1. Andor Fuhrer
Cerner EMR Analyst
October 11-14, 2015
Position Strategy:
Using Cerner tools to gain
efficiencies and create guiding
principles around positions
2. 1
Faced with a number of legacy processes and
positions, Boston Children’s Hospital initiated
a project to optimize their position strategy by
reducing the number of active
Millennium positions. Using Cerner’s Position
Comparison Tool, Boston Children's Hospital
gained efficiencies and created guiding
principles around positions.
3. 2
Boston Children’s Hospital
• #1 Pediatric Hospital US News
and World Report
• 395 Licensed Beds Average
Daily Census: 311.7
• 1551 Registered Nurses (FTEs)
• 351 Nurse Practitioners
• 3200 MDs
• Powerchart
• FirstNet
• SurgiNet
• RadNet
• PharmNet
• PathNet
4. 3
Boston Children’s Hospital
• US News & World Reports
Ranked #1 in 8 out of 10 pediatric specialties by
US News & World Report: 2014 Honor Roll
• Magnet status
Since 2008
• Leapfrog Group
Leapfrog Group Quality and Safety Designation
2014 & prior.
• HIMSS Analytics
Only Massachusetts HIMSS Analytics Level 7
designated hospital 2014 & prior.
7. 6
Why so many positions?
• Easy workaround for new solutions
Clinical Apps Team develop custom solutions
which are added to PowerChart new position will
serve as a security mechanism
• Lack of organization and structure
Currently there is no department/committee that
provides guidelines for positions, new or old
• Customer Service Driven
Ask for a priv/pref change, we will do it
8. 7
Why so many positions
• Accommodation/Easy to create
New position request will usually be copied from
a similar position, gets renamed and privs/prefs
get tweaked.
Minutes to create a new position vs. time to
analyze/review an existing position
• PrivMaint, PrefMaint
Cerner tools were challenging to compare privs
and prefs across one or multiple positions
9. 8
The Outcome?
Redundancy:
CHB2 Clinical Assistant Ambulatory
CHB2 Clinical Assistant CATCR
CHB2 Clinical Assistant DFCI
CHB2 Clinical Assistant Dialysis/Apheres
CHB2 Clinical Assistant ED
CHB2 Clinical Assistant Inpatient
CHB2 Clinical Assistant Inpatient NICU
CHB2 Clinical Assistant Peri Procedure
CHB2 Clinical Assistant Scribe
CHB2 RN Ambulatory
CHB2 RN Ambulatory Cardiology
CHB2 RN Ambulatory ORL
CHB2 RN Ambulatory Peabody
CHB2 RN Ambulatory Procedure
CHB2 RN Anesthetist
CHB2 RN CATCR
CHB2 RN CATCR BMDI
CHB2 RN CATH Lab
CHB2 RN CICU
CHB2 RN CICU Complex Care
CHB2 RN Community
CHB2 RN DFCI
CHB2 RN Dialysis/Apheresis
CHB2 RN ED
CHB2 RN ED with Reporting
CHB2 RN Inpatient
CHB2 RN Inpatient Psych
CHB2 RN MICU
CHB2 RN MSICU
CHB2 RN NICU
CHB2 RN Radiology
CHB2 RN Transport
CHB2 RN Waltham
CHB3 RAD NURSE
CHB3 RAD NURSEDFCI
CHB3 RAD RN PACU
CHB3 SN RN
CHB3 SN RN CT Manager
CHB3 SN RN DSU PreOP
CHB3 SN RN GPU
CHB3 SN RN Pacu
CHB3 SN RN Pacu BMDI
CHB3 SN RN PC INV
CHB3 SN RN Prefcard
CHB2 Ambulatory Service Rep DFCI
CHB2 Ambulatory Service Rep ED Reporting
CHB2 Ambulatory Service Representative
CHB2 ASR Audiology
CHB2 ASR Neurophys
CHB2 ASR Urodynamics
CHB2 Athletic Trainer
CHB2 Practice Assistant
CHB2 Non-Patient Care IN-ERROR
CHB2 Cast Room Tech
CHB2 Food Service Personnel
CHB2 Departmental Indexing
CHB2 COPP
11. 10
The Outcome?
Hard to identify which
positions have the
privileges to do certain
tasks/workflows
“I need a position for a
non-clinical staff
member but needs to be
able to add documents
and powerforms”
12. 11
The Outcome?
Makes the team look bad
Takes a long period of time to accommodate a
simple request
I submitted a request asking to have the Clinical
Assistant access to Chart Search, its been 4
weeks!
