Challenging The Way We Work Health Information Technology (HIT) - - PowerPoint PPT Presentation

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Challenging The Way We Work Health Information Technology (HIT) - - PowerPoint PPT Presentation

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Challenging The Way We Work Health Information Technology (HIT) Working for Us Dunedin Dialysis Laboratory Summary System Donkin B. Dunedin Hospital, Southern District Health Board, Private Bag 1921, Dunedin 9016, New Zealand Challenging The

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SLIDE 1

Challenging The Way We Work

Health Information Technology (HIT) Working for Us Dunedin Dialysis Laboratory Summary System

Donkin B. Dunedin Hospital, Southern District Health Board, Private Bag 1921, Dunedin 9016, New Zealand

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SLIDE 2

Challenging The Way We Work

  • Describe

– ID prob. –

  • Req. change
  • Managed process

– Concept sol’n tool design testing training transition implementation

  • Evaluation

– Outcomes / Comment lit

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SLIDE 3

Challenging The Way We Work

  • HIT +ve imp

– Nsg care & P/O – Pt safety / QofC

(Waneka & Spetz, 2010)

– Biochem mtg

  • 92 dialysis patients (52 HD / 40 PD)
  • Wide geographical area
  • 7% NZ 4.0m (285,000)
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SLIDE 4

Challenging The Way We Work

  • Prob. ID / Need for change
  • Practice
  • Access 3 lab sites

– Each patient – Each test group – Drill down results

  • Transcribing
  • Implications

– RN time (RTC; NPJ)

  • Risk – right results, right patient
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SLIDE 5

Challenging The Way We Work

Questions:

“..how…be done better?” “..how automate process - existing electronic systems?” “.. system orientated, less person dependant?”

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SLIDE 6

Challenging The Way We Work

Faster data collation &

robust data

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SLIDE 7

Challenging The Way We Work Process

  • Concept
  • design
  • testing
  • training
  • transition implementation
  • Min risk:
  • Right patient
  • Right tests
  • Right data / time
  • Safe pt management
  • clinical risk
  • serv. risk
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SLIDE 8

Challenging The Way We Work Process

  • Concept
  • design
  • testing
  • training
  • transition implementation
  • Automate

– Use existing HIT platform

  • work
  • time
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SLIDE 9

Challenging The Way We Work Process

  • Concept
  • design
  • testing
  • training
  • transition implementation
  • Discuss CNM
  • Emphasise time risk safety efficiency

– Prototype approval

  • Find / discuss with right IT

Application Developer

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SLIDE 10

Challenging The Way We Work

  • Smart! - align organisational goals

–Statutory Obj

  • “...improve, promote and protect health

population.”

  • “...promote effective care and support.”

–District Plan

  • “…maintain and enhance capability deliver

quality health services.”

  • “…manage risk.”
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SLIDE 11

Challenging The Way We Work Process

  • Concept
  • design
  • testing
  • training
  • transition implementation

–Replicate look / feel

  • Format
  • Access

–Security / privacy –Cost staff / budget

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SLIDE 12

Challenging The Way We Work Process

  • Testing

– 3/12 Feb – April 2010 – Page structure

  • Format & display

– Data accuracy

  • Inclusion / Omission
  • Transfer errors
  • Corruption
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SLIDE 13

Challenging The Way We Work Process

  • Development & testing
  • Involved other staff

– “show and tells”

  • Feedback shaped syst

– Spec details

  • code (+ date & time)

– Improved pt demographics

  • name & NHI (+ DOB)

– Customise display period

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SLIDE 14
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SLIDE 15
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SLIDE 16

Challenging The Way We Work Process

  • Training

– 9 staff – 8 weeks 2010 training – Face – face basis

  • Display
  • Explain screens
  • Demonstrate
  • Task performance
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SLIDE 17

Challenging The Way We Work Process

  • Transition

– May - Jun 2 syst run side by side (final quality check) – Audit of all trial test results (test database)

  • 100% correct
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SLIDE 18

Challenging The Way We Work Process

  • Implementation

– Change took place from July 2010

  • Test data cleared
  • Data real time
  • Staff informal refreshers
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SLIDE 19

