Mariah Delaire HTM 660 November 22, 2015 Workflow analysis & Space Redesign Workflow analysis allows for there to be a physical depiction of a process which can help clarify workflow, identify bottlenecks and outline dependencies. It provides a starting point and establishes a set of steps. This allows for a discussion of changes for the future and helps to implement new processes (Wagner, 2013). Some of the questions that should be addressed when starting a workflow analysis is: Where are the problem areas? What are the goals and expectations of the new system? How do organizational processes need to change in order to optimize the new systems value and achieve goals? This process allow for an evaluation of existing procedures to identify ways to improve workflow, simplify tasks, eliminate redundancy, improve quality and improve user satisfaction (Wagner, 2013). Before we begin implementing Powerchart Maternity, analyzing and evaluating the current processes and procedures of OB and Labor and Delivery will be done. This gives us the opportunity to find workflow issues and helps to identify the changes needed to ensure the process is as smooth as possible. During this workflow analysis we will need to evaluate our current end user clinical documentation process, bar code scanning processes and procedure for medication administration along with CPOE use. Currently our providers have been using CPOE through our McKesson system, but scores have been unsatisfactory due to cumbersome workflow. We expect that our CPOE scores will improve with the use of Powerchart Maternity.
Involving users at this stage can help gain initial buy in to both the idea and scope of the process redesign. During the workflow analysis, we will also examine the department to see if any redesign is necessary to accommodate new technologies to improve the workflow. The potential locations for new workstations, monitors and tablets will be in private birthing rooms, operating rooms and at the nursing stations. It’s important to get a good idea where things need to be located so an appropriate amount can be estimated for budget purposes. We will also look into any network connectivity and power requirements, and see if anything needs to be upgraded to accommodate this new system. How information will flow between manual organizational processes and electronic information will also be determined to ensure the proper technologies are being integrated.
Training Plan Training is an essential component of any new system implementation. It’s important to have a training program that is tailored to the needs of the users during the implementation process (Wagner, 2013). During the training process, individuals should become comfortable with the system, have had many opportunities to use it before go live, and know where to go if they have any questions. There will be a total of three months allocated for training. February will be the first month of training for super users and main trainers. They will be led by the vendor to ensure that the users are being trained properly on the system. May will consist of online modules for OB staff to complete before they can continue forward into the training orientation days in June. Go live training will be led by trainers and super users for all OB staff and providers, including doctors, nurse practitioners, physician’s assistants, midwives, etc. It’s
important that the super users who are chosen work directly in OB and L&D and have a good rapport with the staff. Cerner specialists will be on site for 90 days to ensure that the super users and trainers can serve as resources to other users once they have left. It is important that there is effective training. To ensure objectives are met, staff needs to be comfortable with the system and needs to know who they can turn to if they have any questions.
Communication Plan Communication plans are essential because they identify how the members of the implementation team will communicate and coordinate their activities and progress. They define how progress will be communicated to key constituent groups such as the board, the senior administrative team, the departments, and hospital staff affected by the new system. Two types of communication plans exist, formal and informal communication. Formal communication will include updates at board and administrative meetings along with written articles in Cherrywood’s monthly newsletter. This ensures the board and administration are fully informed and aware of the implementation plans. Informal communication to departmental staff will include, email announcements, break room bulletin postings, employee portal alerts, and staff meetings. Content will include why this change is taking place, who it will affect, value gained from this change, and people they can contact if they want to become more involved or if they have any questions or concerns.
