Lea Dias – EMR Business Architect
 EMR Business Architect/Senior Pharmacist for PCH
 HIMSS Conference in Sept 2012
 PCH opens Nov 2015
 Health in WA has...
 Evidence gathered by PCH includes:
◦ Sg2 report (commissioned by Strategic Projects)
◦ Interviews with leading global ho...
 Investigate CLMMS
 Evaluate and review implementation of an eMMS
 Interview and selection process of candidates
 Orga...
United States
UCSF Benioff Children’s Hospital (UCSF)
Boston Children’s Hospital (BCH)
Children’s Hospital of Wisconsin CH...
 Governance
◦ Driven by patient safety, not ROI
◦ Strong executive leadership driving change
 Role of Pharmacy Departmen...
PMH UCSF BCH CHW PhCH GOSH Cambridge Schneider
No of paediatric beds 220 180 368 157 355 320 >1000 250
No of neonatal beds...
PMH UCSF BCH CHW PhCH GOSH Cambridge Schneider
System ✖ Epic Cerner Epic AllRx JAC Epic Chameleon
E-prescribing ✖ ✔ ✔ ✔ GE...
PMH UCSF BCH CHW PhCH GOSH Cambridge Schneider
System ✖ Epic Cerner Epic AllRx JAC Epic Chameleon
Dispensary robots ✖ ✔ ✔ ...
 Teaching hospital affiliated UCSF Medical Centre Campus
 180 paediatric/50 neonatal beds
 Unit dosing in the mid-70’s
...
 EMR - Epic
 Integration with PAS
 Electronic Prescribing with Clinical Decision Support
 Integrated Pathology and Dia...
Mar/
April
2010
May to July
2010
July to Oct
2010
Oct 2010 to
(Mar*) Oct*
2011
Sept to
Dec
2011
Dec to
Mar 2012
Mar-
Jun
2...
Mar/A
pril
2012
Jan to Apr
2013
May to
Aug 2013
Sept to Jan
2014
Jan -
Mar
2014
Mar – Oct
2014
Oct
2014
Epic
sign
off
Trai...
 1.5 million doses – no medication errors
 Building COG protocols into oncology system (integration with Apex)
 Buildin...
 Affiliated with Harvard Medical school
 396 paediatric/28 neonatal beds
 In late 90’s, BCH were pioneers in introducin...
 Upgrade Cerner clinical system in 2004 (introduced late 90’s)
 Allscripts for bed management
 Epic for billing and sch...
 Scan in timeline
PMH UCSF BCH CHW PhCH GOSH Cambridge Schneider
System ✖ Epic Cerner Epic AllRx JAC Epic Chameleon
E-prescribing ✖ ✔ ✔ ✔ GE...
PMH UCSF BCH CHW PhCH GOSH Cambridge Schneider
System ✖ Epic Cerner Epic AllRx JAC Epic Chameleon
Dispensary robots ✖ ✔ ✔ ...
<2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
UCSF Epic
May
10
‘GO
LIVE’
June
12
BCH Phase
1
Phas...
 Success of CLMMS dependent on:
◦ Good EMR implementation
◦ Good automation
◦ Robust governance structure
 Driven by pat...
 Day 1 - Automation:
◦ Automated Dispensing Machines (limited function)
◦ Bedside medication drawers
◦ Mobile medication ...
 Dramatic reduction in medication errors
◦ Illegible prescription
◦ Transcription errors
◦ Wrong doses (decimal point err...
 EMR and Pharmacy automation enables future improvements on a
long journey
 Strong support from top down to continue to ...
What could the future look like with a poorly implemented EMR?
Lea Dias, Senior Pharmacist, eMM Project Officer, Perth Children’s Hospital Project - An Evaluation of Top International H...
Lea Dias, Senior Pharmacist, eMM Project Officer, Perth Children’s Hospital Project - An Evaluation of Top International H...
Lea Dias, Senior Pharmacist, eMM Project Officer, Perth Children’s Hospital Project - An Evaluation of Top International H...
Lea Dias, Senior Pharmacist, eMM Project Officer, Perth Children’s Hospital Project - An Evaluation of Top International H...
Lea Dias, Senior Pharmacist, eMM Project Officer, Perth Children’s Hospital Project - An Evaluation of Top International H...
Lea Dias, Senior Pharmacist, eMM Project Officer, Perth Children’s Hospital Project - An Evaluation of Top International H...
Lea Dias, Senior Pharmacist, eMM Project Officer, Perth Children’s Hospital Project - An Evaluation of Top International H...
Lea Dias, Senior Pharmacist, eMM Project Officer, Perth Children’s Hospital Project - An Evaluation of Top International H...