Challenging The Way We Work

  • Evaluation

–Outcomes / Discussion

  • Benefits of the change
  • Disadvantages
  • Literature
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SLIDE 20

Challenging The Way We Work Outcomes

  • System generated

– Customised

– Reports – Database

  • Enhanced access & availability

– Secure

  • Uptake

– Previously 1/3 staff gen. rpt

  • Max to date 5/6 83%
  • Case load allocation
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SLIDE 21
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SLIDE 22

Challenging The Way We Work Outcomes

  • Efficiency & effectiveness

– 1-2 wk/dy gen. rpt – Now 40 min – Hardcopy optional

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SLIDE 23

Challenging The Way We Work Outcomes

  • Sig risk reduction

– Transcribing – Manual calculations – Adj Ca++ / URR

  • Patient focused

– Meeting delays – timely decisions

  • to CKD management

Implementation of decisions sep process!

  • Transferability

– ICU

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SLIDE 24

Challenging The Way We Work Outcomes

  • Disadvantages

–Result availability: tags –Specimen collection dates –Security –PTH data

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SLIDE 25
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SLIDE 26

Challenging The Way We Work

  • HIT impact - recognised lit:

– doc qual – doc time – error – nsg satis – pt care (?)

(Waneka & Spetz, 2010)

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SLIDE 27

Challenging The Way We Work Outcomes

  • User survey

–Internet (confidential, anonymous) –8 invitations

  • 6 completed responses
  • RR 75%
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SLIDE 28
  • Awareness for DLSS development?

100% Y

  • Consulted during the development?

100% Y

  • Listened to: able to influence development?

100% Y

Challenging The Way We Work Survey

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SLIDE 29
  • Reason for change to DLSS well

communicated?

Challenging The Way We Work Survey

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SLIDE 30
  • Number

Ext well Well Could've been better Not so well Really poor

Responses Need for Change

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SLIDE 31

Challenging The Way We Work

Survey

  • DLSS training was done well?
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SLIDE 32
  • Number

Absolutely Good Just ok Could have been better No w ay

Responses Training

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Challenging The Way We Work

Survey

  • Training: what could have been done

better?

–2/6 commented

  • “…to have spent more time on training due to

my mediocre computer skills…”

  • “…but by the time…I had forgotten how to do

it…had to be reminded …have ok since .”

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Challenging The Way We Work

Survey

  • Easy features:

– Accessing results – Adding results – Report display +editing – Add / remove pts

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SLIDE 35
  • Number

Really easy Easy A little tricky Very tricky Impossible

Responses Ease of Use

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Challenging The Way We Work

Survey

  • Ease of use - room for improvement?

–3/6 commented

  • “…more practice…not take long to find this…

easy to use.”

  • “…more practice needed limited time

available…”

  • “…not all (Adj Ca++) are being corrected…”–
  • perator issue addressed ↑ training
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SLIDE 37

Challenging The Way We Work

Survey

  • What difference, has DLSS made …way

… access / use patient test results?

–5/6 commented

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SLIDE 38

Challenging The Way We Work

Survey

  • “…easier”
  • “Handy, quicker / improved access…home

visits”

  • “Great no…handwriting”
  • “Reduces chances…error”
  • “Less nursing resources…”
  • “Great…see trends in (monthly)…results”

– no change … lack of familiarity with system – “…still look up i-Soft…”

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SLIDE 39

Challenging The Way We Work

Survey

  • Comments reflect lit

– +ve integration HIT

Invol staff plan / devel / impl: flex

  • Illus. pt benefit

Impt adeq training ($ needs asst’s)

– Staff satisfaction present

HIT perceived ease use Integrates nsg wk flow

(Waneka & Spetz, 2010)

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Challenging The Way We Work

Survey

  • Comments reflect lit:

– ? RN want in HIT

  • Ease of use
  • Flexibility
  • Effectiveness
  • Benefit → safety ??
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Challenging The Way We Work Critique

  • Frances Hughes

– ID drives innovation

  • Equity
  • Safety
  • Effectiveness
  • Cost constraints ($ /
  • )
  • (Merritt, 85. Deutsh, 85. as cited in Huges, 2010)
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SLIDE 42
  • Def. Tech innovation