Timeline/ Implementation Plan The first part of the plan to implement Powerchart Maternity will be to select the steering committee. The steering committee will guide and manage oversight of the project. They will
also help resolve any changes in scope that affect the budget, milestones, and deliverables. The project team, sponsor, and manager will also be selected (Wagner, 2013). Selecting the leaders for the project increases the likelihood that it will deliver the desired results. What will also take place during the beginning stages of the implementation process is developing the project plan and objectives. The project plan will help provide the details of the tasks, phases, and resources needed, by task and phase timeline. It is also essential that objective metrics are chosen to help set goals and standards of the system. It gives the team something to measure to track results of the new system. Another important phase of this process is the workflow and process analysis. There will be at least one month allocated to analyze and evaluate the current process and procedures of OB and Labor and Delivery. OB staff members will have an opportunity to find workflow issues affected by the system implementation and open up discussions on improving them. Training of the PCM trainers and super users will start after the steering committee is in place and workflow/process analysis is completed. The vendor will provide a training lead who will teach the functionalities of the module. While workflow analysis is being conducted, a full IT assessment done by the IT team will determine the placement and number of workstations and monitors needed. If any redesign is needed within the department, it is determined during this phase of implementation. The next phase, system installation, will take up to three months to achieve. During this phase the system configuration will be determined and the appropriate hardware and software will be ordered and installed. This process will also include a data center to be prepared with an upgrade to the IT infrastructure to facilitate this extension. Software and interfaces will be installed and any customization for the end users will be done. The last step in this phase is to
continuously test and retest to ensure it is ready. The IT team, hospital clinical informaticist, two trainers and a representative from each ancillary department will test the system to ensure clinical applications are performing as expected. They will test to see if data can be entered correctly and orders are transmitted to other hospital IT systems (in departments, such as lab, radiology and pharmacy) without fail. Super user training will begin in February for OB users and super users. Pre go live will start in May and consist of three hours of online based modules for all staff to complete before they can move forward into their go live training. This will help ensure that if there are any questions or concerns before end user training, they can be addressed during the training days. The go live training will consist of two eight hour orientations for all OB staff to complete before the go live date. This gives everyone hands on training with the ability to ask questions and troubleshoot any existing problems. Following training, preparations for go live will take place. July 14th will be the chosen GO live date because summer months usually have an overall lower census. During this phase we will need to make sure there is sufficient staff on hand during go live along with setting up mechanisms for reporting and correcting problems and issues that could occur. The vendor will provide a team leader and 4 vendor assistants who will answer any IT system issues. The OB manager and staffing department will make sure they have extra nurses while staff is working through the changes in daily workflow. The last stage before go live will be to develop downtime procedures and train staff on these procedures. This allows for everyone to know what to do if the system is down. If the timeline is met appropriately, the transition to Powerchart maternity should be smooth. The last phases are post go live phases which include any additional updates that may be needed, such as
updating CPOE to an advanced version 6 months after end user go live, along with analyzing results to ensure objectives are being met.
Potential Risks Risks are something we would like to avoid when going through the transition from our current Mckesson system to Powerchart Maternity. When foreseeing potential issues, appropriate measures can be taken to ensure they do not occur. There may be a loss of productivity during the change from the Mckesson system to Cerner’s Powerchart Maternity. This could be a result of end user resistance, lack of training, or staff not yet comfortable with the new system (Advanced Data Systems Corporation, 2015). There also may be a lack of familiarity with PCM during initial deliveries which may impact the quality of care & infant/mother safety. User resistance may occur due to staff being comfortable and confident in the old system, and unwilling to transition to a new system. They may only see the new system being a barrier to patient care because of unfamiliarity and not being able to see the benefits of having a department specific system. Another risk is the potential lack of quality IT staff and powerchart maternity trainers and auditors. Planning failures that are not anticipated during implementation may become a problem as well. It’s important to design a plan that fits the department’s needs. Another concern is stakeholder hesitation (Advanced Data Systems Corporation, 2015). Even though technology
surrounds us, there are still people who may not be accepting to the idea when receiving health care. Many patients complain about their physician focusing more on their laptop than the conversation in progress. Gaining support from patients and staff members is crucial. Patient education and on-going internal training are instrumental in relieving stress associated with the transition (Wagner, 2013). Another concern to staff and patients is the potential to security breaches. HIPPA compliance and data protection pose serious risks for healthcare providers. Studies show that health records are exponentially more valuable to cyber-criminals than personal credit card data (Advanced Data Systems Corporation, 2015). Integrating best-in-class technology with advanced security features is the only way to ensure maximized data protection. Calculating when a return on investment may be seen after investing millions of dollars into something can also become concerning. It may take years to achieve an ROI when investing in a costly system such as PCM. It’s important to remember that a best-fit system improves patient care, eliminates data entry duplication and enhances documentation within a framework customized for daily operations. This will ultimately help to ensure an ROI is one day seen.
References Advanced Data Systems Corporation. (2015, October 7). Top 5 Risks During the EHR Implementation . Retrieved from Advanced Data Systems Corporation Blog: http://healthcare.adsc.com/blog/top-5-risks-during-an-ehr-implementation Wagner, K. L. (2013). In Health Care Information Systems: A Practical Approach for Health Care Management (pp. 3-65). San Fransisco: Jossey-Bass.
