so far, and whats to come Presented By: Yoel Robens-Paradise Vice - PowerPoint PPT Presentation

The CST project – what we’ve learned so far, and what’s to come Presented By: Yoel Robens-Paradise Vice President, Clinical & Systems Transformation and Lower Mainland Health Information Management To BCHIMPS Education Symposium Feb. 24, 2017

What is the Clinical & Systems Transformation project? 2 A joint initiative of VCH, PHSA, and PHC

Strategic Directions PHSA Key Directions 1. Improve quality outcomes and value for patients 2. Promoting healthier populations 3. Contributing to sustainable health care system 3 A joint initiative of VCH, PHSA, and PHC

Project Composition Sabine Feulgen, Associate Deputy Minister, MoH Carl Roy, President & CEO, PHSA BC Ministry of Health Provincial Health Services Authority CST Vancouver Coastal Health Providence Health Care Dianne Doyle , CEO, PHC Mary Ackenhusen , CEO, VCH 4 A joint initiative of VCH, PHSA, and PHC

5 A joint initiative of VCH, PHSA, and PHC

Three Transformations • Clinical – transforming processes such as work flows, order sets, closed loop medication management • Systems – moving to an electronic medical record housed by a shared clinical information system • Quality Culture – leveraging the power of our transformed processes and systems to continuously improve the patient and caregiver experience 6 A joint initiative of VCH, PHSA, and PHC

6 Regional Cancer Centres 19 Community Oncology Clinics 12 Consultative Clinics 7 A joint initiative of VCH, PHSA, and PHC

Vancouver General Hospital St. Pauls Hospital 35-40 Facilities 3,416 acute beds 2,148 LTC beds • Tertiary/Quaternary academic teaching hospitals • 8+ Provincial Referral Services • Lions Gate Hospital Community Hospitals • Residential Care • Primary & Community BC Cancer Agency Care Integration UBC Hospital Richmond BC Children Women’s Hospitals Hospital Powell River Squamish General 8 A joint initiative of VCH, PHSA, and PHC Hospital LW Large Hospital Forensic MH

5,800 11,100 3,600 PHYSICIANS NURSES OTHER 1,900 400 2,800 Management 400 RESEARCH & STUDENTS** PHARMACISTS ALLIED HEALTH 500 HIM 3,400 600 3,200 LAB CLERICAL CARE ASSISTANTS Total 30,000 - 35,000 9 A joint initiative of VCH, PHSA, and PHC

A snapshot of the future state CLINICAL INFORMATICS APPLICATION SYSTEM Nursing + Physician Informatics Leadership ACCESS + PROVISIONING DEVICES SUPPORT Workflow + Usability Optimization Clinical Decision Support Management + Procurement Strategy w/ Access + Provisioning Optimization Asset Management Technical change control Eg. Secondary Use Access Model EHR-related Quality improvement Maintenance Upgrades + code release Initiatives + Optimization On/Off boarding Life-cycle management Support structuring Clinical Content Management Single sign-on Bedside Medical Device Interface management Data Standards Identity life cycle project Integration (BMDI) Application architecture Clinical Architecture Incident Management Clinical Requirements Data migration Configuration management BUSINESS CONTINUITY Quality Assurance + Testing Downtime – planned vs. unplanned Disaster Recovery Management TECHNICAL SYSTEM SUPPORT LEARNING INFORMATION/DATA EVALUATION MANAGEMENT Curriculum development + maintenance Support structuring New staff/student HER related education + training Infrastructure management Evaluation of CST-stated outcomes Data Quality Remediation education Domain management Metadata Ongoing optimization education Legacy system sustainment + Data Modeling decommissioning Upgrade education development / delivery Analytics (current and new) Disaster Recovery Plan Reporting System performance End user tool kit Reports/Extracts Warehouse Interface Management END-USER SUPPORT Storage / Architecture Integration Monitoring/Alerting Clinical support desk * Technical support structure Privacy / Security POLICY + PROCEDURE Domain strategy Service desk * (shared w/ change control) Real-time adoption / at-the- Support structure including platform Testing elbow support EHR-related Policies + Procedures Device support 10 A joint initiative of VCH, PHSA, and PHC

