Electronic Medication Management (EMM) Program
State and local
implementation lessons
Play EMM Video
Introduction by Dr Peter Kennedy
Deputy Chief Executive Officer – CEC
Chair of NSW EMM Steering Committee
Session agenda
• The role of eHealth in Supporting
Patient Safety
• The Clinical Perspective
• EMM Program Update
• Update...
E-health NSW:
Changing Patient Trajectories
The Role of e-health in Supporting
Patient Safety
Dr Peter Kennedy
Deputy Chie...
Data from HIMSS AnalyticsTM Database 2011 HIMSS Analytics
HIMSS Analytics Asia EMR Adoption Model
Stage 2
Stage 3
Stage 4...
EMRAMAverageStageScore
0
1
2
3
4
5
6
7
Local Health District (n=17) average EMRAM* Scores
Mean
^The Healthcare Information...
The most mature EMR in the country. Usage growing
100 orders placed and results viewed per minute
Electronic Medical Recor...
Communication
Leadership Team Work
TeamSTEPPS
Courtesy of the Agency for Healthcare Research and Quality
Situational Awareness
Shared Mental Model
Mutual Support
TeamSTEPPS
Five
Dysfunctions
of a Team
1
Absence of
trust
2
Fear of conflict
3
Lack of
commitment
4
Unwillingness
to hold one
another...
Executive Sponsorship
Clinical Leadership
Technical Expertise
Equity
Principles for EMR Rollout
Policy Ministry
Governance
Strategy and Architecture
Local Networks / Bandwidth
Central Infrastructure (Data Centres) and ...
IT Platform
eMR & eMM
Clinician led and data driven
HIE Patient Portal
Clinical Analytics
Value added
Outcome measures
Dri...
It has to work for both Clinicians and Patients in
improving patient care and safety.
Key Themes for EMR Rollout
Key Themes:
I. It is an opportunity to look at work
practices and clinical practice
II. Will require increasing standardis...
Key Issues:
I. The Firewall and moving information
between hospitals, General Practitioners
and patients
II. Use of own de...
Key to Successful Implementation
of Programs:
I. Training and education at facility level
II. Ongoing support at each faci...
We need to define with each project what are
the quality parameters that we want to achieve
from the implementation. We ne...
IT is going to be introduced in to the
performance review process for all LHDs and
LHNs in NSW. This means there will be k...
Associate Professor Kathy Gibson
Staff Specialist Rheumatologist
Liverpool Hospital
EMM Program Clinical Secretariat Lead
...
Background
• In Australia, 2-4% of all hospital admissions are
medication related.
• Includes admissions due to adverse dr...
• Australian research shows that
errors can be reduced by more than
55% with the introduction of
electronic systems to hel...
What is EMM?
• Managing tasks and documents
involved in prescribing, administering
and dispensing medications to
patients ...
Why do it?
• Improve accuracy and visibility of
medication information being
communicated between professionals
and health...
CASE HISTORY 1
• 64 year old male patient brought to
the ED by ambulance with fever, low
oxygen levels and coughing up bla...
• ED registrar agreed to write the
medication chart because Oncology
registrar called away
• ED registrar looked up the pa...
• Oral Morphine 20mg =
Hydromorphone 3mg
• Patient admitted to ward and
subsequently received oral
Hydromorphone 20mg as c...
So what went wrong?
• ED registrar incorrectly charted
20mg Hydromorphone instead of
2mg.
• 2 ED nurses gave Morphine 20mg...
• Case 1, Opiate prescribing
• 20mg Hydromorphone vs 2mg
Hydromorphone – transcribing error
EMM system with (existing) rec...
• Lack of recognition of incorrect dose of
Hydromorphone overnight
EMM system could alert to high dose used
and should con...
CASE HISTORY 2
• 66 year old female admitted to
investigate acute blurring of vision in
her left eye and headache
• On war...
• Clexane restarted 48 hours after
surgery at full dose
• A few hours after second Clexane dose
given patient acutely dete...
So what happened?
• No clear verbal or written orders given to
junior staff regarding peri-op anticoagulant
management
• P...