–“…knowledge, skills, methods, techniques to accomplish a task.” –X just technology innovation

  • Sp Technology Transfer

– Prod / proced new to organisation – (DU) improve exist proced, processes

(US General Accounting Office, 2005)

Challenging The Way We Work Critique

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SLIDE 43

Challenging The Way We Work Critique

  • ? take successful change
  • Organisational cult:

– Opp’ys: recognised & encouraged

  • Leadership facilitate (!)
  • Permission giving

(Druder, 86. Blohowiak, 92. Radka, 02 as cited in Huges, 2010)

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SLIDE 44

Challenging The Way We Work Critique

  • Barriers

– Nature comm’n

  • Quantity / Timing / Relevance
  • Personal contact
  • Focus right people
  • Language (? Change agent)
  • Right leadership - impt nsg leadership! (Ref JONA)

– +ve response

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SLIDE 45

Challenging The Way We Work HIT Working for Us

  • Conclusion

–DLSS e.g. decentralised Tech Tx Proj

  • ID prob local level
  • Develop local solutions
  • Addresses
  • issues

$,

  • /
  • ,
  • –Increased staff participation in new process
  • vs. prev
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SLIDE 46
  • Conclusion

–Challenges?

–sustain uptake – Audit data –?HIT imp → RTC? –Diff show HIT +ve nsg sens pt outcomes

(Waneka & Spetz, 2010)

Challenging The Way We Work HIT Working for Us

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Challenging The Way We Work HIT Working for Us

  • Conclusion

–Do diff?

  • Planning – haphazard use info
  • Training – x over est. simplicity
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SLIDE 48

Conclusion

Hope encourages you, your colleagues to ask “why do we do it that way?” and to be innovative!

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Challenging The Way We Work HIT Working for Us

References

1. Copnell, B., & Bruni, N. (2006). Breaking the silence: nurses’ understandings of change in clinical practice. Journal of Advanced Nursing, 55(3), 301-9. 2. Hughes, F. (2006). Nurses at the forefront of innovation. International Nursing Review, 53(2), 94-101. 3. Strategos (2003). What are the barriers to innovation? Survey of 500+

  • executives. Retrieved from

http://venture2.typepad.com/innovationnet/2004/08/what_are_the_ba.html 4. The CEO Refresher (2010). Change Management – Five colossal mistakes to

  • avoid. Retrieved from http://www.refresher.com/aanlchange.html

5. US General Accounting Office (2005). Principles of innovation and change. Retrieved from http://www4.uwm.edu/cuts/bench/princp.htm 6. Waneka, R., & Spetz, J. (2010). Hospital information technology systmes impact

  • n nurses and nursing care. Journal of Nursing Administration, 40(12), 509-514.
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Challenging The Way We Work HIT Working for Us

  • Limitations

– Clinician as change agent

–Self reporting –Dom voice lit

– Change r/t technical care & treat

–Less r/t pt comfort –Obs lit and crit from lit

(Copnell, B., & Bruni, N. 2006)

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SLIDE 51

Challenging The Way We Work Critique

  • ID 15 rules Tech Tx

– My Top 5

  • 1. Comm’n is everything
  • 2. Comm’n / Tech Tx X easy
  • 3. Most respected opinion that of peers!
  • 4. X make life easier wont get used
  • 5. Showing & telling more impt. just showing or

telling

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SLIDE 52

Centralised Decentralised iPM DLS Control / Power

High level: vertical Admin Tech ex

Control / Power

Low level: horizontal Among gp members; peer network

Need ID

High level “Push” down effect: change / solutions

Need ID

Local (gp, peer) “Pull” effect: change / solutions

Local adaptation

Low degree Inflexible

Local adaptation

High degree Flexible

Information and training

High degree Formal

Information and training

Low degree Informal

Uptake

Low

↑Complexity,

distance, delay: training and use

Uptake

High

↓ complex,

local, less delay

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SLIDE 53

Challenging The Way We Work Critique

  • Huges 8 types innovation

–Historical –Research –Clinical –Business –Educational –Technological –Policy