Shared Electronic Health Record (EHR) Implementation Journey

Best Practices and Lessons Learned in Health Information System Collaboration, Feb 28, 2018 Jeannie Borg, Director, Clinical Informatics - Waypoint Wendy Odell, Director, Mental Health HIS Cluster

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Objectives Discuss lessons learned Provide a forum for an open discussion to learn

together and move forward with best practices

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Waypoint at a Glance

Teaching hospital specializing in comprehensive mental health care Waypoint Research Institute 1,200 employees; 301 inpatient beds; over 29,000 outpatient visits Regional Mental Health services for adults including geriatrics Provincial high security Forensic Mental Health services Mental Health HIS Cluster HIMSS EMRAM Level 6

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Ontario Shores at a Glance

Teaching hospital specializing in comprehensive mental health care and addiction services

1,300 employees; 326 inpatient beds; over 60,000 outpatient visits Provide Recovery-oriented Meditech 6.0 and EMRAM HIMSS Stage 7 – first in

Canada and first mental health facility in the world 2015 recipient of HIMSS Nicholas E. Davies Enterprise Award of Excellence

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Shared Health Information System (HIS) Shared Services Agreement Single shared HCIS Waypoint Data Centre Marriage analogy Maintain our own IT, CI, DS and PP

departments Some shared positions at Waypoint to

support the additional infrastructure Expectation that teams work together Director, MH HIS Cluster (new role)

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Purpose of Collaboration Improve quality, safety, patient outcomes and reduce variations in

care with evidence-based practices Develop common clinical standards Support mental health research and population health Create standardized reporting and business intelligence Improve information sharing Improve value per dollar spent and reduce cost and effort to

maintain HIS Aligned with MOH HIS renewal clustering (hospitals must form

clusters to maximize value of investments)

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Project Guiding Principles Focus on evidence based best practices to improve patient safety,

quality of care Standardize unless patient risks and safety issues are identified Unique needs of hospital will be met EHR adoption/optimization is on-going Opportunities for teaching and research Projects will be joint whenever possible Costs allocated equitably and transparently Equitable say in decisions

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Key Departments IT and Decision Support

cornerstones Clinical Informatics as an enabler Professional Practice drives our

work Support clinicians who take care of patients ‘Love them until they love you back’

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Lesson Learned-Change Management • Improve care of mental health patients • Best and evidence based practice • Leading practice in mental health • Collaborate on research • Improve service delivery

• Share a Meditech information system • Implement Advanced Clinicals at Meditech at

Waypoint • Partner with an expert • Shared governance

• Standardize to Ontario Shores existing documentation

• Standardize to Ontario Shores existing workflows

• Comprehensive shared build guidelines

Why

How

What

Simon Sinek – The Golden Circle https://www.ted.com/talks/simon_sinek_how_great_leaders_inspire_action?language=en

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Project Management Tools/Processes SharePoint Issues/action/risk log Project status reports Decision documents GoTo

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Benefits Evaluation Practice and clinical documentation standardization Improved ability to provide Clinical Informatics support Efficiencies for implementing Provincial Initiatives Meditech system availability System adoption/HIMSS EMRAM framework

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Lessons Learned Focus on practice (not system) and future state Standardization guiding principles/vision and

methodology – communication this often All parties need to be open to changing practice for

standardization to occur Engage Risk/Policy staff (practice change=policy change) Consider third party to assist with clinical decisions when

consensus can not be reached

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Lessons Learned Strong governance structure Strict adherence to escalation and decision making processes Take time for team/relationship building in beginning Collaborate on most future initiatives/projects - alignment of

planning cycles Don’t re-invent the wheel

• Leverage partner success and expertise (i.e., adopt already standardized workflow and content and existing proven governance structures)

• SME expertise from Partner site → Decrease consulting costs → Increase team capacity

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Lessons Learned Partnering allowed Waypoint to achieve their goals much faster

• HIMSS 0.8 → HIMSS 6 (4 months post Go LIVE)

Shared commitment to a single goal Ontario Shores had to pause initiatives

Building into an existing LIVE system Zero technical/applications issues Data migration is never as simple as it sounds Focus on the more complex workflows early Virtual team work can be challenging, face time is critical Our vision = shared practice decisions Change management key to success

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Project and Change Management

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Leader Engagement and Support Sponsorship

ADKAR planning 100%

Workshops – Leading Change, Managing Resistance, Coaching

Project Integration Team

EHR Change Management Committee

Daily updates

Link with LEADS

Tools – recognition and communication

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Staff Engagement and Support Customized unit change plan with staff input

EHR Advisory Group

Super-users

Staged Go-Lives

Operational Readiness Committee

Open demos

WOW Fair

Workshops – Changeability, Managing Stress of Change

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Staff Engagement and Support

Senior Leader walk around schedule

EAP promotion

Wellness, Psychological Health & Safety Activities

Technology surveys Brand survey

Meet and greets

Celebration station

Breaks

Contests

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Next Steps Future joint projects The Royal Ottawa Care Group joining MH-HIS Cluster Other HIT initiatives Data analytics and business intelligence, pop. health Research Alignment with HIS Renewal and Provincial eHealth Initiatives Operations and Sustainment

• Support for shared system • Further defining change management • Optimization • Collaborative roles

Thank You

Questions?