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1. Turning Failure into Success Training the SMS 2. Austin Health Major tertiary health provider in northeast Melbourne Three campuses The Austin Hospital Heidelberg Repatriation Hospital Royal Talbot Rehabilitation Centre Major services Liver & Gastro-intestinal transplantation Spinal Cord Injuries Oncology Vic Respiratory Services ONJ Centre MH External sites Dialysis external sites 3. The Austin Health EMR Journey Clinical System Chosen: 4. The Austin Health EMR Journey 2011 - Radiology orders, Pathology orders, e- Prescribing, Discharge Summaries, Results & Results Endorsement 2012 2013 - Inpatient medications prescribing, MAR, Fluid balance chart, 724 Access 5. The Austin Health EMR Journey 2014 FirstNet, Referrals 2015 Clinical Documentation, Electronic Clinical Observations, Between the Flags, Task Manager 2016 SurgiNet, PowerChart Oncology 6. First Training Attempt On Monday 25th July 2012, 6 Cerner Trainers began a planned 2 month training exercise in the Outpatient Departments in both Austin Hospital and Heidelberg Repatriation Hospital. The training was aimed at Senior Medical Staff to assist them in becoming proficient in using the Cerner system for outpatient lists (scheduling), looking up results, ordering pathology and radiology and ordering prescriptions. 7. First Training Attempt All the nurses in the Department were trained to Superuser level but this was not embraced by the nursing staff. Many staff were not computer literate. Most came along because they were told they had to. 8. First Training Attempt Within the first few days, it was recognised that the system was proving to be difficult for doctors to use. There were many legitimate reasons for this. 9. Issues Identified Some clinic/SMS were not built into the system Some clinics shared lists Cerner is built for 1 list per Doctor Printing pathology forms was not intuitive Miss trust of the paperless Radiology order 10. Issues Identified Access to SMR was very clumsy Multiple prescription numbers Difficulty in locating the Medicare Number Not all results were available in Cerner Non-attendance/Time limited training Management of multiple systems in Outpatients Refusal of Training 11. Training Stats In 2012 the training was initially planned for 2 months, but it continued on until Friday 23rd December a total of 22 weeks. 12. Training Stats 382 doctors (303 SMS) within the 22 week period were scheduled (this also included rebooking for the staff who could not attend training for various reasons). Out of the 382 sessions, 113 were unattended. (30%) Of the sessions that were held a significant proportion were shortened sessions Only a very small percentage of SMS were actively ordering on Cerner 13. Lessons Learned Better understanding of workflows Need OPD management support Hospital Executive support SMS working party A NEED TO USE THE SYSTEM! 14. Damage Limitation The Clinical Informatics Education team should not have proceeded with training after the first week as the continuation of training and the increasing frustration of the SMS lead to a complete mistrust of the system. 15. Changes made The feedback received from the SMS throughout the 22 weeks prompted some significant changes to be made to make the system more intuitive 16. Significant Changes Medicare number displayed on bannerbar Direct link to SMR Tamperproof printing of pathology and radiology requisitions Tamperproof printing of prescriptions All results fed into Cerner 17. But Despite making as many significant changes as possible, the majority of SMS still refused to use Cerner in the OPD 18. Why? There still remained no requirement to use Cerner by the SMS as paper requisitions for pathology and radiology were still available and acceptable. Paper prescriptions were still left on the desks each day by nursing staff. Results remained available in Medtrak. Past notes were viewable on SMR. 19. SMS Stats Report requested from HR for all SMS names Total number = 678 20. SMS Stats 156 have no Cerner accounts Reasons: Honorary employees ROPP Resigned 21. SMS Stats 522 remaining Out of these 160 have not logged on in the last 3 months Reasons Sabbatical Leave Maternity Leave Long Service Leave Will not access Cerner 22. SMS Stats Non users Out of the 160 non users: 19 from Anaesthetics 14 from Cardiology 51 from Surgical 23. Future Planning With a clear goal of improving patient safety through investments in a centralised clinical system, it became clear that there was a need for SMS to use Cerner 24. Feedback Survey Monkeys were sent out to all medical staff to ascertain what difficulties they mostly had with using Cerner. There were varying (and interesting) responses: 25. Responses It is far too slow. It has been designed to fulfil the requirements of non-medical personnel who do not see