ePHR - Plunket's Technology Journey
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This document summarizes Plunket's journey to implement an electronic personal health record (ePHR) system. Some key points: - Plunket aims to modernize its services and provide frontline nurses mobile access to digital client information through a new ePHR app. - Significant challenges include transitioning from paper-based to digital records and ensuring the new system integrates well with clinical workflows. - Early successes include equipping all frontline nurses with smartphones by 2014. The in-development ePHR app aims to improve access to real-time client data and allow for more time with families. - Full implementation will require focus on change management, training, and monitoring impacts to
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ePHR - Plunket's Technology Journey
- 1. ePHR - Plunket’s Technology Journey Andrea McLeod (Chief Operating Officer) 1
- 2. Implementation – It’s easier said than done! What this session will cover: • Brief History – why go paperless? • The ePHR ‘application’ in a nutshell • Where are we up to in the project? • What are the current challenges? • What will success look like?
- 3. Keeping Plunket Relevant... Moving us into the 21st Century....... Challenging our thinking.... Challenging our behaviour.... Why change? 2 Our ambition was for our frontline staff to have and use digital technology every day.
- 4. The challenges 4 But, it is no simple task! We are literally moving from this.......... to this.........
- 5. Our nurses now have email ! 5 Nurses with mobile technology Last year we delivered 603 smartphones. Our nurses now have access to digital information and are better connected with our organisation. Our GOAL was: 100 %of all frontline staff (nurses and health care workers) to have smartphones by the end of 2014. Our GOAL was: 100 %of all frontline staff (nurses and health care workers) to have smartphones by the end of 2014.DELIVERED! DELIVERED!
- 6. 6
- 7. electronic Plunket Health Record (ePHR) So what is the ePHR? 7 Six ePHR modules 1HOME Contains login, landing page and sync (data) management. 2SEARCH Contains search functionality. 3APPOINTMENTS Contains options to view all appointments, or to add or manage an appointment. 4CLIENTS Contains enrolment into the Well Child service, and the management of client information. 5RELATIONSHIPS Contains the ability to link relationships. 6CONTACTS Contains the electronic version of all current Contacts. The ePHR is an application (app) that will enable us to connect with our Well Child customers using technology. The aim is to ensure that we have integrated and up-to-date information in real time, at the point of care. It is a user-friendly mobile app.
- 8. The benefits of the ePHR Population Benefits • Improved case management and case load management • Timely referrals • Improved access to ‘real time’ data • Increased time to care for, and work with, families • High quality data - accessible and available 8
- 9. Benefits cont.... Strategic Benefits • Relevance • Improved integration of services • Opportunities for interoperability • Sector Leadership 9
- 10. (video) 10
- 11. People, Process & Technology • IT capabilities • Training/support • Perceived benefits • Clinical champions 11
- 12. People, Process & Technology • Ease of use • Fit with clinical workflow • Process redesign • Workload impact 12
- 13. People, Process & Technology • Software design • User centric – fast & functional • Future proof 13
- 14. What does success look like? 14
- 15. What do we need to get us there? • A robust change management process • Support and development for our leaders • A platform for change • Increased capability and confidence 15
- 16. Communicate the Vision, Rationale and Plan Communicate the Vision, Rationale and Plan Create Short-Term Wins, Maintain Momentum, and Learn Create Short-Term Wins, Maintain Momentum, and Learn Implement Organisation Re- Design for Realignment Implement Organisation Re- Design for Realignment Develop and deliver communications - vision, rationale, and change strategy workshops Track and monitor impact Realign change plan as required Actively manage stakeholders Design and initiate interventions and learn from response Create short-term wins Maintain momentum Implement parallel organisation design changes to realign other areas of the organisation around the major change – changes may be in structure, process, culture, leadership, rewards and people LEAD PHASE Facilitate Employee Participation, Buy-In, and Skill Development Facilitate Employee Participation, Buy-In, and Skill Development Broaden participation by involving key influencers Employee workshops to outline impacts, identify issues and problem-solve solutions Train in new skills Work with deployment to manage issues as they arise Undertake Organisational Assessments Undertake Organisational Assessments Assess organisational readiness for change Assess business, culture, people and organisation design impacts and identify and set up key parallel projects Undertake detailed Stakeholder Assessment Determine Change KPI’s 16
- 17. 17
- 18. Questions? References: Darbyshire, P. ‘Rage against the machine?’: nurses and midwives eperiences of using computerised patient information systems for clinical information. J Clin Nurs. 2003; 13(1): 17-25. Lorenzi, NM. Beyond the gadgets: non-technological barriers to nformation systems need to be overcome too. BMJ. 2004;328(7449): 1146-1147. Lorenzi, NM., Riley RT. Managing change: an overview. J Am Med Inform Assoc. 2000;7:116-124. Sassen, E. Love, Hate, or Indifference: How nurses really feel about the electronic health record system. CIN: Computers, Informatics, Nursing. 2009; Vol 27, No. 5, 281-287. 18
Editor's Notes
- I thought it would be useful to give you some history about some of the key drivers for Plunket – what the ePHR is and why we chose the application we have, and then follow this with a ‘hot off the press’ look at the application in action with a short video clip of one of our nurses and families. Of course, the bulk of this presentation is about technology implementation and so I will be giving you some insight into the key challenges that we have found during our pilot, and some of the remedial action we are taking in order to get the ePHR and our organisation ready for national implementation.
