iHT2 Pre-Summit CMIO Symposium 2013 - Dr. Charles Watson, D.O. and CMIO, KHM, Presentation: "The Road Less Traveled: Speeding Physician Adoption with Point of Care Information Technologies"
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Dr. Charles Watson, D.O. and CMIO, Kettering Health Network (KHN), will discuss how his team successfully challenged the preconception that advanced technologies coupled with EMR implementations create dissatisfied physicians. He will review the physician facing technologies KHN successfully integrated into their Epic EMR implementation and how these technologies resulted in better patient care and increased physician satisfaction. Learning objectives: ∙ Dr. Watson will discuss how information technology sped the physician adoption of the newly installed KHN Epic EMR ∙ Discuss and review the clinical impact of specific technologies including: voice dictation, bio-medical device integration, multi-factor authentication, smart phones, and tablet (iPad) ∙ Discuss how technology enhances CPOE/CPOM outcomes and adoption ∙ Review the planning required to achieve a successful Epic EMR implementation ∙ Discuss and review barriers to physician and processes to remove them, garner buy-in, and achieve success
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iHT2 Pre-Summit CMIO Symposium 2013 - Dr. Charles Watson, D.O. and CMIO, KHM, Presentation: "The Road Less Traveled: Speeding Physician Adoption with Point of Care Information Technologies"
- 1. The Road Less Traveled: Speeding Physician Adoption with Point of Care Information Technologies Charles Watson DO, CMIO Kettering Health Network
- 2. Abstract Dr. Charles Watson, D.O. and CMIO, Kettering Health Network (KHN), will discuss how his team successfully challenged the preconception that advanced technologies coupled with EMR implementations create dissatisfied physicians. He will review the physician facing technologies KHN successfully integrated into their Epic EMR implementation and how these technologies resulted in better patient care and increased physician satisfaction.
- 3. Learning Objectives • Discuss how information technology sped the physician adoption of the newly installed KHN Epic EMR • Discuss and review the clinical impact of specific technologies including: voice dictation, bio-medical device integration, multi- factor authentication, smart phones, and tablet (iPad) • Discuss how technology enhances CPOE/CPOM outcomes and adoption • Review the planning required to achieve a successful Epic EMR implementation • Discuss and review barriers to physician and processes to remove them, garner buy-in, and achieve success
- 4. KHN – Background and Vital Statistics Kettering Health Network located in Southwest OH, in the Dayton area • 8 Hospital IDN • ~1800 beds • 113 sites using Epic Care Ambulatory • ~95 more to roll out over the next two years • 4 Affiliate sites • More than 10,000 employees • More than 12,000 named users Clinical Computing Environment • Deployed Epic for clinicals and revenue • Epic Care Inpatient/Ambulatory • All deployed, CPOM go-live at last two sites June 2012 • Working on Epic 2012 upgrade planned for late Spring 2013
- 6. It’s a Symphony! (timeline) • 2008 – KHN began the process of investigating next generation EMR/CPOM system • 2009 – Spurred on by internal quality initiatives and ARRA KHN selects Epic as their EMR partner – Desktop strategies discussed and selected to manage EMR application • 2010 – July KHN buys Forth Hamilton Hospital, FHH, – 12 month conversion – November, first hospital, Sycamore Medical Center, goes live with Epic – KHN on-track to double desktops across the environment within two years – December, Citrix not seen as a viable long-term alternative, VDI pilot begun • 2011 – May, largest hospital, Kettering Medical Center, goes live with Epic - VDI in some clinical areas – July, FHH goes live with all KHN applications – VDI is core system – October, Grandview and Southview Hospitals go live with Epic • 2012 – February, Greene Memorial Hospital goes live on Epic and new hospital opens on Epic – VDI infrastructure
- 7. Preparing Physicians Be Honest: “This will rock your world.”