How could an EMM
system help?
• Case 2
• Full dose Clexane restarted 24 hours
after brain surgery
EMM can contain links to...
Will EMM prevent all errors?
• No! E-systems can introduce new errors
• Everybody (administrators, IT staff,
clinicians, t...
The Physician/Clinician
Champion
• What are they?
• Who are they?
• Why do we need them?
The physician/clinician
champion can provide expert
input to project team
• Clinical expertise assists the team in
plannin...
The physician/clinician
champion can communicate to
and from physician colleagues
• Physicians and other clinicians may
“t...
The physician/clinician
champion can help make
critical decisions
• The effective clinician leader is a
highly-skilled dec...
Are physician and IT project
leaders ready for this change?
Of course I will
be involved!
I’d love to have
physician input...
Are physician and IT project
leaders ready for this change?
I will tell you
exactly what you
need to do for
me!
We don’t n...
Are physician and IT project
leaders ready for this change?
My partners can
be so
unreasonable!
He needs to fix
those
dema...
Are physician and IT project
leaders ready for this change?
This needs to be
fixed by Friday
or we cancel the
project!
I d...
Clinical IT projects:
A fork in the road for work
processes
Improve! Worsen!
It is never neutral!
Recommendation: Appoint
clinical champions for all clinical
IT projects and especially EMM!
• Effective clinician input in...
Dr Robin Mann
EMM Program Director
Program progress and plans
EMM Challenges
• Readiness
• Capacity and capability
– LHDs and vendors
• Product maturity
• Integration with existing arc...
EMM Maturity
Hospital
Administer
Review
Prescribe
Check
Dispense
DischargeReconcile
GP
Community
pharmacy
Community
servic...
EMM Program
Dr Angus Ritchie
Silvia Fazekas
Cheryl McCullagh
Update from initial sites
Dr Angus Ritchie
Renal Physician and EMM Clinical Lead
Concord Repatriation General Hospital, Sydney LHD
Initial site upda...
Concord Update
• EMM Phase 1
• EMM Phase 2
• Enhanced IV functionality
IV Enhancements
• What is an IV?
• Intermittent
• Continuous
• Sequenced
IV Enhancements
After eMAR
documentation
IV Enhancements
Proposed Display
Current Display
Phase 1
• 2005 Project begins
• 2007 EMM two Aged Care wards
• 2010 EMM three more wards
• Road blocks
– iPharmacy-Pharmne...
Phase 2
• Inpatient EMM – all wards
• Outpatient prescribing
• Medication history & reconciliation
Phase 2
Sep 2012 Nov 2013
Project kick-off Conversion target
Phase 2
Sep 2012 Nov 2013 Mar 2014
Project kick-off Conversion target New conversion target
Phase 2
Sep 2012
Nov
2013
Mar
2014
TBC
Project kick-off Conversion target New conversion target
Changes
• Bigger team
• Comprehensive scope
• Change management
• Timeline replanning
Clinical Leadership
Usual Practice New Model
Paid for another role Dedicated funding
Specialty-specific view Big-picture v...
Clinical Leadership
Usual Practice New Model
Paid for another role Dedicated $
Specialty-specific view Big-picture view
Cl...
Clinical Leadership
Usual Practice New Model
Paid for another role Dedicated $
Specialty-specific view Big-picture view
Cl...
Current priorities
• IV Project leadership
• Change Control Board
• Medication reconciliation
– Admission conversion
– Dis...
Silvia Fazekas
eMEDS Project Manager
South Eastern Sydney Local Health District
Initial site update
Cheryl McCullagh
Director Clinical Integration
Sydney Children’s Hospitals Network
Initial site update
The MEMORY strategy describes the plan for implementation of a fully integrated health
record across SCHN; it involves mor...
SINGLE
EMR
CHW
SCH
2013 2014 2015 2016 2017
EMM
+ EMRP
Westmead
Clin-docs
build
Move to
SurgiNet
PathNet
c/compass
Move of...
