marking an
    RFS as Complete in the system.
  6. Monthly production report runs (i.e. reminder or
    tickler systems) should be tracked outside of the
    RFS system.

26
Rules of Engagement
  • An RFS must be created for
  • Help Desk calls that require more then 30
    minutes to complete. This includes total
    resolution effort analysis, build, test, and
    implementation. etc.)
  • For every Request for Change (RFC) including
    code changes.
  • Multiple RFS must be created for regularly
    scheduled maintenance, according to the schedule
    (ex. 1 RFS per month for monthly maintenance, 1
    RFS per quarter for quarterly maintenance, etc).
  • All RFS must have a defined scope.
  • Each application team must open its own RFS for
    integrated projects.
  • All parties are responsible for keeping the RFS
    system accurate and current.
  • Any change to the RFS process must be approved by
    the RFS Committee, chaired by Medical Informatics
    and Information Systems.

27
There are still.
  • Clandestine Spread Sheets

Unrecorded requests
Things that get done because of who you are or
know
But All cynicism aside
  • Things are more organized
  • Less gets lost

28
In Summary
  • Long Journey
  • Classified Requests/Issues
  • Formalized the processes
  • Returned ownership of change back to Operations
  • Improved Communication

29
Contact Information
  • Kate Reynolds, RN
  • KReynolds_at_enh.org
  • Janet Ryan, BS, RN
  • JRyan_at_enh.org
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