- 8. Pre-Epic Clinical Computing • Best of breed application approach • Clinician-approved clinical workstation image – Carelink with standard applications • Some mobile carts with laptops • Single-sign-on with clinical context awareness with integration into all key applications (front-end integration) • Active proximity badges • Fingerprint readers
- 9. Rebuilding Carelink! • Epic implementation gave us an opportunity to vision a new clinical computing environment from the ground up • Leveraged four key groups/stakeholders: – Clinical Champions – Physician Advisory Council – Ambulatory Physician Advisory Council – Information Systems
- 10. The KHN Device Universe • Current OS: Windows XP • Thick Desktops – Wall mount, limited patient rooms, nursing areas • Mobile Carts - laptops
- 11. Getting Buy-In • Extensive clinical needs discovery – Focused on what was needed to get to MU – Incorporating years of positive clinical computing experience, as well as frustrations • Extensive IS technology discovery – Starting with Epic best practices – Input from technology partners: CTG, Microsoft, HP, VMware, EMC – Discovery of up and coming technologies/practices • Clinical Demonstrations
- 12. The Technology Short List …or Herding Cats!
- 13. The Fast Lane Single Sign-on w/Clinical Context • Reduced need for SSO and CCOW with Epic, due to reduction in the depth of external clinical applications • Need still existed for core application group and clinical workflow
- 14. Ready…Tap… Go! • Removed all active proximity badges and fingerprint readers • Replaced the deployed multi-factor authentication model with passive tap badge readers • Re-badged every person in the entire organization • Tested, tested, tested!!!
- 15. Digital Dictation • Clinician desire for digital dictation and voice prompts • Research • Executive Selling • Selected Nuance Dragon Medical Dictation solution • Training
- 16. BYOD • Provided e-mail and calendaring • Provided remote access for PC’s • Rolled out AirStrip • Piloted Epic’s Haiku and Canto • Evaluated security risks for additional devices/access • Implemented VMware View for tablet access
- 17. What is Carelink+, and why we care! KHN’s clinical workstations are branded as carelink+ and are designed to simplify the login process and speed workflow through the use of passive proximity RFID readers, SSO and CCOW provided by Vergence’s Sentillion and Client Side Desktop Virtualization provided by VMware View.
- 18. CareLink+
- 19. Our Approach to Desktop Virtualization • Desktop Virtualization - VMware View running on HP Client Virtualization Reference Architecture • HP Windows-embedded clients – Kiosk mode – Follow-me Desktops
- 20. Clinical Help Desk • Evaluated existing Help Desk • Needed more direct clinical support • Created call route prioritizations for patient- centric issues • Implemented dedicated physician line 24x7 • Implemented dedicated ambulatory line • Implemented new call management software to provide better quality control and reporting
- 21. Regulatory Challenges Ensue! • Ohio Board of Pharmacy requires secure, multi- factor medication administration workflow. • KHN worked with OSBOP to ensure Carelink+ workflow and Epic build aligned to state medication administration requirements • KHN solution: SSO, tap-n-go readers, and Epic.
- 22. The NEW KHN Device Universe • Current OS: Windows XP, Windows 7 • Thick Desktops – Wall mount, limited patient rooms (legacy), nursing areas • Thin Clients (HP Windows 7 embedded) – patient rooms, wall mount, nursing areas, carts • Tablets / iPads • Mobile Carts • Remote Office/Home (2 factor or VPN)
- 23. Results Speak for Themselves! • Over 25 physician FTEs saved per year • More than 125 clinical FTEs saved per year • 40% reduction in manual transcriptions costs with significantly reduced turn around times for remaining dictations • And, most importantly, improved clinical satisfaction with IS from 2.85 to over 4.25, on 5.0 scale, within 12 months of go-live • Reduced clinician time spent getting their work done = more time with patients!
- 24. More Results • Clinical provider can access Epic from any device from anywhere in a secure manner that meets compliance in a cost effective model • Simplified client administration of our clinical workstation environment by implementing VDI as we scaled from 993 devices to 2,555 over 18 months. • Reduced system administrative load – less time spent working on devices in the field, longer MTBF • Desktop support FTEs went from ~1:450 to ~1:700
- 25. Lessons Learned • Give clinicians technology options that IS can support well • Get physician AND nursing buy-in • Give clinicians options and a voice • Train Train Train • Communicate! • You Can Never Have Too Much Support!