Implementation Process
EMM/EMRP Project Milestones
End-User Training
Go Live
Aug 2015
Project Kick-
off
10/03/14
System
Re...
Policy
Governance
Strategy and Architecture
Local Networks / Bandwidth
Central Infrastructure (Data Centres) and Operation...
What we have worked out so far
•Who reads email
•Face to face needs senior support
•Surgeons are hard to find
•Coherent, c...
The MEMORY strategy needs everyone
Addressing old risks adds different risks
 Champion responsibilities
 Communication, ...
MEMORY Strategy Stories
•Critical mass- 80%
•Story for each project
•Story for each site
•Lead with safety quality access
...
MEMORY strategy outcomes
•HIMMS level 6
•The first implementation of paediatric
EMM in Australia
•The first implementation...
Questions ?
Questions for the panel?
Chaired by Dr Peter Kennedy
Electronic Medication Management (EMM) Program
State and local
implementation lessons
Upcoming SlideShare
Loading in …5
×

Dr. Peter Kennedy, Deputy Chief Executive Officer – CEC, Chair of EMM Steering Committee - PANEL - Electronic Medication Management in the Context of eHealth in NSW

1,618 views

Published on

PANEL: NSW Health 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
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
1,618
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
59
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Dr. Peter Kennedy, Deputy Chief Executive Officer – CEC, Chair of EMM Steering Committee - PANEL - Electronic Medication Management in the Context of eHealth in NSW

  1. 1. Electronic Medication Management (EMM) Program State and local implementation lessons
  2. 2. Play EMM Video
  3. 3. Introduction by Dr Peter Kennedy Deputy Chief Executive Officer – CEC Chair of NSW EMM Steering Committee
  4. 4. Session agenda • The role of eHealth in Supporting Patient Safety • The Clinical Perspective • EMM Program Update • Updates from our initial EMM sites • Questions for the Panel
  5. 5. E-health NSW: Changing Patient Trajectories The Role of e-health in Supporting Patient Safety Dr Peter Kennedy Deputy Chief Executive Officer Clinical Excellence Commission 25 March 2014 3rd Annual Electronic Medication Management Conference
  6. 6. Data from HIMSS AnalyticsTM Database 2011 HIMSS Analytics HIMSS Analytics Asia EMR Adoption Model Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7 Stage 1 Stage 0 CDR, Controlled Medical Vocabulary, CDS, may have Document Imaging; HIE capable Nursing/clinical documentation (flow sheets), CDSS (error checking), PACS available outside Radiology CPOE, Clinical Decision Support (clinical protocols) Full Complement of Radiology PACS Physician documentation (structured templates), full CDSS (variance & compliance), Closed Loop Med Admin Complete EMR; CCD transactions to share data; Data warehousing; Data continuity with ED, ambulatory, OP Ancillaries – Lab, Rad, Pharmacy – All Installed All Three Ancillaries Not Installed
  7. 7. EMRAMAverageStageScore 0 1 2 3 4 5 6 7 Local Health District (n=17) average EMRAM* Scores Mean ^The Healthcare Information and Management Systems Society *EMR Adoption Model • Overall low average (1.41) comparable when very small / MPS sites excluded • Goal NOT to get all hospitals to Level 6, however HIMMS assessed 40 hospitals have fulfilled the majority of pre-requisites • EMRAM is acute care focused – handover to and from Primary and Community Care important Maturity