Lea Dias, Senior Pharmacist, eMM Project Officer, Perth Children’s Hospital Project - An Evaluation of Top International H...
Lea Dias, Senior Pharmacist, eMM Project Officer, Perth Children’s Hospital Project - An Evaluation of Top International H...
Lea Dias, Senior Pharmacist, eMM Project Officer, Perth Children’s Hospital Project - An Evaluation of Top International H...
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Lea Dias, Senior Pharmacist, eMM Project Officer, Perth Children’s Hospital Project - An Evaluation of Top International Hospitals in Proven and Effective eMM Technologies.

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Lea Dias delivered this presentation at the 3rd Annual Electronic Medication Management Conference 2014. This conference is the nation’s only event to look solely at electronic prescribing and electronic medication management systems.

For more information, please visit http://www.healthcareconferences.com.au/emed14

Published in: Health & Medicine
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Lea Dias, Senior Pharmacist, eMM Project Officer, Perth Children’s Hospital Project - An Evaluation of Top International Hospitals in Proven and Effective eMM Technologies.

  1. 1. Lea Dias – EMR Business Architect
  2. 2.  EMR Business Architect/Senior Pharmacist for PCH  HIMSS Conference in Sept 2012  PCH opens Nov 2015  Health in WA has lagged behind introducing automation and ICT  Reasons to automate: ◦ Dramatic reduction in human error ◦ Standardisation of process ◦ Reduction in variation and improved efficiency ◦ PATIENT SAFETY AND PREVENT HARM
  3. 3.  Evidence gathered by PCH includes: ◦ Sg2 report (commissioned by Strategic Projects) ◦ Interviews with leading global hospitals ◦ Churchill Fellowship  Recommendations from Sg2 report ◦ Pharmacy Automation, Business Case for Electronic Medical Record (EMR)  Australian Commission for Safety and Quality in Healthcare (ACSQHC) Electronic Medication Management Guidelines  Other Australian states well advanced
  4. 4.  Investigate CLMMS  Evaluate and review implementation of an eMMS  Interview and selection process of candidates  Organising the Fellowship  Contacting the hospitals  Writing the report - humbug!!  Disseminating information to the wider Australian public
  5. 5. United States UCSF Benioff Children’s Hospital (UCSF) Boston Children’s Hospital (BCH) Children’s Hospital of Wisconsin CHW) Phoenix Children’s Hospital (PhCH) United Kingdom Great Ormond Street Hospital (GOSH) Cambridge NHS Trust Petach Tikva – Israel Schneider Children’s Medical Centre
  6. 6.  Governance ◦ Driven by patient safety, not ROI ◦ Strong executive leadership driving change  Role of Pharmacy Department ◦ Dynamic and innovative ◦ Differences in Pharmacy services internationally  Enabling technology and automation ◦ Differences in adoption of automation and technology systems ◦ Complex paediatric specific dosing  “Closing the loop”  Implementation of EMR
  7. 7. PMH UCSF BCH CHW PhCH GOSH Cambridge Schneider No of paediatric beds 220 180 368 157 355 320 >1000 250 No of neonatal beds 30 50 28 110 No of ICU beds 139 Total 250 230 396 296 465 320 >1000 250 Number of pharmacist 30 40 55 40 40 50 >75 10 Number of technicians 10 >50 120 60 >70 >60 >90 >15 Ward based rounds ✖ Y Y Y Y Y Y ✖ Satellite pharmacies ✖ 2 3 6 ? Y A lot 1 24 hour / 7day service ✖ Y Y Y Y ✖ ✖ ✖ Unit dosing ✖ Y Y Y Y ✖ ✖ ✖
