From Go-Live to HIMSS Level 6 in 10 months The Royal Children s Hospital EMR experience Lauren Andrew, Matthew Thatcher, Jackie McLeod, Mike South, Jennifer White, Adrian Hutchison 9 th August 2017
Royal Children s Hospital
RCH cannot aspire to be a GREAT children's hospital, leading the way, if it continues to rely on paper-based records and antiquated systems for communications and patient care transactions.
Why Epic? Most advanced software (KLAS reports) Best vendor partner model Most suited for academic paediatric hospital Extensive background investigation Our staff chose Epic: - Over 250 staff attended tender demonstrations - Over 70 staff, formal tender evaluation process Tender evaluation: Clinical 50% Technical 17.5% Implementation 17.5% Tenderer Capability 10% Contract 5%
What was in scope?
Device integration 220 fixed bedside monitors Ventilators NICU / PICU
Point of Care equipment Computer On Wheels Hand held android device - Rover Mounting solutions ipads Laptops at home services car charges 23 screens Label printers medications Barcode scanners Desktop printers Touch screens anaesthetics
Portals patient & family See & Request changes to appointments See allergies / immunisations See medications and request repeats See test results (8 day auto release) See clinic notes / correspondence Self scheduling pilot commenced Messaging clinicians coming soon Questionnaires coming soon
Sharing care
Integration 22 interfaces Internal & External Systems JCAPS integration engine HL7 2.4.1
Research Subject identification / recruitment Research coordinator notification Routine & study data collection Family portal data collection Embedded analytics Data warehouse
Why big bang?
Why big bang? Patient safety focus Clear cutover plan from paper to EMR for current inpatients All documentation to be completed in the EMR All clinical documentation available in one place EMR Workflows were built to support patient flow across all areas
Why big bang? From an organisational perspective - Organisation focus for one period - More efficient to concentrate support to one period of time, not two - Reduce fatigue for the project team. - It was more cost effective
What does it take to deliver? 30 clinical systems replaced or integrated Millions of records migrated from legacy systems 2600 computers checked prior to go live 3,785 staff trained with over 20,000 hours of training delivered 100+ Epic experts at go live from the RCH EMR team & Epic staff 400+ super users all from RCH staff volunteering to take shifts to help out their colleagues
Success factors - methodology
Success factors - team EMR team Many analysts were RCH clinicians External recruits to fill skill gaps Emphasis on training mandatory Vendor support team Strong onsite support from Epic Strong support model from Verona The RCH team Governance committees Clinical decision making Management team Recruitment to EMR advisors (Drs), trainers, super users positions
Success factors - governance Strong internal governance structure Commitment from all levels Executive leadership Managers program Focus on EMR project
Success factors readiness Go live readiness program 30, 60, 90, 120 day Go live checklists for managers Technical and clinical dress rehearsals
Success factors go-live The system: 24/7 support for 4 weeks EMR Command Centre EMR and IT Help Desk colocated 4206 Help Desk jobs logged 95% resolution rate Focus on addressing technical issues For staff: 24/7 support for 5 weeks Super user support centre - Staffed by EMR trainers - 400 super users connected to EMR by WhatsApp 19,000 messages in first 5 weeks Support from Epic and Stanford Children s Health Reduced activity in outpatients and theatres
Go live supports Top 10 @ 10 with Executive team Executive rounding Daily Patient Safety Meetings Monitored all reported incidents Quality and Safety dashboards
HIMSS 2017 2012
Benefits - clinicians Information all in one place Fast Easy to find Clear overview of whole patient Specialty level customisation One logon/password Remote access PC / ipad / phone
Benefits - productivity 2015/2016 2016/2017 Variance Number of multiday stay patients 21322 21062-1.23% Number of same day patients 23357 27593 15.35% Average LOS 2.64 2.56-3.12% Number of outpatients 184705 193679 4.6%
Reduction in testing Total pathology tests completed Total medical imaging examinations 2015/2016 2016/2017 Variance 1235500 1228732-5.50% 88406 85992-2.80%
Quality & Safety - examples Improved patient identification through barcode scanning Improvement in completion of transfusion consent Improved management of specialist clinic wait list Improved compliance in state government CPE (bacteria) screening guidelines
Financial benefits 87% reduction in transcription and costs Savings from sunsetted software 32% reduction in pre-printed form costs 6.3% reduction in senior medical recall Increased revenue due to improved compliance PBS scripts, MBS referrals 8.3% increase private patient revenue 12.4% increase in prosthetic revenue 4.6% increase in outpatient revenue
Future Benefits Adherence to standardised care Review data on variance from CPG for diagnoses Increase sophistication of Best Practice Advisories Guide use of Criteria Led Discharge Full closed loop medication and unit dose dispensing Implement additional Epic applications
Thank You Contact: matt.thatcher@rch.org.au