  8. 8. The most mature EMR in the country. Usage growing 100 orders placed and results viewed per minute Electronic Medical Record January 2014 activity Mar-12 Jan-14 Mar-12 Jan-14 Mar-12 Jan-14 % change Orders 127,000 131,000 3,861,000 4,000,000 46,000,000 48,000,000 4 Patient Charts Opened 180,000 206,000 5,462,000 6,200,000 65,544,000 75,000,000 14 Clinical documents created 16,500 21,000 502,000 640,000 6,024,000 7,700,000 28 Decision support alerts 6,900 10,600 211,000 323,000 2,532,000 3,900,000 54 Mar-12 Jan-14 % change Average transaction time 0.95 0.52 45 Transactions (Millions) 139 233 68 Monthly AnnualDaily Reduction is due to hardware and system upgrades Growth in system use Improved Performance: Growth in system use: Up 65% sine March 2012 Average transaction time: Down 45% since March 2012 Key activity per day: Orders: 131,000 up 4% since March 2012 Chart opens: 206,000 up 14% since March 2012 Clinical Documents Created: 23,000 up 28% since March 2012 Decision Support Alerts: 10,600 up 54% since March 2012
  9. 9. Communication Leadership Team Work TeamSTEPPS Courtesy of the Agency for Healthcare Research and Quality
  10. 10. Situational Awareness Shared Mental Model Mutual Support TeamSTEPPS
  11. 11. Five Dysfunctions of a Team 1 Absence of trust 2 Fear of conflict 3 Lack of commitment 4 Unwillingness to hold one another accountable 5 Inattention to results Patrick Lencioni
  12. 12. Executive Sponsorship Clinical Leadership Technical Expertise Equity Principles for EMR Rollout
  13. 13. Policy Ministry Governance Strategy and Architecture Local Networks / Bandwidth Central Infrastructure (Data Centres) and Operations (EMR) eHealth NSW Local Project Management, Implementation and Training Program Management, Procurement End User Computing (PCs, Mobile Devices, TeleHealth Endpoints, Wireless Networks, Phones) Ownership Work Practice Review Standardisation and Content Knowledge Education Clinician Support Benefits Realisation ACI / CEC / HETI / NSW Kids and Families Local Health Districts EnablersChangeManagement Risk Category Owner 13
  14. 14. IT Platform eMR & eMM Clinician led and data driven HIE Patient Portal Clinical Analytics Value added Outcome measures Drives change Validates process measures, projects & priorities Business applications Infrastructure Standardisation Technovigilance Interoperability Is key to success
  15. 15. It has to work for both Clinicians and Patients in improving patient care and safety. Key Themes for EMR Rollout
  16. 16. Key Themes: I. It is an opportunity to look at work practices and clinical practice II. Will require increasing standardisation of care III. Will provide opportunities for much better information on what we do and also in terms of outcomes Key Themes for EMR Rollout
  17. 17. Key Issues: I. The Firewall and moving information between hospitals, General Practitioners and patients II. Use of own devices III. Standardisation IV. Evaluation Key Themes for EMR Rollout
  18. 18. Key to Successful Implementation of Programs: I. Training and education at facility level II. Ongoing support at each facility III. Adequate infrastructure at the facility level – devices, wireless network, speech recognition etc. Key Themes for EMR Rollout
  19. 19. We need to define with each project what are the quality parameters that we want to achieve from the implementation. We need to build them into the development process. Quality cannot be an afterthought, it must be a driver. Quality in the EMR
  20. 20. IT is going to be introduced in to the performance review process for all LHDs and LHNs in NSW. This means there will be key performance indicators and regular review of progress at the 3 monthly meetings. Executive Buy-In
  21. 21. Associate Professor Kathy Gibson Staff Specialist Rheumatologist Liverpool Hospital EMM Program Clinical Secretariat Lead The clinical perspective
  22. 22. Background • In Australia, 2-4% of all hospital admissions are medication related. • Includes admissions due to adverse drug reactions and those due to medication errors which together are termed adverse drug events (ADEs) • Overall, about 43% of these are deemed preventable (1) • Errors occur at every step of the medication management pathway • But most occur during prescribing 1. Runciman WB et al. (2003) Adverse drug events and medication errors in Australia Int J Qual Health Care 15 (suppl 1): i49-i59.
