PALMS WEST HOSPITAL

CPOE WITH ADVANCED CLINICALS IMPLEMENTATION

PHYSICIAN CHAMPIONS “WHAT I WISH I HAD

KNOWN BEFORE I STARTED”

RESPONSIBILITIES

• 10-20 HOURS PER WEEK AS PILOT PHYSICIAN CHAMPION

• HOW DID YOU GET TO THIS NUMBER? o MONTHLY PAG MEETING o MONTHLY STEERING COMMITTEE MEETING o CONFERENCE CALLS

• ASSIST CEO & CNO WITH IMPLEMENTATION

• EBOS BUILD AND APPROVAL PROCESS

TIME MANAGEMENT

• NEED TO SET ASIDE TIME TO BE THE PHYSICIAN CHAMPION

• PRIORITIZE • BUILDING AND APPROVAL OF ORDER SETS • YOUR PRACTICE • LIGHT AT THE END OF THE TUNNEL

PHYSICIAN CHAMPION ROLE

• PHYSICIAN NEGOTIATOR • “ONE OF THE TEAM” • CHEERLEADER • LIAISON WITH ORDER SET BUILD TEAM • LIAISON TO CEO, CNO, CFO• LIAISON TO MED EXECUTIVE COMMITTEE• EMOTIONAL INTELLIGENCE, PERSUASIVE

SPEAKER• DIPLOMAT• RESOURCE FOR YOU!

PHYSICIAN LEAD & DAC RELATIONSHIP

• COLLABORATIVE WORKING RELATIONSHIP

• FREQUENT COMMUNICATION• CONSISTENT MESSAGE• OPEN ACCESS TO EACH OTHER

What does Physician Champion need from you?

• Partnership with Executive Sponsors, CEO and CNO

• Communication

• Support of decisions and implementations during the project

PALMS WEST HOSPITAL

• SERVICE LINES:• 175 BED/ACUTE CARE MEDICAL-SURGICAL FACILITY

• Breast Care Center • Cath Lab• Emergency Room• Obstetrics • Orthopedic and Spine Institute • Outpatient Rehabilitation Services • Pediatrics• Radiology and Diagnostic Imaging

• TEACHING AFFILIATE OF NOVA SOUTHEASTERN MEDICAL SCHOOL WITH MEDICAL RESIDENCY PROGRAMS

CLINICAL STAFF

PROVIDERS NURSING AND CLINICIANS

• 500+PHYSICIANS• 100+ARNP’S, PA’S,

CRNA’S. • MEDICAL STUDENTS

AND RESIDENTS

• 350+ NURSES• 35+ UNIT CLERKS• 40+ TECHS, NURSING

ASSISTANTS• ANCILLARY STAFF,

INCLUDING HIM, LAB, RAD, RT, PHARMACY

CPOE TEAM

• PHYSICIAN CHAMPION: DR LUIS REGALADO• DIRECTOR OF CLINICAL APPLICATIONS:

STEPHANIE NOEL• MASTER TRAINERS • EBOS SPECIALIST • PHARMACY EBOS SPECIALIST • STEERING COMMITTEE• PHYSICIAN ADVISORY GROUP• CORE TEAM • SUPERUSERS

TEAM DEVELOPMENT

• INTERACTIVE WORKING RELATIONSHIP• COMMUNICATE WITH ONE ANOTHER

ABOUT REQUESTS• SHARE IDEAS WITH ONE ANOTHER• CONSIDER THE RELATIONSHIPS EACH

PERSON HAS WITH DIFFERENT PROVIDERS• SHARE PRESENTATIONS – FACILITY

LEADERS OF THE PROJECT• OFFER REPRIEVE TO ONE ANOTHER

PREP WORK

• SELECTION OF PHYSICIAN LEADER/CHAMPION AND CORE TEAM, PAG, STEERING COMMITTEE MASTER TRAINERS AND SUPERUSERS

• GAP ANALYSIS/WORKFLOW ASSESSMENT

• DEVICE ASSESSMENT

• TIER A AND B PHYSICIANS

• TRAINING

OPERATIONAL & PROCESS IMPACT

Area From ToNursing Color coded chart tags, paper

copies, hourly chart checksStatus board order acknowledgement

Manual translation of orders to plan of care

Orders integrated to plan of care automatically

Current orders recorded on paper Kardex

Current orders available in electronic form

Faxing medication orders to pharmacy

Pharmacy orders process automatically

Manual paper chart check Electronic chart checks

Respiratory Therapy Paged by nursing for new orders Immediate system paging for stat orders, status board notification of orders

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OPERATIONAL & PROCESS IMPACT

