CHS Springs Memorial Meditech CPOE pilot * lessons learned

Report
Vision Service Center (VSC) Overview
Our ‘Rapid Build’ Solution
Table of Contents
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VSC Overview
MU Overview
MU Components
CPOE Example
VSC Approach
The IT Problems
Benefits to our Clients
Real World Examples
VSC Overview
The Vision Service Center (VSC)
• Consists of industry experts, automated processes and proven
workflow methodologies.
• Our combination of people, process, and programs facilitate the
rapid design, build and implementation of IT projects.
• Utilizing HIS Vendor Meaningful Use Best Practices during
implementation.
• Will provide cost savings for the organization as it relates to
implementation and resources.
• Allows the organization to focus on clinical transformation and
adoption tied to advanced clinical deployment.
• Accelerated path to achieve Meaningful Use.
VSC Overview
The VSC is staffed with various levels of expertise in many skill sets,
including: pharmacy technicians, order management, laboratory,
radiology, pharmacists, clinicians, IT specialists, and project
managers. By complementing these skill sets with workflow
technology – the VSC saves time and money for our clients, while
reducing overall project risk.
An Example Application
of the VSC - MU
The VSC is beneficial beyond MU, but this document has been
created using a typical MU project (Specifically CPOE) as an example
utilization of the VSC.
As part of this presentation, Vision is using a MEDITECH based
hospital as an example – but it is important to note that the VSC
approach is applicable within any system type.
Client Objectives/MU
Clinical Documentation,
Order Sets, EBOS, etc.
EMAR, Med Reconciliation,
BMV, Order Sets, EBOS, etc.
Medication
Physician
Doc
MU &
Advanced
Clinical
Capability
NonMedication
Order Sets, EBOS, etc.
Local (IE: Clinician Specific,
Departmental, etc.
Order Sets
EBOS
Nursing
Doc
Care Plans, Assessments,
Order Sets, EBOS, etc.
Standard Evidenced Based,
Med & Non-Med, etc.
Traditional vs. VSC Approach
Traditional Approach (Timeline):
3 Months
Software
Upgrade
3 Months
6 to 9 - Months
Build Advanced Clinical Capability
Adoption
VSC Approach (Timeline):
3 Months
Software
Upgrade
3 -4 Months
Build
3 Months
Adoption
Go-Live / Adoption
MU Overview
Example MU Project (What’s Involved):
Step 1 – Upgrade Software
Step 2 – Build Capability
Step 3 – Adoption
• Upgrade HIS System to MU
Compliant version (IE: 5.4.x
to 5.6.x)
• Validate DTS’s (software
changes)
• Install new software (new
applications or new
functionality)
• Prepare for MU capability
• 3rd Party application
integration
• Nursing Care Plans
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• Clinical Assessments
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• Pharmacy Bedside Med
•
Verification (BMV)
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• Med Reconciliation
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• Electronic MAR
• Medication Ordering
• Evidence Based Order Sets
(EBOS)
• Physician Documentation
• Technology Improvements
Nursing system training
Physician system training
Defining Physician favorites
Departmental training
IT training
MU Overview
Traditional Approach (Timeline):
3 Months
Software
Upgrade
6 to 9 - Months
Build Advanced Clinical Capability
3 to 6
Months
Adoption
Within a Traditional Approach, hospitals supplement existing staff (IT and
Departmental) with external resources. The following are key issues / constraints with
this approach:
1. Access to Subject Matter Experts (SME’s) – difficult to locate
2. Resources (SME’s) are expensive – demand has driven rates upward
3. Sub-optimization of resources – SME’s do all activities
4. HIS Systems are inefficient – do not allow for Rapid Build approach
5. For multi-facility implementations controls are lacking – lack of controls
6. Approach is expensive – Labor rates and Travel costs are high
7. Risk – reliance on key individuals increases risk
CPOE Impact
HIS System
(MEDITECH example)
12+ Applications
Impacted
Goal: CPOE
Impact Summary
• MIS
MIS
• 10+ Tables (100’s Entries)
• OE
Order Entry
• 10+ Tables (1000’s Entries)
• PCM, PCI
• POM/POE/PDOC/AOM
• NUR or PCS
Physician
• 7+ Tables (100’s Entries)
Nursing
• 4+ Tables (1000’s Entries)
Lab
