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

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 Way We Work Describe • – ID prob. – Req. change Managed process • Concept sol’n � tool design � testing � – training � transition implementation Evaluation • – Outcomes / Comment lit

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)

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

Challenging The Way We Work Questions: “..how…be done better?” “..how automate process - existing electronic systems?” “.. � system orientated, � less person dependant?”

Challenging The Way We Work Faster data collation & � robust data

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

Challenging The Way We Work Process Concept � � � � design � � � testing � � � � training � � � � � • transition implementation • Automate – Use existing HIT platform � work • � time •

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

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 .”

Challenging The Way We Work Process Concept � � design � � testing � � training � � � � � � � � � � • transition implementation – Replicate look / feel • Format • Access – Security / privacy – Cost staff / budget

Challenging The Way We Work Process • Testing – 3/12 Feb – April 2010 – Page structure • Format & display – Data accuracy Inclusion / Omission � • Transfer errors � • • Corruption �

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

Challenging The Way We Work Process • Training – 9 staff – 8 weeks 2010 training – Face – face basis • Display • Explain screens • Demonstrate • Task performance

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

Challenging The Way We Work Process • Implementation – Change took place from July 2010 • Test data cleared • Data real time • Staff informal refreshers

Challenging The Way We Work • Evaluation – Outcomes / Discussion • Benefits of the change • Disadvantages • Literature

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

Challenging The Way We Work Outcomes • Efficiency & effectiveness – 1-2 wk/dy gen. rpt – Now 40 min – Hardcopy optional

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

Challenging The Way We Work Outcomes • Disadvantages – Result availability: tags – Specimen collection dates – Security – PTH data

Challenging The Way We Work • HIT impact - recognised lit: – � doc qual – � doc time – � error – � nsg satis – � pt care (?) (Waneka & Spetz, 2010)

Challenging The Way We Work Outcomes • User survey – Internet (confidential, anonymous) – 8 invitations • 6 completed responses • RR 75%

Challenging The Way We Work Survey • 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 • Reason for change to DLSS well communicated?

Need for Change � ��� � ��� Number � � �� � ��� � Ext well Well Could've Not so well Really poor been better Responses

Challenging The Way We Work Survey • DLSS training was done well?

Training � ��� � Number � �� � ��� � Absolutely Good Just ok Could have No w ay been better Responses

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 .”

Challenging The Way We Work Survey • Easy features: – Accessing results – Adding results – Report display +editing – Add / remove pts

Ease of Use � ��� � Number � �� � ��� � Really easy Easy A little tricky Very tricky Impossible Responses

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…”– operator issue addressed � ↑ training

Challenging The Way We Work Survey • What difference, has DLSS made …way … access / use patient test results? – 5/6 commented

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…”

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)

Challenging The Way We Work Survey • Comments reflect lit: – ? RN want in HIT • Ease of use � • Flexibility � • Effectiveness � • Benefit → safety ??

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)

Challenging The Way We Work Critique • 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 • ? take successful change • Organisational cult: – Opp’ys: recognised & encouraged • Leadership facilitate (!) • Permission giving (Druder, 86. Blohowiak, 92. Radka, 02 as cited in Huges, 2010)

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

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

Challenging The Way We Work HIT Working for Us • Conclusion – Challenges? – sustain � uptake – Audit data – ?HIT imp → RTC? – Diff show HIT � +ve nsg sens pt outcomes (Waneka & Spetz, 2010)