patients on ward rounds or in Out Patients I dont think the program is necessarily the problem but I think the hospital hardware is letting us down 26. Responses I cant see any good points about Corner (SIC) Cerner is a very poor clinical IT system I have done outpatients clinics in the past, and once I learned how to use it, I found it very simple 27. Appropriate Marketing Q: How do we get buy in from SMS? A: Show them how it will benefit them and their patients 28. How did we achieve this? Support from hospital executive Marketing and communication strategies from Corporate Communications Specific training modules on LMS for SMS Inclusion in targeted SMS meetings (by our SMS Clinical Informatics Lead) Individual, tailored one on one training Group training 29. Hospital Executive Support Austin CEO medical background an active (and supportive) Cerner user Communication from Chief Medical Officer, CEO and SMS Chairman re expectations in using Cerner Patient risk identified 30. Market and Communication Strategies Corporate Communication involvement in identifying most effective way to communicate with SMS - Alternative media, not always email! - Be visible - Listen - Be available - Supportive 31. Hotline Number A dedicated hotline number available for SMS only No IT Service Desk queuing Cerner specific Confidential Immediate help and support Number placed on each OPD and theatre computer 32. LMS (Learning Management System) Although an LMS was already available, it was recognised that the SMS did not need to use Cerner to the same capacity as junior medical. Due to this, a separate job role was created - Senior Medical Staff. This job role had 2 associated lessons with it and took approx 10 minutes to complete. This was not aimed to replace face to face training but was more an introduction to the programme. Instructions for registering and accessing the LMS was created in brochure form and placed on each desk in the OPD. 33. LMS Brochure- placed on each desk in the OPD 34. Tips and Tricks At the advice of Corporate Communication, the CIU SMS lead created a series of Tips and Tricks for SMS. These were greatly received and used! 35. Acknowledgement of Current Users Using Mobile M- Pages 36. Current Users Cerner in Theatre 37. Current Users Cerner in OPD 38. Was this Enough? No! We did more! Went to clinics Set up favourites folders Trained in offices Attended Departmental meetings Advertised our services 39. Reported to the Clinical Systems Steering Committee Reported to the Outpatients SMS Committee Reported to the Heads of Departments 40. And then Followed up on the Cerner haters Followed up on the Cerner lovers Followed up on the Cerner Inbetweeners! 41. 42. Incentive Needed Some SMS still refused to use Cerner!!! WHY? 43. Because Nursing staff in OPD continued to place paper pathology and radiology request slips and prescription pads on the desks for the doctors use and doctors were still able to access patients results from Medtrak 44. Solutions Train Nurse SuperUsers in OPD Pre-requisites - Nominated - Computer literate - Current Cerner user - Interested 45. Expectations Able to troubleshoot with ordering and printing Understanding of authority and streamlined PBS codes Status of test ordering Height, weight, BMI documentation Location of results Downtime processes 46. Solutions Train Clerical SuperUsers in OPD Pre-requisites - Nominated - Computer literate - Current Cerner user - Interested 47. Expectations Understanding relationship between Medtrak and Cerner Reporting printer issues Restocking printers with correct paper Access and navigation Customisation of accounts Locating Discharge Summaries 48. Bonus! Agfa replaced with Xero Images now available on Cerner via a view image button 49. Roadblock But why do I need to use Cerner? I can get everything I need on Medtrak and SMR 50. Incentive As Cerner was becoming increasingly powerful in its clinical capacity, the need for results to also be fed into Medtrak became under scrutiny by the hospital executive. Why have 2 clinical systems? What was one of the most frequent complaints we continuously received? 51. Password Overload! 52. Decision Time! A date was fixed to stop results being fed into Medtrak. This decision to date has been the most effective yet Number of SMS has increased dramatically since the message has been published and that is expected to increase further when the results are switched off next month 53. One Login Access to results, orders (pathology, radiology and prescriptions), discharge summaries, SMR, Xero, ResMed, MIMS, Clinicians Channel 54. Have we succeeded? So far Increased numbers in Cerner radiology orders Increased numbers of Cerner pathology orders Increased numbers of Cerner outpatient prescriptions Increased requests for training Increased support from Heads of Departments Increased r