by andrew staples addenbrookes & rosie ehospital go- live & benefits realisation
TRANSCRIPT
BY A N D R E W S TA P L E S
ADDENBROOKES & ROSIE EHOSPITAL GO-LIVE & BENEFITS REALISATION
INTRODUCTION
• Background• Go-live • Workflow consideration• The future• Summary
What is eHospital?10yr+, £200m, programme to deliver high quality care underpinned by modern informatics tools
CUH - 2010• Multitude of clinical IT systems• Limited functionality, accessibility• Inflexible & poor integration – technical limitations• Decades old – impending permanent loss of support• No results reporting audit trail• No decision support
Background (I)
Background (II)
• Full tender process, weighted to clinical quality• Extensive clinician involvement and feedback• Epic selected
> 150 million US patients 40% of US academic centres
• External board assurance
Workflow validation• 1,000+ clinicians validated modules• 100+ clinician builders (doctors, nurses & pharmacists) seconded for
18 months
Training• > 95% of staff trained (10,000 + people)• > 175,000 hours of training over 9 weeks
Preparation (I)
Preparation (II)
• 120, 90, 60 & 30-day pre go-live eHospital assessments• Parallel divisional operational assessments
• Specialty-level risk assessments• Dress-rehearsals including inter-departmental high-risk pathways• Increased focus on high-risk prescribing and WHO checklist at go-live
• Go-live final decision made by full executive
• Run akin to ‘Internal major incident’
• 150 people on-site command centre, 24/7 for 6 weeks• > 100 WTE CUH analysts, > 250 Epic staff, >50 HP staff• > 22,000 ‘tickets’ in 5 weeks
• 4 weeks of CUH / Epic ‘at-elbow’ floor-walkers
• Regular communication with CQC, CCG, GPs, Monitor, HM Coroner, governors and local MPs
• External assurance review in early December 2014
Go-live (I)
• Daily executive meetings to review safety and take action• Daily senior nursing ‘huddles’ to assess clinical safety
• Categorisation of ‘tickets’ to identify potential or actual safety issues for action
• Tip sheets and alerts developed
• Existing paper notes available until October 2015• Access to historic data (letters & results) through ‘LARDR’
Clinical safety at Go-live (II)
EPIC HAPPINESS CURVE
Stabilisation & Optimisation work streams• Inpatients & discharges• Emergency department• Medication• Outpatient administration & clinical• Hardware
Ongoing Governance• Executive-led weekly assurance board, including CCG, Union
representation• External review by Stanford Hospital, CA, USA, HIMSS
Post Go-live
• Pathology & transfusion• Pathways• Training & education
People• 50 additional substantive posts – analysts, trainers• CMIO appointed and developing further divisional / specialty
engagement• CIO being recruited
Processes• eHospital Operational Board meeting monthly• Complete integration with Transformation programme• Increased training resource, supported in division
Supporting the organisation
BUILDING AND IMPROVING
• Optimisation working groups• Focus on key trust priorities / patient safety initiatives
• Help desk & system support• Staff raising issues that are critical problems to resolve
• Planned system updates• Planned SU programme to receive developments from EPIC to improve
workflows / functionality
• Maintenance programme• Preforming maintenance tasks e.g. FDB Multilex data load
INTEGRATION OF PRESCRIBING AND PHARMACY (1)
• Unique feature of the CUHFT install compared to the rest of the UK • The dispensary systems are fully integrated with ePrescribing• Benefits
• Workflow efficacy• No transcription phases, no unnecessary manipulation
• Accuracy • Audit trail • Research
INTEGRATION OF PRESCRIBING AND PHARMACY (2)
• Challenges of integration• Configuration • Dispensary inventory Vs. what is ordered• Workflow sequencing
• Challenges• What if the item is not a stocked item / what if the item is not the exact
product you want to dispense• What if you want to manipulate your label
EXAMPLES (2)
• Aseptic workflow (cytotoxics)• Regimen eprescribed within EPIC• Chemotherapy including intelligent selection of preparation based on
order can occur, generate an appropriate worksheet.
• Challenge• “release” of orders
• Beacon will not allow the order to release ahead of time
THE FUTURE
• Improve our response time and capacity for adapting the system to different clinical needs• Bring online workflows that sit outside of EPIC and introduce
new functions• MyChart, External PO
• Work with EPIC to implement large system updates to improve functionality for CUHFT staff
SUMMARY
• In 18 months CUHFT implemented two trust wide streams• A hardware stream updating the trust physical structure• A software stream implementing a single solution across all areas of the
trust• We successfully utilised a rapid roll out implementation• All areas within CUHFT are live in EPIC
• The only hospital in the UK to achieve a HIMSS level 6 within 12 months of go-live date.
• Maintaining and improving the system based on clinical feedback and targeted improvements.