Turning Failure into Success

– Training the SMS

Austin HealthMajor 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

The Austin Health EMR Journey

Clinical System Chosen:

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

The Austin Health EMR Journey

• 2014 – FirstNet, Referrals

• 2015 – Clinical Documentation, Electronic

Clinical Observations, Between the Flags,

Task Manager

• 2016 – SurgiNet, PowerChart Oncology

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.

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.’

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.

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

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

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.

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

Lessons Learned

• Better understanding of workflows

• Need OPD management support

• Hospital Executive support

• SMS working party

• A NEED TO USE THE SYSTEM!

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.

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

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

But…

Despite making as many significant changes as possible, the majority of SMS still refused

to use Cerner in the OPD

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.

SMS Stats

Report requested from HR for all SMS

names

Total number = 678

SMS Stats

156 have no Cerner accounts

Reasons:• Honorary employees

• ROPP

• Resigned

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

SMS Stats

Non users

Out of the 160 non users:

19 from Anaesthetics

14 from Cardiology

51 from Surgical

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

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:

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 don’t think the program is necessarily the

problem but I think the hospital hardware is

letting us down’

Responses

‘’I can’t 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’

Appropriate Marketing

Q: How do we get ‘buy in from SMS?

A: Show them how it will benefit them and their

patients

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

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

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

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

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.

LMS Brochure-

placed on each

desk in the OPD

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!

Acknowledgement of Current Users

Using Mobile M-

Pages

Current Users

Cerner in Theatre

Current Users

Cerner in OPD

Was this Enough?

No! We did more!

•Went to clinics

•Set up ‘favourites’ folders

•Trained in offices

•Attended Departmental meetings

•Advertised our services

•Reported to the Clinical Systems Steering Committee

•Reported to the Outpatients SMS Committee

•Reported to the Heads of Departments

And then…

•Followed up on the Cerner haters

•Followed up on the Cerner lovers

•Followed up on the Cerner Inbetweeners!

…

Incentive Needed

Some SMS still refused to use Cerner!!!

WHY?

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

Solutions…

• Train Nurse SuperUsers in OPD

Pre-requisites

- Nominated

- Computer literate

- Current Cerner user

- Interested

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

Solutions…

• Train Clerical SuperUsers in OPD

Pre-requisites

- Nominated

- Computer literate

- Current Cerner user

- Interested

Expectations

• Understanding relationship between Medtrak and

Cerner

• Reporting printer issues

• Restocking printers with correct paper

• Access and navigation

• Customisation of accounts

• Locating Discharge Summaries

Bonus!

• Agfa replaced with

Xero

• Images now available

on Cerner via a ‘view

image’ button

Roadblock

But why do I need to use Cerner?

I can get everything I need on Medtrak and

SMR

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?

Password Overload!

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

One Login

Access to results, orders (pathology,

radiology and prescriptions), discharge

summaries, SMR, Xero, ResMed, MIMS,

Clinicians Channel

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 recognition in the benefits of Cerner

Radiology

•Radiology Cerner orders have increased

from

21.4% in Jan 2013

47.0% in Oct 2014

We’re Getting there!

Questions?