• 3 Tables (1000’s Entries)
• RAD or ITS
Radiology
• 4 Tables (1000’s Entries)
• PHA, RXM
Pharmacy
• 20+ Tables (1000’s Entries)
• LAB
CPOE Impact (Tables)
Goal: CPOE
MIS
Tables (Dictionaries) Impacted:
Provider Group, Providers, Menus, User, Outside Location, Order Source,
MRI Forms, Interaction, Allergy, CDS, Frequencies
Order Entry
Physician Heading, Physician Set Heading, Category, Procedure, Care
Procedures, Dietary Procedures, Quick Scripts (Drug Order Strings),
Process Level, Access
Physician
Location, Headers, Footers, Access, Preferences, Consult Notes, Nurse
Notes, Desktop
Nursing
Lab
Intervention, Status Board, Canned Text, Rule, Access
Test, Exam, Rule
Radiology
Access, Exam, Exam Types, Rule
Pharmacy
Next Slide
CPOE Impact (Tables)
Tables (Dictionaries) Impacted:
Pharmacy
Inpatient:
• Route of Administration
• Admin Criteria
• PRN Reason / PRN Reason Category
• Rule
• Generic Name
• Meds (Basic, Piggyback, Premixed, Large Volume IV Fluids, Additives,
Compound Ingredients, TPN, Non-Formulary)
• Override Comment
Outpatient:
• Drug, Action Sets, User Defaults, Shared User, Print Forms, Printing
Setup, Rules, Call-in Status
• Client Specific: Refill Period, Order Period, Import Procedures,
Procedure Quick Update, Procedure, Order Group, Order Set, Canned
Text
Traditional Approach
Most firms deliver their CPOE build service within a Traditional
Approach:
• Provide multiple SME’s to address workload (IE: CPOE
Analyst, Physician System Analyst, Pharmacy Analyst, Project
Manager, etc.)
• SME’s build 100% of data (or work with departmental staff to
build data)
• Build Order Sets/EBOS based upon paper orders and
typically without ‘real-world’ expectation
• 100% of work completed on-site
• Build timeline per vendor guideline (often too long – and
open ended)
• Which increases time, resource dedication and expense
VSC Approach Flowchart
HIS System
(MEDITECH)
Goal: CPOE
Data
Export
Vision Software
MIS
Order Entry
Data Load
Data
Import
VSC Automation
Data
Compare
Physician
Nursing
Lab
Final
Lists
Work/
Verify
Lists
Radiology
Pharmacy
VSC
Database
VSC Specialists (Manual)
Client
Standard
Generate
Output
EBOS
Vendor
Comparison
After a decision is made on the Order Sets to be implemented, the
following is a comparison between the approaches (MED Build Only):
Traditional Approach
(16 to 24 weeks)
VSC Approach
(12 weeks)
• Analyst(s) review tables
• Analyst(s) work with departmental
staff to begin table edits
• Table edits are jointly made (typically,
excel spreadsheets are used as a
common tracking mechanism)
• Build process for ~5,000 Meds takes 4
to 6 months
• Validation and testing occurs with all
departments (1 to 2 months)
• Tables extracted (week 1)
• Automation is executed (week 1)
• SME’s within VSC validation matches
(week 2)
• SME’s within VSC work with Pharmacy
expert to manage exceptions (weekly)
• VSC builds Med’s to comply with EBOS
(weeks 3 to 9)
• Final validation occurs with client
(week 10 to 11)
• Load Med’s (week 12)
Comparison
Traditional Approach (Timeline):
3 Months
Software
Upgrade
3 Months
6 to 9 - Months
Build Advanced Clinical Capability
Adoption
VSC Approach (Timeline):
3 Months
Software
Upgrade
3-4 Months
Build
3 Months
Adoption
Go-Live / Adoption
Note: By reducing the time to build, more time can be allocated to
training, improving adoption, and enhancing order sets
Multi-Facility
Value Proposition
Key Value’s Gained:
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The VSC can process up-to 50 hospital databases at a time (scale)
It saves time and money
Greater control of build (accuracy, safety and compliance)
By using this approach, a single-enterprise database is created so that the
following can be achieved (beyond initial build):
 As EBOS are updated, the process to update all hospital databases is
fast
 If individual hospital databases change (alter compliance for EBOS),
then monitoring routines will notify the appropriate personnel
 Clean-up of existing orders (optimization) can be achieved
 Organizations have the ability to ‘see what individual hospitals are
doing’ at a order level
• Utilization of orders & order sets can be managed through a central point
• Best practice can be achieved across the enterprise
• As a result of a rapid build, more focus can be applied to adoption!