Area From To

Pharmacy Receives orders by fax queue Orders present on tracker for review

Delays in processing Reduced turn around time for medication availability

Laboratory Delay for manual order entry Orders process immediately

Staff reconcile duplicates and corrections manually

Reduced duplicates and time for reconciliation

Radiology Delay for manual order entry Orders process immediately

Peak load hours after physician rounds

Peak load hours shift

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OPERATIONAL & PROCESS IMPACT

Area From To

HIM Page by page manual deficiency management

Order signature deficiency management automated

Therapies Manual plan approval Plan electronically communicated and signed by physician

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IMPACT ON PHYSICIANS

Area From ToRounding Single paper chart required for

reviewing data, ordering, and documenting

Electronic result and patient data available to all, order and document from any computer

Signing charts Weekly visit to HIM Sign all orders and documents from any computer

Admitting patients Telephone orders, faxing orders Admit orders electronically using evidence based order set

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YOUR BRAIN PRE-CPOE

IMPLEMENTATION OVERVIEW

Faci l i ty Charter CompleteDiscuss/Kickoff EBOS Weekly Status Meetings , Monthly PAG and Steering Committee Meetings

Wave 1 / Corp Kickoff

ACE Summit

Go Live Support and Prep Planning Initiation Builds CommunicationsOM Go Live Project Resourcing Complete Builds Complete Division KickoffCPOE Go Live Facility Charter Complete Training Comm Plan Complete

Readiness Assessments Review EBOS & PDoc Core Team Training Corporate KickoffAssessments Complete Establish CPOE Goal End User Training Facility Kickoff

Workflow Assessment Staff Planning and Contracting Technical Readiness EHR Open HouseProcess Changes Complete Phys Contracts Complete Device Deploy Complete

Optimization

Non-CPOE Super User ID, Master / Super / End User Tra iningCPOE Super User ID, Master / Super / End User Tra ining

Contract Phys icians

Readiness AssessmentsFaci l i ty Customization

Draft and Sign Fac. Charter

EBOS Review

Secondary Tech Assesment

Para l lel CPOE Testing

Staffi ngPrep for Faci l i ty Open House

Med Mgmt Bui ldRXM Bui ld

Non-CPOE Physician Go Live Nursing Go Live CPOE Soft Go Live

PDoc Review

EBOS Bui ld & Va l idation

RXM Supporting Dictionaries

Month 2 Month 5 Division Kickoff

Prep for Fac. Kickoff

CPOE Hard Go Live

PDoc Bui ld

Month 3 Month 7

Set Bui ld ParametersSoftware Licensure

Comm Planning

Month 6Month 0

Non-Med Bui ld

Month 8

Implementation of Process Change

Technica l Readiness (assess , order, receive, deploy devices )

Departmenta l Workfl ow AssesmentsDevelop and Fina l i ze Dept. Action Plans

Month 4 Facil ity Kickoff

Month 1

LEGEND

Non Med Bui ld Tra ining

Team Lead Tra ining

Communications Del ivery

eRx Bui ld

Med Mgmt Bui ld Tra ining

Go Live Prep and Support

CPOE IMPLEMENTATION TIMELINE

• Open House • PHASE 1 GO LIVE

PDOC IMPLEMENTATION FULL FACILITY GO LIVE WITH NURSING AND

PHYSICIAN TRANSITION TO CLINICAL REVIEW• PHASE 2 GO LIVE:

SOFT GO LIVE IMPLEMENTATION STAGED IMPLEMENTATION OF HOSPITALISTS

HARD GO LIVE: IMPLEMENTATION ALL REMAINING HOSPITALISTS, SPECIALISTS,

SURGEONS

LESSONS LEARNED

The Four Agreements By Don Miguel Ruiz

LESSONS LEARNED

• CHANGE IS DIFFICULT AND SCARY • RESIDENTS AND MEDICAL STUDENTS CAN BE YOUR BEST

ASSET• YOUR IDEA IS GREAT, BUT IT’S NOT MY IDEA • “CULTURE EATS STRATEGY FOR LUNCH” • TRIAGE DIFFICULT PHYSICIANS• MEANINGFUL USE CRITERIA • “WHY NOT 30%?” USE • CERNER VS. EPIC VS. MEDITECH • NOT EVERYONE KNOWS HOW TO TYPE• NOT EVERYONE USES A COMPUTER• BE FLEXIBLE• CUSTOMIZE TRAINING• PATIENCE IS TRULY A GIFT• IMPORTANCE OF “PREP WORK”

CPOE STATISTICS

GOOD LUCK!!!

THANKS FOR COMINGREMEMBER WE ARE HERE IF YOU HAVE

QUESTIONSPlease feel free to contact us