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West Bend, Wis.
- "Technology does not drive change at all. Technology merely enables change. It's our collective cultural response to the options and opportunities presented by technology that drives change."
Those are words, uttered by technology forecaster Paul Saffo
, which Kim Pemble lives by. For Pemble, VP/CIO of SynergyHealth
in West Bend, they were instructive during the recent implementation of Epic Systems'
electronic Medication Administration Record, or eMAR system, to address patient safety goals at St. Joseph's Hospital.
In that project, Pemble learned to ask something that many wish state government had asked before it delved into a series of ambitious, and ultimately problematic and expensive information technology projects - does this implementation plan make sense? And as always, people and their workflow were key considerations.
Pemble has been preaching something similar to Saffo throughout his career as an information technology manager, college professor, consultant, and health system advisor. "I came by it through experience," Pemble said of Saffo's advice, "but I knew it going into this project."Healthcare synergy
SynergyHealth includes St. Joseph's Hospital, the West Bend Clinic, and its satellites. St. Joseph's was the first Epic System site to incorporate bar coding, which is a central part of the eMAR system, at project rollout. The goal of project is to address workflow and enhance safety in the administration of medicine, which is aligned with corporate objectives for safe patient care delivery.
eMAR originally was scheduled to "go live" with the opening of a new hospital in August of 2005, but Pemble, in consultation with the nursing staff, respiratory therapists, and pharmacists, began to rethink that decision. The subsequent postponement bought some time for an immersion approach to training after members of the nursing staff became familiar with their new work environment.
"We felt the scope of change was a little overwhelming for the nurses, given all of the changes they would be going through in connection with the new hospital," Pemble said.
Following their environmental adjustment, it was time to learn a new tool. Well in advance of implementation, committees established workflows that were structured around the new work environment, and changes the new technology would bring.
About 320 affected employees were required to attend a seven-hour training session on the eMAR system. They later would apply what they learned in a mandatory two-hour workflow session, and then have additional lab time to practice workflow on workstations complete with sample wristbands for the patients and sample medications that had been coded.
Nurses had opportunities to come back to the lab and talk to an instructor about functionality, and each staff member had to take a competency test to make sure they had mastered the technology.
"So we had class practice time, lab practice time, workflow practice time, and we had a competency test," Pemble said. "Those pieces, all brought together, were a key to the success of the project."Project ownership
Many organizations view information technology projects as strictly information services projects, and in so doing they exclude what Pemble called "business owners," those that have the expertise on how work is supposed to flow. Not infrequently, he said the lack of business owners "at the table" results in shortcomings in the implementation.
"One of my principles as to how we look at patient services is that projects of this scope are not IS projects, but they have a shared ownership with, in this case, the clinical departments and information services," he said.
That, he said, should be a more consistent way of looking at IT projects than he has witnessed in a variety of industries, including healthcare. Prior to joining Synergy Health, he served as a principal for Information eVolution Consulting, an advisor to healthcare organizations, as an assistant professor in the College of Health Sciences
at the University of Wisconsin-Milwaukee
, and as general manager of EMSystem, LLC
, a subsidiary of the Mequon-based Infinity Health Care
, where he served as vice president of information technology.
Pemble also serves as secretary/treasurer of the Wisconsin Health Information Exchange
, an organization that is exploring ways for healthcare providers to electronically share patient information.Cool tool
Given this background, he not only is cognizant of change management, but of the need to give employees the right tools, and the eMAR system could be the first of several Epic product added to the toolbox of the nursing staff.
, medication orders initially are entered by a pharmacist, and nurses and respiratory therapists then validate the order. Once an order is received, they log onto to a computer on wheels, or COW, stationed in each room. When users administer medication to a patient, they log on to eMAR and scan the patient's arm band, which also contains bar codes. The system automatically selects the patient and knows which medications are due for that patient, and when.
The system checks to validate that an order for each of those medications actually exists for that patient, that the dose that has been scanned actually matches the order, and that the timing of the administration matches the order.
Nurses also can enter related information, such as when medications were administered late because the patient was at a procedure.
Thus far, Pemble said he has received very positive feedback from the nurses. They have commented that implementation wasn't as difficult as they expected, and that eMARS is a better way to document the administration of medication.
Paula Doyle, a registered nurse and coordinator of St. Joseph's Intensive Care Unit, said a project rollout at the same time nurses were learning a new environment and new processes that came with it would have been "too much, too fast" for people. "The eMAR was the first absolute must where everybody had to get on board," she said. "The decision to delay was a very good decision."
People at Epic, meanwhile, told him this was one of the smoothest implementations they had seen. "Epic was scheduled to be here for a week during the initial live time, and they were sent home on Tuesday afternoon," Pemble said.
Now, the hospital has electronic information on workflow compliance that previously was buried on paper charts, and it should know by the third quarter of this year how well the system has worked to reduce medical errors.
This is the first major Epic software piece for the nursing staff. Prior to this implementation, the hospital went live with the Epic pharmacy system and the Epic surgical scheduling system - implementations that helped it plan the eMAR dress rehearsal. Still to be installed are Epic solutions for clinical documentation and physician order entry.
In the end, it was a little patience that made for a smooth transition. "It was critical that the initial piece of functionality be successful in its implementation," Pemble said, "because it would set the ground rules for how future Epic installations would occur in the [new] hospital."Related stories
Doyle asks health professionals to overcome barriers
Wisconsin Health Information Exchange shares burden of electronic medical records
Tom Still: Electronic health records can save lives and improve medical care