  23. 23. • Australian research shows that errors can be reduced by more than 55% with the introduction of electronic systems to help manage medication prescribing, dispensing and administration (2) 2. Westbrook JI et al. (2012) Effects of two commercial electronic prescribing systems on Prescribing error rates in Hospital patients: A before and after study. PLoS Med 9 (1):e1001164. doi:10.1371/journal.pmed.1001164
  24. 24. What is EMM? • Managing tasks and documents involved in prescribing, administering and dispensing medications to patients using an electronic system • Includes automated tools to assist in choosing medications and doses to be prescribed (decision support) • Includes automated checking for allergies and other patient factors that make certain medications unsafe to prescribe
  25. 25. Why do it? • Improve accuracy and visibility of medication information being communicated between professionals and health care settings • Improve communication with patients about their medication • Increase legibility of medication orders • Reduce variance in prescribing practice • Reduce medication errors and associated adverse events
  26. 26. CASE HISTORY 1 • 64 year old male patient brought to the ED by ambulance with fever, low oxygen levels and coughing up black sputum • History of end stage lung cancer self discharged against medical advice 3 days before this presentation • In ED patient confused and agitated • Seen by the ED registrar and the Oncology registrar and admission arranged
  27. 27. • ED registrar agreed to write the medication chart because Oncology registrar called away • ED registrar looked up the patient’s previous medications and recharted them by hand • Wrote oral Hydromorphone 20mg • Previous dose was oral Hydromorphone 2mg • In ED two junior nurses checked the chart and gave the patient oral Morphine 20mg
  28. 28. • Oral Morphine 20mg = Hydromorphone 3mg • Patient admitted to ward and subsequently received oral Hydromorphone 20mg as charted and breakthrough subcutaneous Hydromorphone 0.5mg (equivalent to about 1.5mg oral Hydromorphone) overnight • Patient died the following morning although not necessarily as a direct result of high dose of Hydromorphone
  29. 29. So what went wrong? • ED registrar incorrectly charted 20mg Hydromorphone instead of 2mg. • 2 ED nurses gave Morphine 20mg orally not Hydromorphone. • Nobody overnight recognised the error in the Hydromorphone dose charted.
  30. 30. • Case 1, Opiate prescribing • 20mg Hydromorphone vs 2mg Hydromorphone – transcribing error EMM system with (existing) record of usual medication being taken on admission plus medication reconciliation process could help • 20mg oral Morphine vs 20mg oral Hydromorphone – administration error EMM system with alerts regarding look alike/sound alike meds and/or rules that only allow prescription of Hydromorphone using the trade name Dilaudid How could an EMM system help?
  31. 31. • Lack of recognition of incorrect dose of Hydromorphone overnight EMM system could alert to high dose used and should contain record of medications being taken on admission for comparison/cross check 31 How could an EMM system help?
  32. 32. CASE HISTORY 2 • 66 year old female admitted to investigate acute blurring of vision in her left eye and headache • On warfarin to thin her blood because of chronic atrial fibrillation • At admission changed to clexane (short acting anticoagulant) • Found to have a tumour in her brain • Clexane correctly witheld 24 hours before surgery
  33. 33. • Clexane restarted 48 hours after surgery at full dose • A few hours after second Clexane dose given patient acutely deteriorated due to a large bleed into her brain • Bleed drained in theatre and patient sent to ICU but made no recovery and died 12 days later • The senior neurosurgeons consulted stated that full dose anticoagulation after this kind of brain surgery is contraindicated for several weeks post- op
  34. 34. So what happened? • No clear verbal or written orders given to junior staff regarding peri-op anticoagulant management • Policy to guide junior staff found to be ambiguous • The medication order for Clexane expired on the day of surgery • It was recharted on a new chart that day but only the dose 24 hours after surgery was marked to be witheld • Therefore restarted the next day
  35. 35. How could an EMM system help? • Case 2 • Full dose Clexane restarted 24 hours after brain surgery EMM can contain links to specific policy on anticoagulation and could have rule to prevent anticoagulation prescription within specific time frame from surgery • Clexane recharted by hand on day of surgery As above
  36. 36. Will EMM prevent all errors? • No! E-systems can introduce new errors • Everybody (administrators, IT staff, clinicians, trainers etc) needs to be involved in testing, reviewing, implementing and refining these systems • Everybody who prescribes, dispenses, administers or takes a medication in a hospital is a stakeholder as is everybody involved in managing hospital care
  37. 37. The Physician/Clinician Champion • What are they? • Who are they? • Why do we need them?