Multi-Facility Diagram
In this example, 4 hospitals (or more)
are processed concurrently, within a
single process – in less time!
Standard
Order Sets
EBOS
Vendor
VSC Processing
Hospital 1
Hospital 2
Hospital 3
Hospital 4…
MIS
MIS
MIS
MIS
Order Entry
Order Entry
Order Entry
Order Entry
Hosp 1
Physician
Physician
Physician
Physician
Hosp 2
Nursing
Nursing
Nursing
Nursing
Hosp 3
Lab
Lab
Lab
Lab
Radiology
Radiology
Radiology
Radiology
Pharmacy
Pharmacy
Pharmacy
Pharmacy
Hosp 4
VSC Workflow Diagram
• Client Sign-off
• Data Imported
• Training Occurs
• Utilization & Monitoring!
Verify &
Upload
Data
• Multiple Layers of Data
Validation
• Clean up & Prepare for
Upload
Client
• Scope Defined
• Detailed Project Plan
• Communication Plan
• Dashboard Reporting
Workflow
Export
Engine
Data
Process
Data
• Data Exported
• Data Automation Occurs
• Exception Data Processed
• Multi-Level Experts Review
The IT Problem
CPOE – All Hospital’s Example with
‘Traditional Approach’
1 to 2
Months
3
Estimated 6 Months
Estimated 3 Months
4
2-Year
Design
Phase
5
Software
Upgrade
CPOE Build
Sample IT Staff Required:
• MTECH Pharmacy Analyst
• MTECH CPOE Analyst
1
• Project Manager
• MTECH Ancillary Analyst
• MTECH Generalist
CPOE
Adoption
All Analysts perform 100% of tasks required!
6
All Edits Performed in HIT System!
2
The IT Problem
CPOE – The Problems with the
Traditional Approach
1
2
3
4
5
6
7
ACCESS TO RESOURCES – With supply/demand for resources – overall timeline can
NOT be reached
SUB OPTIMIZATION OF RESOURCES – Even if resources could be found – performing
100% of all tasks is costly and inefficient
TIMELINE TOO LONG – 6-Month Build per hospital makes achieving overall timeline
impossible
LACK OF CONTROL / STANDARD – By having separate teams build individual
hospitals, the Standard if difficult to obtain – and control is lost
ADOPTION IS THE KEY – More time, or improved focus on adoption should be the
goal
CORE SYSTEM IS SLOW – By editing within the core system – the labor impact is
increased dramatically!
THERE ARE MORE ISSUES WITH THIS APPROACH – The END-RESULT: HCA could
not meet the timeline with the Traditional Approach!!!
The Solution
CPOE – The Vision Service Center
Approach
VSC Solution:
 Rapid build processing
 Fixed Bid (or T&M if desired by client)
 Guaranteed build to meet standard
 Centralized control & dashboard reporting
 Scalable
 Reduced time allows for focus on adoption
 Access to resources
Value Proposition
CPOE – HCA Example (150 Hospitals)
Total Cost of Ownership
HCA Traditional Approach – 150 Sites Rollout
Per Site (Build Only) Estimate:
Total Cost:
$503,500
$75.525MM
* Assumed: Lower ‘standard’ industry rates, and includes travel
Total Cost of Ownership
VSC Approach – 150 Sites Rollout
Per Site (Build Only) Estimate:
Total Cost:
$185,000
$27.750MM
Estimated savings = $47.775MM
Value Proposition
CPOE – HCA Example (150 Hospitals)
Other Tangible Benefits:
 VSC can build 50 hospitals at a time (scalable)
 Reduced build time by ~50%
 Meets objectives for:
 Standardization
 Control
 Measuring Compliance
 Future Benefits?
 Updates are processed in a rapid manner (IE: database of
all sites in single location – so EBOS upgrade can be managed
rapidly!
VSC Quick Facts
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25 Completed VSC CPOE Rapid Builds
100 RXM Lite Implementations
25 Currently in Progress
Upon approved scope of work can start deployment within 60
days or less
Remote build and knowledge transfer – limited travel expenses
HIS specific Meaningful Use best practices are utilized during
implementation
Deep clinical expertise: PharmD’s, RN’s, Order
Set/Management
Minimalizes data errors and timeline risks

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