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EHR Implementation from an Acute Hospital Perspective


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Title: EHR Implementation from an Acute Hospital Perspective

EHR Implementation from an Acute Hospital
  • Michael Strachan
  • EHR Program Manager

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

Mater Footprint
Mater Patient Activity
Queensland Context
  • Queensland Health (QH) is a major partner of
  • 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

EHR Strategy Chronology
  • Early 2003 Commenced EHR strategy sponsored by
  • 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

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.

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
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

Engaging Empowering Clinicians
Understand Clinical Attitudes
  • Plenty of war stories about failed EHRs
  • Clinicians unconvinced an EHR can deliver
  • 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!

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

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
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
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

Verdi - A Solution for Mater ?
  • Commercialised software solution originally
    developed by Peter MacCallum Institute for
  • 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

Verdi Clinical Trial
  • 6 month trial with three clinical teams or 60
  • Replaced existing information systems practices
  • External Private Results SN / QML (Mothers
  • 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
  • Good design methodology iterative / rapid

Governance Execution of the Maters EHR
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

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

HIMSS Analytics Adoption Model
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
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)

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.

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.

Shared EHR Project
  • Provider Portal
  • GPs access generally and specifically to support
    for shared care models i.e. Maternity, Diabetes
  • 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

Electronic Health Record Program Structure
EHR Stage 1 Projects
Program Office Support
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

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
  • Including enterprise and local functionality
    important for clinical buy-in in a hospital

Change Communication Mgt
  • Implementation is incremental to maintain
  • 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
  • Resourcing recognising the change management
    function in EHR project is critical to success

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

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

Current Future State
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
5 Years from now
  • One stop shop clinical portal scanned paper
  • Eliminate reliance on paper record overhead
  • Better system data quality information
  • 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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