  38. 38. The physician/clinician champion can provide expert input to project team • Clinical expertise assists the team in planning phases • Knowledge of clinical process helps define/change plan • Risk anticipation and remedies can be quickly identified
  39. 39. The physician/clinician champion can communicate to and from physician colleagues • Physicians and other clinicians may “tune out” non-clinical experts • Nobody carries more authority than a respected colleague • Physician/clinician champion can listen, assess and translate colleagues concerns
  40. 40. The physician/clinician champion can help make critical decisions • The effective clinician leader is a highly-skilled decision maker • Informed decisions require background on the entire project • Formal decisions should include clinician input
  41. 41. Are physician and IT project leaders ready for this change? Of course I will be involved! I’d love to have physician input and leadership!
  42. 42. Are physician and IT project leaders ready for this change? I will tell you exactly what you need to do for me! We don’t need to brief the physicians on every problem…
  43. 43. Are physician and IT project leaders ready for this change? My partners can be so unreasonable! He needs to fix those demanding physicians.
  44. 44. Are physician and IT project leaders ready for this change? This needs to be fixed by Friday or we cancel the project! I don’t do surgery, I wish he would stop trying to be my project manager!
  45. 45. Clinical IT projects: A fork in the road for work processes Improve! Worsen! It is never neutral!
  46. 46. Recommendation: Appoint clinical champions for all clinical IT projects and especially EMM! • Effective clinician input into clinical IT projects is necessary • The clinician champion role can assist in the two most important factors in project success: – Executive leadership – User involvement • Clinician champion education for clinical IT project leadership needs to be developed
  47. 47. Dr Robin Mann EMM Program Director Program progress and plans
  48. 48. EMM Challenges • Readiness • Capacity and capability – LHDs and vendors • Product maturity • Integration with existing architecture • Federated delivery model • Standardisation and reuse
  49. 49. EMM Maturity Hospital Administer Review Prescribe Check Dispense DischargeReconcile GP Community pharmacy Community services Outpatient care Supportedby Level1EMM Supportedby Level2EMM Supportedby nationalservices Consumer
  50. 50. EMM Program
  51. 51. Dr Angus Ritchie Silvia Fazekas Cheryl McCullagh Update from initial sites
  52. 52. Dr Angus Ritchie Renal Physician and EMM Clinical Lead Concord Repatriation General Hospital, Sydney LHD Initial site update
  53. 53. Concord Update • EMM Phase 1 • EMM Phase 2 • Enhanced IV functionality
  54. 54. IV Enhancements • What is an IV? • Intermittent • Continuous • Sequenced
  55. 55. IV Enhancements After eMAR documentation
  56. 56. IV Enhancements Proposed Display Current Display
  57. 57. Phase 1 • 2005 Project begins • 2007 EMM two Aged Care wards • 2010 EMM three more wards • Road blocks – iPharmacy-Pharmnet interface – Functional deficits
  58. 58. Phase 2 • Inpatient EMM – all wards • Outpatient prescribing • Medication history & reconciliation
  59. 59. Phase 2 Sep 2012 Nov 2013 Project kick-off Conversion target
  60. 60. Phase 2 Sep 2012 Nov 2013 Mar 2014 Project kick-off Conversion target New conversion target
  61. 61. Phase 2 Sep 2012 Nov 2013 Mar 2014 TBC Project kick-off Conversion target New conversion target
  62. 62. Changes • Bigger team • Comprehensive scope • Change management • Timeline replanning
  63. 63. Clinical Leadership Usual Practice New Model Paid for another role Dedicated funding Specialty-specific view Big-picture view Clinical work prioritised Clinical work balanced Learn by experience Specific training Slow, consultative decisions Rapid decision-making Vague lines of reporting Clear lines of reporting Reluctant to take ownership
  64. 64. Clinical Leadership Usual Practice New Model Paid for another role Dedicated $ Specialty-specific view Big-picture view Clinical work prioritised Clinical work balanced Learn by experience Specific training Slow, consultative decisions Rapid decision-making Vague lines of reporting Clear lines of reporting Reluctant to take ownership Take ownership of problems