- Why Change? A very good question indeed……. Our journey started back in June 2011. At that time we started by looking at how we could better support our staff and use technology to our advantage. At the heart of our technology transformation is the child and their family. Right from the start, our journey has ensured that children and their families were firmly at the centre of what we do - our drive for better technology is centered on Plunket’s vision to provide the best start in life for every child. The original idea was simply based on the need to move away from a paper-based client information system, to a digital one...... However since that time our vision has grown into the concept that will see us integrate all of our services, data and intelligence – it will see us connect with other providers, and we will be using data and information in a completely different way. When we began this journey we recognised that we needed to move away from our paper-based client information systems to an integrated, interactive digital one. The starting point for us was the ‘Well Child’ service. As a leader in the field of child health care and parenting support, we know that we need to improve support, advice and health outcomes for New Zealand children and their families by ensuring we have access to accurate, reliable, integrated, real time, and up-to-date information. We also realise that to be a relevant, agile, and flexible organisation we need to organise ourselves better, provide up-to-date support services to our customers and our people (including IT and technology solutions) and we need to become more efficient at what we do. There is no more money and we are constantly being challenged to do more for less. Like many health organisations we have a plethora of data and information held in our Plunket systems – we need to use this information better to inform future services and advance business intelligence and service knowledge. (next slide) However to do this has been far from simple........ (next slide)
- Talking points Technology today is a driving force for many organisation’s around the world – it is key to growth and development in the sector. Technology forms part of Plunket’s strategic direction and is driven forward by our transformative vision of which promises a better connected future both internally and externally. (next slide)
- It’s hard to imagine that a few years ago minimal Plunket staff used email – just seven years ago less than 200 of our staff had access to a Plunket email! Today most of our organisation relies on email as a normal way in which to conduct business. And, now importantly, our frontline staff are connected with the rest of Plunket, and key stakeholders external of our organisation. The days of cascading information via pieces of paper are in the past and we now use technology to keep us connected. (next slide)
- Plunket is working to transform the future for child health, building on our knowledge, the knowledge of others, improving support to families, and developing our communities in order to improve health outcomes. (next slide)
- Talk to slide. “There are many benefits of the ePHR….” (next slide)
- Improved case management and case load management leading to better service delivery for customers Timely referrals to external service providers which will lead to better health outcomes Improved access to ‘real time’ data which ensures we can identify issues, and provide intervention in a timely way Increased time to care for, and work with, families – using technology saves time - there is no getting away from it – but “how” we use this freed up time is really important. 5. High quality data, accessible and available, that can be quickly acted upon at both a local and national level when population trends develop
- Plunket will become a relevant organization using technology as an enabler to connect with customers in the most appropriate way possible, to provide a wide range of services Improved integration of services within and external of Plunket. We are looking at interoperability between Plunket systems right now – for example PlunketLine. Opportunities for interoperability with other health systems – sharing of data, seamless service delivery and improved outcomes for families. We are working closely with primary care to find solutions for electronic referrals and data sharing. Plunket will be seen as a leader in the field of child health – there are opportunities to use the ePHR as the starting point for a single health record for all NZers – wouldn’t that be a novel idea??
- Introduce the video “We have been piloting the application with a group of clinical staff and administrators for several months now. We have had some challenges along the way and despite all the perceived benefits of technology and the drive to become more relevant, and efficient in the way we work, the question remains about whether or not nurses will accept these new technologies” Play Video……. So, this all looks good, seems reasonable, doesn’t it? But we all know that the reality is that it isnt as simple or as easy as it sounds. The majority of literature that we have read suggests that there are three categories that adoption barriers fall into – situational, cognitive, and attitudinal. I thought it would be useful if we explored these barriers with specific stories and examples from the Plunket experience.
