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Roles Access control >766 000 records Basic documentation all professions Referrals Multimedia Scanning Messages and letters Linkages E-messages SOM Psyk BUP SOM Psyk BUP SOM Psyk BUP SOM Psyk BUP SOM Psyk BUP SOM Psyk BUP SOM Psyk BUP SOM Psyk BUP VO ORKR MO L TR LE NA PAS PatientID, Contacts ROS/LAB Blood bank PACS/RIS Web services DocuLive TS X 50 Scanning Multimedia >13 500 users >1200 concurrent >130 000 documents a week Slide 2 Content in todays DocuLive Users and access control Users and access control Documentation logistics Documentation logistics Scanning Multimedia Scanning Multimedia Messages, letters Messages, letters Documentation all professions Documentation all professions Internal referrals Internal referrals Prescriptions RTV forms RTV forms Patient overview PAS Integration LAB Integration LAB Integration RTG/X-ray Integration RTG/X-ray RTG Digital discharge notes Digital discharge notes Prim. lege Slide 3 Electronic patient records - history, status and challenges Guest lecture Health informatics 1. september 2005 project manager Rut Naversen Project introduction EPR St. Olav Hospital Slide 4 01.09.2005R Naversen 4 Some background MEDINA project from 1996 MEDAKIS project from 1998 Joint development project for the 5 regional hospitals Industrial partner: Siemens Regional EPR project from 2000 Reorganization due to State takeover of hospitals Wish for common EPR and solutions in Helse Midt- Norge (Central Norway Regional Health Authority) Another reorganization in 2003 HEMIT 1. juli 2003 New regional project manager HEMIT: Terje Dale New project manager St. Olav: Rut Naversen Slide 5 01.09.2005R Naversen 5 Project organization Project owner: Helse Midt-Norge RHF Steering committee: Regional steering committee for PACS/RIS and EPR Project manager: Terje Dale, HEMIT Scanning Prj. Mng. Reference group Project group Workflow Prj. Mng. Introduction NT: Ingunn Bjrkli Reference group Reference group Reference group Project group Project group Product development.Introduction XX: ?? Project group Reference group Slide 6 01.09.2005R Naversen 6 Organization St. Olav IT steering committee Stein Sundmoen (finance director/manager) Ola Bergslien (chief medical officer/system owner) Gudmund Marhaug (director Children and youth) Arild Faxvaag (senior physician Department of rheumatology/NTNU) Liv Sjvold (divisional manager Psychiatric health care) Ragnhild Br Vardehaug (Spec.cons./nurse) Ida Lise Salberg (General manager/Orkdal hospital) Thore Smevik (IT strategist/secretary) Slide 7 Ajour per 1. september 2005 Slide 8 01.09.2005R Naversen 8 Departmental EPR groups Multidisciplinary Doctor, nurse, secretary Plan introduction in coordination with line management Introduce new software components Routine adaptation Organizational adaptation Work on record content quality Requests for changes to production functionality Slide 9 01.09.2005R Naversen 9 Superusers new in 2005 25 secretaries and 76 nurses teach new employees, temps and students from own occupational group within own department Secretary superusers are also responsible for educating doctors responsible for follow-up/guidance of new and existing EPR users train colleagues when introducing new software modules follow up on document flow and work lists Slide 10 01.09.2005R Naversen 10 Introductory activities When new functionality is to be introduced Assess need for pilot Prepare user documentation Prepare paramount procedures and guidelines Disseminate information (meetings, Kilden etc.) Educate superusers Pre and post planning and follow-up on department/clinic Evaluate the delivered product and project introductory activities Provide feedback to the regional project on eventual required changes Slide 11 01.09.2005R Naversen 11 eLearning www.helse-midt.no/elaring Practice module Theory module Certification module (intranet) Regional project manager Jane Wik Slide 12 01.09.2005R Naversen 12 Progress The new university hospital Comprehensive use of IT tools is a design prerequisite for area dimensioning An total efficiency gain of 30 % is assumed the use of a complete EPR by all record users is presumed to be the most important efficiency improvement measure No areas for paper archives Patient records Case files Patient areas are not dimensioned for temporary paper storage Slide 13 Paperless patient record within 1. Januar 2007 although not a paperless hospital Slide 14 01.09.2005R Naversen 14 Status from user database, June 2005 Today, all departments except Psychiatric healthcare are using DocuLive Somatic: a total of ca. 5000 users Assistant nurses ca. 590 40 % are users - divided on 75 % authors 25 % readers Nurses ca. 3000 Roughly 80 % authors, 100 % with access rights Doctors ca. 800 Other occupational groups ca. 800 Slide 15 01.09.2005R Naversen 15 Towards the paperless hospital May 2005Nurses and other professionals ca. 3500 quit making printouts to the paper records Sep 2005Completion lab answers + signing via DocuLive X-ray answers available via DocuLive Oct 2005Pilot introduction Psychiatric healthcare Digital dictation Oct/NovPaper deficient record for Women- children Slide 16 01.09.2005R Naversen 16 Towards the paperless hospital Jan 2006Basic training EPR transferred to superusers Feb 2006Referrals/letters/messages to/from primary care, other hospitals, central authorities Jun 2006Anesthesia/intensive care system Birth/maternity system Patient chart/prescriptions Medication Care plans Slide 17 01.09.2005R Naversen 17 Challenges Relocation determines deadline/progress rate and sequencing of training Lab center relocates Sep/Oct 2005 Women-children relocates Oct/Nov 2005 Scanning paperless patient record Dermatology department pilot spring 2004 Lab center Medical genetics Women-children Children and youth department Gynecological department Access to EPR not stable backup paper solution still required for the following months Slide 18 01.09.2005R Naversen 18 Challenges Training capacity for basic training has increased over the last year Diversified offerings E-learning Decentralized guidance for super user follow-up Phasing out of introductory project course room classes Remaining author training Somatic: ca. 500 nurses + 200 assistant nurses Psychiatric health care ca. 800 in total Distributed on 350 caregivers and 450 environment therapists Maintenance training ca. 1300 a year! Equipment The XP project has lead to a hospital-wide renewal of machinery equipment by June 2005 There will also be an increase of PCs in the old hospital as units relocate to the new hospital Slide 19 01.09.2005R Naversen 19 Minister of Health and Care Services, Ansgar Gabrielsen S@mspill 2007 shall secureS@mspill Strengthened and efficient cooperation between different disciplines and administrative areas Improved user contact Quality improvements Inquiry into investment effects Changing work processes and routines might be the biggest challenge. Up to 90 percent of the resource allocation in the wake of a successful IT implementation will often be in skills development and organizational development