  65. 65. Clinical Leadership Usual Practice New Model Paid for another role Dedicated $ Specialty-specific view Big-picture view Clinical work prioritised Clinical work balanced Learn by experience Specific training Slow, consultative decisions Authority to make decisions Vague lines of reporting Clear lines of reporting Reluctant to take ownership Take ownership of problems
  66. 66. Current priorities • IV Project leadership • Change Control Board • Medication reconciliation – Admission conversion – Discharge documentation • “Form wars” • Compliance (legal, regulatory) • Evaluation
  67. 67. Silvia Fazekas eMEDS Project Manager South Eastern Sydney Local Health District Initial site update
  68. 68. Cheryl McCullagh Director Clinical Integration Sydney Children’s Hospitals Network Initial site update
  69. 69. The MEMORY strategy describes the plan for implementation of a fully integrated health record across SCHN; it involves more than 20 projects in the next three years. Aims include:  safer care  better access, for multiple users  current complete records  reduced risk around missing or incomplete information  reduced errors  accessible to all from anywhere  improved reporting
  70. 70. SINGLE EMR CHW SCH 2013 2014 2015 2016 2017 EMM + EMRP Westmead Clin-docs build Move to SurgiNet PathNet c/compass Move off iPM to SCHN stack Voice Rec in ED PAS: add Facility ID PAS feed To CHW EMM across Randwick FirstNet Surginet SCHN EMR Strategic Roadmap- 4 years 70 EIR SCH scanning PCEHR Voice Rec in ED EMR CHW EMR SCHN Backscanning lanier END ENDVR lanier VR lanier Email, Reports, Lync, MRD, Scanning, Coding, IT support, PCs, Printing, BYOD, PAS, shared patients NAP forms CCIS CCIS TBA NAP forms EMR SCHN
  71. 71. Implementation Process EMM/EMRP Project Milestones End-User Training Go Live Aug 2015 Project Kick- off 10/03/14 System Review 12/03/14 Design Review 23/06/14 System Validation Sessions 29/09/14 8/12/14 Trainer & Conversion Prep 16/02/15 Maintenance Training 6/04/15 Integration Testing 1 18/05/15 Post Conversion Assessment 16/11/15 Client Executive Session 10/3/14 Integration Testing 2 29/06/15
  72. 72. Policy Governance Strategy and Architecture Local Networks / Bandwidth Central Infrastructure (Data Centres) and Operations (EMR) Local Project Management, Implementation and Training Program Management, Procurement End User Computing (PCs, Mobile Devices, TeleHealth Endpoints, Wireless Networks, Phones) Ownership Work Practice Review Standardisation and Content Knowledge Education Clinician Support Benefits Realisation Local Health Districts need to focus on all of these EMM-the biggest leap in the EMR EnablersChangeManagement Risk Category Owner 72
  73. 73. What we have worked out so far •Who reads email •Face to face needs senior support •Surgeons are hard to find •Coherent, consistent and real reasons for change •Champions need support too •Little EMR changes are big clinical changes •Only users can defend the decisions we make •Long term credibility is more important that short term change
  74. 74. The MEMORY strategy needs everyone Addressing old risks adds different risks  Champion responsibilities  Communication, vigilance, feedback  Support  Sharing the messages  Keep the momentum forward  Eyes on the end goal  Focus on the journey
  75. 75. MEMORY Strategy Stories •Critical mass- 80% •Story for each project •Story for each site •Lead with safety quality access branding video /E-learning ++++++ Professional group visits Support from exec down Champion Visibility
  76. 76. MEMORY strategy outcomes •HIMMS level 6 •The first implementation of paediatric EMM in Australia •The first implementation of full documentation in paediatric oncology •Electronically accessible records for all patients •Summary information available to GPs and Families •Lifetime e-record for all children going forward
  77. 77. Questions ?
  78. 78. Questions for the panel? Chaired by Dr Peter Kennedy
  79. 79. Electronic Medication Management (EMM) Program State and local implementation lessons

×