  8. 8. PMH UCSF BCH CHW PhCH GOSH Cambridge Schneider System ✖ Epic Cerner Epic AllRx JAC Epic Chameleon E-prescribing ✖ ✔ ✔ ✔ GE ✔ ✔ ✔ Clinical documentation ✖ ✔ ✔ ✔ ✔ ✔ ✔ ✔ Pharmacy Info System ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ EMAR* ✖ ✔ ✔ ✔ ✔ ✖ ✔ ✖ LIS/PIS integration ✖ ✔ ✔ ✔ ✔ ✖ ✔ ✔ Oncology Info System ✖ ✔ HG ✔ ✖ Chemocar e ✔ ✖ ICU Information System ✖ ✔ IMDsoft ✔ ✔ IMDsoft ✔ IMDsoft Anaesthesia Info System ✖ ✔ IMDsoft ✔ ✔ ✔ ✔ IMDsoft Patient Admin System ✖ ✔ AllRx ✔ ? IPM ✔ ? Billing and scheduling ✖ ✔ Epic ✔ ? ? ✔ ? EMR ✖ ✔ ✔ ✔ ✔ ✖ ✔ ✖ *EMAR – Electronic Medication Administration Record
  9. 9. PMH UCSF BCH CHW PhCH GOSH Cambridge Schneider System ✖ Epic Cerner Epic AllRx JAC Epic Chameleon Dispensary robots ✖ ✔ ✔ N/A N/A ✔ ✔ ✖ Pharmacy carousel ✖ N/A N/A ✔ ✔ N/A N/A ✖ IV Robotics ✖ ✔ ✖ ✔ ✖ ✖ ✖ ✖ TPN compounder ✖ O ✔ ✔ ✔ ✔ ✖ O Automated Dispensing Machines ✖ ✔ ✔ ✔ ✔ ✖ Pilot ✖ Bar coding technology ✖ ✔ ✔ ✔ ✔ ✖ ✖ ✖ Smart pumps ✖ ✔ ✔ ✔ ✖ ✖ Post GOLIVE ✖ Unit Dose Packaging ✖ ✔ ✔ ✔ ✔ ✖ ✖ ✖ Computer On Wheels ✖ ✔ ✔ ✔ ✔ ✔ ✔ ✔ Bedside BCMA “closing the loop” ✖ ✔ ✔ ✔ ✔ ✖ ✖ ✖
  10. 10.  Teaching hospital affiliated UCSF Medical Centre Campus  180 paediatric/50 neonatal beds  Unit dosing in the mid-70’s  Oct 2010 Mission Bay, Robotic Manufacturing Pharmacy  Bar code unit doses: ◦ tablets, capsules, liquid syringes, IV syringes and IV infusions ◦ full bar coding capability  Early 2011, Benioff went live with an EMR
  11. 11.  EMR - Epic  Integration with PAS  Electronic Prescribing with Clinical Decision Support  Integrated Pathology and Diagnostic Imaging  Pharmacist verification queue  Full BCMA  Medication reconciliation  Integrated with automation
  12. 12. Mar/ April 2010 May to July 2010 July to Oct 2010 Oct 2010 to (Mar*) Oct* 2011 Sept to Dec 2011 Dec to Mar 2012 Mar- Jun 2012 Epic sign off Training & certification Training in Basics of Epic Capabilities of system Validation Epic facilitate workflow sessions with subject matter experts. Big picture decision with pharmacy and nursing (3 x3hr sessions). Build Phase Decision made through validations configured by doctors, pharmacists, nurses. *Timeline blowout Training Super user training Training End user training Testing of system 6 months Phase 1- Mar 12 GO LIVE Pharmacy, EMAR, BCMA, Nurse documentation Phase 2 – Jun 12 CPOE, Clinical documentation, scheduling, billing etc *Initial date GO LIVE Oct 11
  13. 13. Mar/A pril 2012 Jan to Apr 2013 May to Aug 2013 Sept to Jan 2014 Jan - Mar 2014 Mar – Oct 2014 Oct 2014 Epic sign off Training & certification Training in Basics of Epic Capabilities of system Validation Epic facilitate workflow sessions with subject matter experts. Big picture decision with pharmacy and nursing Build Phase Decision made through validations configured by doctors, pharmacists, nurses. *Timeline blowout Training Super user training Training End user training Testing of system 6 months Team workflows Clinical documentatio n Radiology Ordering Pharmacy Med rec Discharge Bloods Meds mgt Epic training Definitions Multiple choice 5 weeks validation 2-3 months training or more GO LIVE Oct 14 Example Inventory Ordering meds from ward Swimlane visio Documenation and validation Epic training and exams
  14. 14.  1.5 million doses – no medication errors  Building COG protocols into oncology system (integration with Apex)  Building interface with IV robotics and Smart Pumps into Apex  MB facility studying molecular gene therapy
  15. 15.  Affiliated with Harvard Medical school  396 paediatric/28 neonatal beds  In late 90’s, BCH were pioneers in introducing technologies with three main functions:  Basic science research  Direct clinical applied research  Continued research and to enable benchmarking against other paediatric hospitals in the US  HIMSS Level 7 hospital
