Successful automation requires integrated effort
Involve physicians in selection of systems
Automation is an increasingly important component of effective case management programs. But John Hinton, DO, MPH, vice president of clinical information management at Catholic Healthcare Partners (CHP) in Cincinnati, warns that physicians, who often are not involved in the selection process of automated systems, must be part of the selection process if hospitals expect to achieve physician buy-in.
"The ability to check allergies and proper dosages helps us provide better care, reduces adverse outcomes, and helps prevent comorbidities," he explains. "As I work with physicians on computerized provider order entry [CPOE], those are some of the key features that I look for."
According to Hinton, it is not that the numbers are unimportant but rather that what is behind those numbers, including indications for potential interventions, is most critical.
"It is not just one provider, one nurse, one pharmacist that can influence the process," he explains. "It is the process of care delivery, the process of medication administration, and the process of diagnostic evaluation and treatment that we have to examine."
Barb Quick, RN, MS, CPHQ, CMAC, director of case management at Barnes Jewish Hospital in St. Louis, says that decisions regarding automation also must involve both the information systems and case management departments. "Successful implementation is the result of thorough planning," she asserts.
"We are highly automated," Quick says. "The only thing in our medical record that is not automated is physician order entry and history and physical." However, she notes that approval recently was granted for CPOE, which will be a four-year, $10 million project.
Quick reports that when the hospital implemented its automated case management system, it had a lot of the customization already completed, and that helped achieve buy-in for the new product among the staff.
"Many of our staff did not feel the need to be automated, and they did not want to be automated," she points out. "We had to do a lot of sales to them as far as getting them to use the product."
A team of people sat down and looked at each of the work processes, using a training module of the software product, Quick says. That required bringing in staff who perform particular functions, she says. For example, certification coordinators likely will have very different needs than the case coordinators and the appeals coordinators, she explains.
According to Quick, it also is important to understand how the current processes will be integrated with the new system.
During the six-month period when the interface was being developed, she says implementation was being planned. "By the time the interface was ready, we did some testing, and about a month later, we were ready to go live," she says.
Learning through trial and error
From a case management standpoint, Quick says there was no person dedicated to implementation. However, after some trial and error, the hospital eventually learned that was not sufficient. She notes that one smaller facility attempted to implement the new process using a staff-level person who was reluctant to upset her peers.
"Four years later, that hospital is still not totally automated," she reports. "They still have staff that don’t use the system because they have never had a management team to insist they use the system and to sell the rationale behind that."
According to Quick, the hospital’s information systems staff person spent two weeks in training classes with the vendor learning the system. "I don’t think we would have been able to go live without it. That was extremely beneficial." That also eliminated the need to have the vendor on site, she adds.
Quick says it took considerable time and effort to convince information systems management that she needed someone who could manage the system. She considered having a part-time RN manage the system on a full-time basis. However, she was convinced the information systems person had to be able to interface with his or her peers. "When changes are made to the upstream or downstream systems, somebody has to be there to test them," she explains. "We just don’t know enough to do that."
The information systems person also is responsible for working on the interface errors, Quick says. Initially, there were roughly 50 errors a day, but that has been reduced to one or two a day, she says. The information systems person also will have to know how to change screens, she adds.
The product her department uses does not let users change any of their screens, but it does allow custom screens to be built. "We have really taken advantage of that," she says.
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