- The literature suggests that successful implementation of an electronic health record is determined by three things - people, process, and technology itself. The people need to have an understanding of the benefits and the usefulness of the technology. We have found that the use of clinical champions and advisory groups is critical, as is having user involvement right from the outset of a technology project. User resistance is a substantive theme in the literature. As Lapointe and Rivard suggest, users have considerable power as to the success of the implementation. If clinicians don’t want to use the system for any number of reasons, the implementation could fail. It is imperative that ways are found to successfully incorporate an electronic health record into practice – the end result is ultimately one where clinicians want to use the system and where the system supports their practice. (give example of nurse stating she wont use the tablet – a barrier to her relationship with her client) Darbyshire states that nurses are creatures of habit, just as people are in general. Everyone is most comfortable with the status quo. People like performing their jobs in the way to which they have become accustomed. The only person who probably really loves change is a wet baby!! The prospect of change can arouse many feelings ranging from uncertainty, powerlessness, loss, and fear. (next slide)
- The processes need to fit with clinical workflow and be easy to understand and use. We have found the workflow mapping and process redesign has been necessary and we have done this taking a multidisciplinary approach. According to Darbyshire, an EHR is often promised to decrease paperwork, save time for nurses, improve documentation, decrease liability, improve access to client information, and enhance client outcomes. In essence, the EHR changes HOW work gets done. However, as Sassen states: “if the EHR does not support the nursing workflow, suspicions and myths are not dispelled, expectations are not managed, and nursing is not included in the long term vision, the EHR will face serious adoption challenges” Lorenzi and Riley state that “even the best technology system can fail if the end users were not involved from the beginning and consequently refuse to use it in the end” Because technology investments mostly consist of things such as software and hardware, it is easy to be misled into thinking that implementation has occurred when everything has been purchased and installed. However, nothing works without people. (give example of administration – current & future process and the impact on staff) (next slide)
- The software design itself is important – for the user it has to be user centric, functional and fast. For the organisation it needs to allow for future development such as interoperability, compatibility and flexibility. We involved our nursing staff in the early phases of system design…….(talk about the app – intuitive – vibrant – swipe screens – drop down boxes – alerts – tablet function (Lenovo)…… (next slide)
- So, what is success and how will we get there….? Kurt Lewin’s Force Field Analysis Model is a good model to apply to help implement an EHR successfully. Lewin defines changes as two dynamic opposing forces in an environment. There are driving forces that move toward a positive region and facilitate change, and static conditions that try to keep the status quo, known as restraining forces. Restraining forces can keep a change from occurring by manufacturing barriers. For a change to occur, the driving forces must be fortified in favor of the change while the restraining forces are deleted or weakened. Lewin talks about the three stages required in the change process – these are (1) unfreezing the status quo; (2) changing; and (3) refreezing. Unfreezing requires us identifying the current problem or need. At Plunket, our problem was our paper-based system which needed to be replaced with an electronic one. When we first started talking about the ePHR, and even now when it is on the cusp of roll out, some staff are still verbalising feelings of anxiousness and unease. We have been very open and honest about the extent of the impact the change will have – the fact is that everyone, and every function in our organisation will be effected. Our communication has been on point and we are working hard with those leading the change so that they can listen to concerns and work with us to problem-solve out in the field. During the pilot phase of our ePHR we have identified a number of the key driving and restraining forces. Many of these driving forces have been related to the acceptance of the ePHR and they include things like the desire to learn something new – we have nurses chomping at the bit to get electronic and move forward; comprehensive and adequate training, prior computer experience – many of our nurses are IT literate and are keen to get using our app, belief that improvement is needed over current practices, and a positive experience with change in the past, and so on….. We have found that some of the restraining forces include lack of computer skills; attitude towards technology, negative attitude towards the organisation, dislike of learning new things; and past negative experiences with change, and so on. Yet despite this, we are sensing that the need for change is being acknowledged across the country and accepted by most….and the “driving forces are counteracting the restraining forces” (next slide)
- So, finally, where are we up to in our change programme – as you can see from this slide, we are in the “lead” phase. The things we are focusing on most as we get ready to roll out and implement in early 2016 are: (1) Change Readiness - Ensuring Plunket is capable of accepting the change (2) Change Impact - we need to ensure all the change impacts are identified and then managed (3) Governance – ensuring the change process is governed and led effectively (4) Business Readiness – we are aiming for minimal disruption to BAU during the change and acceleration to business improvement post change (5) Organisation Design – making sure there is alignment of other organisational elements to the change (processes, structure, capabilities, people, rewards, culture, leadership) Right now we are planning the first phase of our national roll out programme - this will take place from mid January next year. We will be rolling out the ePHR to Wellington/Wairarapa, and following an evaluation of that implementation we will then make decisions about the next regions to roll out to and the timeframe for each. The aim is to have the ePHR rolled out across all NZ by the end of 2016. Momentum and excitement is building We don’t want to leave any of our people behind – (next slide)