14. 13
To Recap
What are we faced with:
• Lack of structure/categorization for positions
• Lack of documentation explaining role types/positions
and privs/permissions – Users would be place in
wrong positions
• Lack of governance that decides privs/permissions
• No transparency or reporting capability for positions
• Difficult naming convention; Position name = job title
15. 14
Looking into the Future
• Specialty specific workflows (DyDoc), which will
require clinical positions for specific specialties
• MD Cardio, MD GI, MD Derm, etc
• This means even MORE positions will be created
• Cleanup and organization is crucial
16. 15
Position Strategy
The aim of this initiative is to:
Reduce the number of positions by consolidating similar
positions and retiring old positions
• Categorize/classify positions
• Align the positions, yes, all 290…
• Create guiding principles and standardization for
BCH positions
17. 16
Position Strategy
• Engage Health Informatics Management (HIM),
HR and Compliance teams to mandate
permissions and privs for positions
• Create guidelines for teams requesting new
positions
• Reinforce collaboration/change culture
• Transparency
• Update/Reform position naming convention*
20. 19
Position Strategy – Getting Started
Design a position matrix to classify positions on a macro
level with standard tasks/solutions
21. 20
Position Strategy – Analysis
• Once matrix is in place, we will use this to show
current state – start the conversation
• Engage Compliance and HIM to review current state
• Out of compliance?
• Guiding principles?
• Who can see what?
• How do we handle scope of practice?
• How flexible are we – Conservative?
• Make necessary changes and DOCUMENT
changes
• Changes were made because…
22. 21
Cerner Tools
Position Comparison
• Improves maintenance substantially
• Ability to compare privs and prefs for one or many
positions at once
• Align privs and prefs across multiple positions
• Easy to use
• Provides transparency to position set up
HNAUser
• Provides functionality to create/store Position Roles
and associate them to positions
• Ability to associate Position Roles with
‘Responsibilities’
27. 26
HNAUser
• HNAUser has the functionality to store Role Types
and associate them to positions
• The position matrix can now be stored in Millennium
• The ‘Responsibilities’ functionality is being used to:
• Define the category/role type
• Associate major tasks category/role type has
permission
30. 29
HNAUser – Role Type Management
• Outcome:
Role Type with
associated positions
and responsibilities
31. 30
Next Steps: Positions to target
• ASR – Ambulatory Service Rep
• ‘Front Desk Staff/Schedulers/Registration
• Solution Specific positions
• SurgiNet / RadNet / PathNet
• Scheduler positions for SN
• 61 Non-Clinical / Admin positions
• RN’s and Clinical Assistants
• Reduce DBA Positions
32. 31
Next Steps: Projections
Lab Positions will be cut in half (12 positions)
Admin Positions will be reduced by more than half (30)
Approximately 15/20 positions we know we can retire
Finalize guidelines for position roles:
• Access
• Permissions
• Privileges
Estimated to reduce positions from 290 to 200
33. 32
Next Steps: Ideas
Numerical Level for Positions
Who said positions have to be the name of a role or job
title?
Instead of a naming convention that is dependent on
licensing, what if its based on a numeric level?
Similar to HR’s grading level
i.e. managers are levels 12-15, directors are
levels 16-21
34. 33
Next Steps: Ideas
Eliminates the need to
create positions for
‘new’ roles
Allows more fluidity
Eliminates the need
to create positions for
‘new’ roles
Role Position Job Title/Role
Non-
Clinical
Read Only
Level 1
Read Only
Positions/Tracking
Board
Admin
Level 2
Level 3
Level 4 Help Desk
Level 5 Medical Records
Level 6 Auditors
Level 7 Schedulers
Level 8 Non-Patient Care
Level 9
ASR
Level 10
Level 11
Level 12
Clinical
Licensed Direct Pt Care
Level 13
Patient Care/CA/Case
Manager
Licensed Non Direct Pt Care
Level 14 COPP
Level 15 Pharmacist
Non-Licensed Direct Pt Care Level 16 Medical Students
RN
Level 17 - Ambulatory
RN
Level 17 - Inpatient
NP
Level 18- Cardiology
NP
Level 18- Ambulatory
Level 18- GI
Level 18- Neurology
Level 18- ORL
PA Level 19 PA
MD
Level 20 - Cardiology
MDLevel 20 - Ambulatory
Level 20 - GI
35. 34
Ideas
HR Role Types
Review HR Roles and determine if appropriate
Millennium will be in sync with HR role type; may be
more logical that licensing approach
No need to recreate the wheel, recycle what has
already been established