- 26. Questions
Editor's Notes
- Best of breed application approach – briefly discuss application mixClinician-approved clinical workstation image – Carelink with standard applications – briefly describe what Carelink isSome mobile carts with laptops – very few, battery issues and satisfaction issues with the carts (nursing)Single-sign-on with clinical context awareness with integration into all key applications (front-end integration) – briefly give example of a patient search – and emphasize this was all engineered by KHN and was difficult to maintainActive proximity badges – which were very trouble-proneFingerprint readers – got dirty, ad wouldn’t even work for a few of our users – CNO had no fingerprint!
- Clinical Champions– strong inpatient and nursing influencedPAC– diverse group, varying levels of technical savvyAmbulatory PAC – an even MORE diverse group with very different/competing viewsInformation Systems – a team that had grown from a small department supporting four hospitals to one four times it’s size supporting, ultimately twice as many facilities and an enterprise-wide Epic roll-out on a VERY short timeline.
- Review the myriad options we provide for clinician connectivity – enabling clinicians to work the way they want to – they way most effective for them.
- Extensive clinical needs discovery Focused on what was needed to get to MUIncorporating years of positive clinical computing experience, as well as frustrations – discuss challenges/frustrationsExtensive IS technology discoveryStarting with Epic best practices- What did our key clinical partner know? What did other Epic clients know? Environment of sharing!Input from technology partners: CTG, Microsoft, HP, VMware, EMC – working big tech partners with broad reach – how could KHN be innovative!Discovery of up and coming technologies/practices – industry research, blogs, reports, etc.Clinical Demonstrations– bringing technologies that we COULD SUPORT and COULD AFORD in for clinical buy-in “Device Fairs”
- Let’s review the point of care technologies that made our short list for inclusion in the project!
- Discuss SSO and clinical context integration
- Took a dissatisfier and turned it into a strengthWorked with different areas to adjust timeoutsWorked with HR and Security teams to make badge distribution work in our timelinesBetter flexibility for auto-enrollment and support for physicians to easily follow lost/forgotten badge protocol
- Review the process for getting Nunace adopted – huge gap between desire and CFO buy-in little faith in reduced transcriptions costsCosts from transcription were spread between cost centers, this drove up consolidated costs – local hospital budgets were left intactImportance of selecting a partner to assist with work-flow based training
- Describe Haiku/CantoDiscuss AirStripSecurity concerns:Concerns with physicians viewing clinical data and follow-upHITECH concerns with localized dataView slide following desktop
- Discuss the process of creating and updatingCarelink+ workstationHomogenous clinical desktop across all venues, including remote and BYOD, means less training physicians on HOW to access the data and more on how to use the applciation
- Key points: patient-centered workflow in patient rooms, kiosk mode, device uses Epic locking and allows new users to connect, based upon their role with the patientFollow-me desktop, allows physicians in general nursing areas, or their offices, to take their desktop from device to device.
- Current Help Desk had improved dramatically but KHN still needed more direct clinical supportImplemented physician line, streamlined workflow for key areas (surgery), warm hand-offs, support team members with advanced trainingImplemented Amb line to assist with dedicatedSeparate lines enabled better reporting Call software enabled calls to be reviewed for quality
- Discuss OSBOP requirements – New York has also gone this way and CA will likely be close behind.
- Review the myriad options we provide for clinician connectivity – enabling clinicians to work the way they want to – they way most effective for them.
- Clinical Champions Group – strong inpatient and nursing influencedPhysician Steering Committee – diverse group, varying levels of technical savvyAmbulatory Physician Steering Committee – an even MORE diverse group with very different/competing viewsInformation Systems – a team that had grown from a small department supporting four hospitals to one four times it’s size supporting, ultimately twice as many facilities and an enterprise-wide Epic roll-out on a VERY short timeline.