  16. 16.  Upgrade Cerner clinical system in 2004 (introduced late 90’s)  Allscripts for bed management  Epic for billing and scheduling  Epic - MY CHART, Online Patient Portal  IMDsoft – ICU and anaesthesia  ALICE for patient tracking  Home grown system for oncology COG protocols (integrated with IHS)  Homegrown cardiology and ophthalmology systems  Vecna – Infectious Diseases (2.5 years in development)  Integration with automation and smart pump technology
  17. 17.  Scan in timeline
  18. 18. PMH UCSF BCH CHW PhCH GOSH Cambridge Schneider System ✖ Epic Cerner Epic AllRx JAC Epic Chameleon E-prescribing ✖ ✔ ✔ ✔ GE ✔ ✔ ✔ Clinical documentation ✖ ✔ ✔ ✔ ✔ ✔ ✔ ✔ Pharmacy Info System ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ EMAR* ✖ ✔ ✔ ✔ ✔ ✖ ✔ ✖ LIS/PIS integration ✖ ✔ ✔ ✔ ✔ ✖ ✔ ✔ Oncology Info System ✖ ✔ HG ✔ ✖ Chemocar e ✔ ✖ ICU Information System ✖ ✔ IMDsoft ✔ ✔ IMDsoft ✔ IMDsoft Anaesthesia Info System ✖ ✔ IMDsoft ✔ ✔ ✔ ✔ IMDsoft Patient Admin System ✖ ✔ AllRx ✔ ? IPM ✔ ? Billing and scheduling ✖ ✔ Epic ✔ ? ? ✔ ? EMR ✖ ✔ ✔ ✔ ✔ ✖ ✔ ✖ *EMAR – Electronic Medication Administration Record
  19. 19. PMH UCSF BCH CHW PhCH GOSH Cambridge Schneider System ✖ Epic Cerner Epic AllRx JAC Epic Chameleon Dispensary robots ✖ ✔ ✔ N/A N/A ✔ ✔ ✖ Pharmacy carousel ✖ N/A N/A ✔ ✔ N/A N/A ✖ IV Robotics ✖ ✔ ✖ ✔ ✖ ✖ ✖ ✖ TPN compounder ✖ O ✔ ✔ ✔ ✔ ✖ O Automated Dispensing Machines ✖ ✔ ✔ ✔ ✔ ✖ Pilot ✖ Bar coding technology ✖ ✔ ✔ ✔ ✔ ✖ ✖ ✖ Smart pumps ✖ ✔ ✔ ✔ ✖ ✖ Post GOLIVE ✖ Unit Dose Packaging ✖ ✔ ✔ ✔ ✔ ✖ ✖ ✖ Computer On Wheels ✖ ✔ ✔ ✔ ✔ ✔ ✔ ✔ Technology/automation integration ✖ ✔ ✔ ✔ ✔ ✖ ✖ ✖ Bedside BCMA “closing the loop” ✖ ✔ ✔ ✔ ✔ ✖ ✖ ✖
  20. 20. <2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 UCSF Epic May 10 ‘GO LIVE’ June 12 BCH Phase 1 Phase 2A Phase 2B Phase 3 CHW Allscripts 2000 BDM centric ity (GE) Interfac e develo p-ment Bi- direction al interface Epic Jan 10 ‘GO LIVE’ Sept 12 PhCH Allscripts 1999 ‘GO LIVE’ 2002 BDM centric ity (GE) Bi- direction al interface Sunrise full integrati on Rolled out to wards PICU/ NICU/ ED Ambulat ory care GOSH Ascrib e JAC Cambridge Epic Jan 12 ‘GO LIVE’ Oct 14 Schneider IMDsoft Chame leon
  21. 21.  Success of CLMMS dependent on: ◦ Good EMR implementation ◦ Good automation ◦ Robust governance structure  Driven by patient safety, not ROI (all sites)  Best of breed systems - resource and time intensive and costly  Set realistic timeframes, avoid rapid implementation  Resource constraints poses a serious risk to patient safety  Do not overdo ‘alerts’ or ‘hard stops’ - ALERT FATIGUE!!  Select systems with usability by multiple users at the same time
  22. 22.  Day 1 - Automation: ◦ Automated Dispensing Machines (limited function) ◦ Bedside medication drawers ◦ Mobile medication carts ◦ Paper medication charts  Pharmacy Automation ◦ Whole Pack Robotics ◦ Unit-Dose Robotics  EMR staged rolled out ◦ Electronic prescribing with clinical decision support ◦ Bar code medication administration = CLMMS
  23. 23.  Dramatic reduction in medication errors ◦ Illegible prescription ◦ Transcription errors ◦ Wrong doses (decimal point error) ◦ Wrong drug selection  Improvement in Nursing workflow  Operational efficiencies for Pharmacy  Data decision support and standardised treatment sets  Accurate measuring and collection of data: errors and outcomes
  24. 24.  EMR and Pharmacy automation enables future improvements on a long journey  Strong support from top down to continue to drive development  Ambitious long-term project with realistic Day 1 position  Moving towards CLMMS in Western Australia
  25. 25. What could the future look like with a poorly implemented EMR?
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