Nurses take command for a successful EMR Implementation Lorelei Stellwag RN, MSN Director of Technology Transformation Medstar Georgetown University Hospital

Objectives • Understand how involvement of end users in implementation process contributes to success • Define the “at the elbow” and superusers approach and its advantages • Describe three critical factors to implementation of electronic systems in hospital setting

Background • A 9 hospital system based in the midAtlantic region between Baltimore and Washington DC • Design and Implementation of – Laboratory – Pharmacy – Nursing documentation – Respiratory documentation

It’s about 10% software “The most fundamental change that will be needed if hospitals are to make meaningful progress in error reduction is a cultural one.” Leepe, L. JAMA 1994

90% Cultural

Project Goals • • • •

System Optimization & integration Enhancement of quality systems Standardizing of best clinical practice Enhancement of patient care delivery and patient safety • Improving clinician workflow in hospitals • Enhancement of financial strength

Clinicians vs. IT • Collaborative process between patient care providers and IT • IT provides technical support • Nursing informatics support from system hospitals • End user real time feedback

Corporate Support • Steering committee chaired by Chief Nursing Officer comprised of members of various entities • Collaborative multidisciplinary work teams • Entity decision making

New Standard of Patient Care • • • • •

Standardized work processes Standardized views Standardized equipment Bar Code Specimen Collection Electronic Medication Administration Record (eMAR) • Bar Code Medication Administration (BCMA)

Design Decisions • Collaborative discussions • Service level workflow localization • End user design team members involved in – Build – Testing – Implementation

System Configuration • Clinical Documentation Nurse driven build • Best practice – Consensus decisions

• Evidence based methodologies

Workflow Localization • A disciplined and structured approach to designing the future state of specific workflows through out the organization • Directly involves the staff that are affected by the change • The staff use future state workflows to determine what will STOP, START and CONTINUE

Workflow Continued • Staff ask the questions and develop processes – How will the new process affected my job? – How will the new work flow benefit the patients, clinicians, and the organization – What training will I need for the new workflow processes? – What policy and procedures will need to be created, changed or modified? – What will the new downtime policies be?

Project • Kick-off celebration • On going communication in print media and presentations – Town hall meetings – Unit staff meetings – Posters/fliers

• Community awareness – Letters to patients – Lobby signage

Device strategies • Device selection by end users at device fairs • Unit device needs by Clinical Managers and Medical Directors • Early deployment of WOW’s (Workstations on Wheels) and printers • Collaborative device management by Nursing and ITSS

Training • Train the trainers – Uber Users • Super Users • End Users – Total of 1400 associates to train

• Computer Labs used 16 hours a day, 6 days a week, 6 weeks • Class instruction by Super User (2 per)

Conversion Plan - T – 6 weeks • • • • •

Early process changes Equipment deployment Just in time training/refreshers Command Center preparations Educational evaluation

Super Users • The SU candidate is – A direct patient care provider – Computer literate – Unit leader – Enthusiastic, upbeat Continues to mentor, instruct, console and support staff after go-live Acts as a resource to new hires to re-train or provide support for upgrades to system

Command Center • • • • •

On site command center Off site War room – corporate IT support Two weeks 24/7 Nursing Informatician in commander role Super Users deployed directly to units – 1 per unit 24/7 for two weeks – 1 per 2 units 24/7 for one week – 1 per building 24/7 for one week

Command Center  COMMUNICATION COORDINATION CONSISTENCY • Daily shift report updates to SUPERUSERS • Provided all SUPERUSERS with mobile phones • Utilized a call system of reporting issues • Deployed immediate assistance to inpatient units as needed • Coordinated device trouble shooting

Successful System Implementation • • • • •

Smooth transition End user system experts Embrace technology Achieve greater patient safety Team collaboration

Celebrate

Contact Information • • • • •

Lorelei Stellwag MSN, RN Director of Technology Transformation Medstar Georgetown University Hospital [email protected] 202-444-2472