Putting
the I.T. in Caritas
Following up on the organization's recent Stage 6
accomplishment, Caritas Christi Health Care shares its
strategic approach to installing MEDITECH's Advanced
Clinicals throughout its six facilities, and stresses the
importance of thorough, organization-wide preparation and
teamwork.
(11/4/2010)
Implementing Advanced Clinical software
enterprise-wide, at six different hospitals, requires top-notch
organizational skills, extensive preparation, and
interdisciplinary collaboration. So when the executive team
at Caritas Christi Health Care (Boston, MA) chose to install
MEDITECH's Physician Care Manager (PCM) and Patient Care and
Patient Safety (PCS) applications back in 2006, they had the
foresight to create an I.T. project management team with
strong clinical representation.
As it turned out, this I.T. project management team--responsible
for both planning and executing the PCM and PCS
implementations throughout the organization--was key to
Caritas Christi's success.
"Thanks to the team's expertise and dedication, we were
able to implement MEDITECH's Advanced Clinical solutions at
all of our hospitals in just three years," says Todd
Rothenhaus, MD, FACEP, senior vice president and CIO at
Caritas Christi.
Charting
the Course
As one of their first orders of business, Caritas' project
management team created application-specific implementation
charters, as well as a charter for the I.T. infrastructure
changes needed to accommodate them. To help keep the
implementations on track, the team created PCM and PCS
timelines--with projected go-LIVE dates--for each site.
Because of the project's size, Caritas also designated local
governance committees to manage the implementations, train
users, and handle the go-LIVE. Since the project management
team was appointed to oversee all the installs, the
organization selected I.T. analysts, nurses, physicians, and
pharmacists from each Caritas location to comprise the
committees.
"We felt it was important to get clinicians at the
individual hospitals involved from the beginning," says
Mary O'Brien, director of information systems and the project
management team.
"We really wanted them to accept ownership of the
project, and we knew that getting their input on
standardization, workflow adjustments, and process changes
would help us to build a system that best meets their needs."
Laying the
Groundwork
With the local governance committees assembled, O'Brien and
her team hosted a project kick-off meeting in February 2007,
during which they reviewed the hospitals' charters and
implementation timelines.
"We used the kick-off meeting as an opportunity to
stress the importance of meeting projected go-LIVE dates,"
says O'Brien. "Right up front, we were very clear with
the governance committees about our expectations."
Starting with PCS and Bedside Verification (BV), the project
management team prepared for their first implementation at
Norwood Hospital (Norwood, MA). They met with Norwood's
governance committee twice a week for several months to
analyze workflows, determine how to transition processes, and
devise strategies for training clinician end users.
According to O'Brien, the team's thorough planning helped to
smooth the way for a more efficient implementation. And,
since the preparation had such a positive impact at Norwood,
they made sure they followed the same steps when preparing
for the installs at the other five hospitals.
Collaborating
Across the Care Team
With a solid plan in place, the project management team was
ready to begin building and installing PCS at Norwood. Susan
Adams, senior project manager, and Lauren Josie, advanced
clinical applications manager, assembled a group of local
nurses to lead the PCS build. These nurses worked with
pharmacists, medical staff, and departmental clinicians
throughout the implementation and go-LIVE, to ensure they
were considering every aspect of care during the build.
Meanwhile, the Pharmacy staff worked closely with the nurses
on Norwood's governance committee and the nurses leading the
PCS build, to automate and streamline medication
administration and barcode scanning processes. To make sure
the Pharmacy staff was familiar with nursing's perspective,
the nurses met with them regularly to provide training on BV
and the electronic Medication Administration Record (eMAR).
"When we went LIVE at Norwood, we learned PCS affected
not just the nurses, but the entire care team," says
Adams. "We quickly figured out we had to consider every
department in our planning and training."
Josie adds that, as her team applied all the lessons learned
at Norwood to the next implementation, their confidence
steadily grew: "Each installation went better than the
previous one, as we got more proficient."
Clearing
the Path to CPOE
As the other five Caritas hospitals implemented PCS, Karen
Hughes, lead clinical analyst on the project management team,
led the medical staff through their PCM and CPOE builds. She
selected physician champions at each location and met with
them regularly to develop strategies to help their colleagues
adapt to the new system. The physician champions also met
with other care team members, to understand how the new
physician workflows would impact their disciplines and to
work through potential issues.
"We actually required the physician champions to develop
a new PCM workflow before we even started the implementation,"
says Hughes. "This mandate forced the champions to
really think about what was going to change and find
solutions to any problems, before we rolled it out to the
entire medical staff."
Next, Dorcas Rushton, Caritas Christi's Pharmacy systems
analyst, collaborated with the physician champions to build
the order sets. "We understood how critical it was to
get the content right from the beginning, to make the
ordering process as error-proof as possible," says
Rushton. "We also made sure to coordinate training with
the physicians early on, to help them through the transition
from paper to electronic ordering."
The team helped ease the transition to CPOE even further by
using existing paper order sets during the go-LIVE. Hughes
felt it would be less of a learning curve if the physicians
already recognized the order sets, focusing instead on the
new ordering process. "Once we built the paper sets in
the system, we showed physicians the electronic versions and
helped them to work through the new process," says
Hughes. "During implementation, we tweaked some of the
order sets to suit clinician usage, and then reevaluated them
once more when we went LIVE."
Working
Hard, and Smart
The Caritas project management team attributes their success
to intensive preparation and a smart rollout strategy; they
never missed a projected go-LIVE date by more than a week.
Norwood Hospital--the site of their first implementation--went
LIVE with PCS and BV in the summer of 2008. Their final site,
Holy Family Hospital (Methuen, MA), went LIVE in early 2010.
MEDITECH
Medical
Information Technology, Inc.
MEDITECH Circle
Westwood, MA 02090
781-821-3000
www.meditech.com