Major linkages 11 A joint initiative of VCH, PHSA, and PHC

How the transformation looks on the ground Example: Lions Gate Hospital Number of beds: 337 Lions Gate Hospital Programs and Services Number of ambulatory clinics: 38 Inpatient Programs / Visits per year: approx 85k (including ambulatory visits) Inpatient Programs Ambulatory Clinics / Services Services Number of Users: 2,658 Maternity Medicine Cardiac Rehab Obstetrics General Medicine Respiratory Therapy Midwifery Dermatology Rehab Services ENT/Audiology COPD Clinic Rehabilitation Rheumatology/Arthritis ECG Neurology EEG End of Life Respirology Geriatric Outreach Associated Facilities Palliative Care Joint Replacement Renal Mammography Clinical Support Pediatrics Nephrology Maternity Services General Pediatrics Dialysis Neuro Rehab Evergreen House Neonatology Medical Imaging Nutrition Residential Care Pharmacy Surgery/Anesthesia Pediatric Asthma Cardiac Lab General Surgery Pre Surgical Screening Cardiac Care Unit HIM Neurosurgery Rapid Access Spine Ophthalmology HOpe Center for Mental Health & Addictions Orthopedics Psychiatry & Education (HOpe Center & ED) ENT Outpatient Clinics Tertiary Mental Health Gastroenterology Psychiatric Emergency Spinal Cord Emergency/Trauma North Shore Hospice Adult Psychiatry Oncology – Plastics Chemotherapy Older Adult Psychiatry Vascular Same Day Care Surgery Urology Cardiology Dental Endoscopy IV Therapy Critical Care Pulmonary Function Lab Adult Intensive Care Medical Outpatient Pediatric Intensive Care Neonatal Intensive Care 12 A joint initiative of VCH, PHSA, and PHC

Transforming how we deliver patient care 13 A joint initiative of VCH, PHSA, and PHC

Insights from other implementations 14 A joint initiative of VCH, PHSA, and PHC

Frame the project as a Clinical Transformation, not an IT project. 15 A joint initiative of VCH, PHSA, and PHC

With multiple sites, standardization of practices is critical 16 A joint initiative of VCH, PHSA, and PHC

Engage all stakeholders 17 A joint initiative of VCH, PHSA, and PHC

Provide an outlet for ongoing continuous quality improvement after go-live can help manage expectations 18 A joint initiative of VCH, PHSA, and PHC

Learn from those who have experience 19 A joint initiative of VCH, PHSA, and PHC

Do not underestimate the human resources needs 20 A joint initiative of VCH, PHSA, and PHC

Have a nimble process for dealing with issues as they arise 21 A joint initiative of VCH, PHSA, and PHC

Applying what we’ve learned The overall strategy for CST design is based on the following key tenets: 1. For clinicians by clinicians 2. Efficiency 3. Produce a product that can be clinically and operationally consumed 4. Integration across the continuum of care 22 A joint initiative of VCH, PHSA, and PHC

Engagement with health professionals is key Subject Matter Experts and • Physician Champions provide clinical input into system design Road Shows and Product Demos • provide a sneak peek of the system and help raise awareness of the changes to come Clinical transformation • workshops give front line health professionals a chance to take a test drive of the prototype system and provide feedback to design teams 23 A joint initiative of VCH, PHSA, and PHC

CST Project Website – CSTProject.ca 24 A joint initiative of VCH, PHSA, and PHC

Challenge questions 1. What are you doing to incorporate user feedback into the design and execution of your health IT project? 2. Based on what you’ve learned from this session, can you identify any opportunities to improve your approach? 25 A joint initiative of VCH, PHSA, and PHC