E-Clips Physician training

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EE--CLIPS Training Project: CLIPS Training Project: The Good, The Bad, The Good, The Bad,

The Great!The Great!January 19, 2007January 19, 2007

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MHS and Our Training StoryMHS and Our Training StoryAgenda and PresentersAgenda and Presenters

Introduction MaryLee Newman, RN, MS

Logistics Arnie Park, MA

Implementation Victoria del Valle, RNC, MSN

The Nurse Perspective Shanna Bock, RN

Conclusion MaryLee Newman, RN, MS

Questions Panel

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OBJECTIVESOBJECTIVESLearn:• About Memorial Health System• The basic structure of a clinical system project

plan• A successful approach to effect an enterprise

training plan for nursing• A Nursing Perspective • Benefits of the electronic system for nurses

MaryLee Newman

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Patients First…More Patients, More Choices

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Memorial Hospital CentralMemorial Hospital Central

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Major Services to Meet the Community’s Needs

•Emergency/trauma

•Maternity/delivery

•Infant and child care•Cancer treatment

•Heart care

•Orthopedic surgery

•Rehabilitation

•Outpatient services

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Memorial Hospital Central AdditionMemorial Hospital Central Addition

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Memorial Hospital NorthMemorial Hospital North

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The EThe E--CLIPS ProgramCLIPS ProgramElectronic Clinical Information Processing

System (E-CLIPS)

Mission: To be able to capture all patient care information at the point of care, with immediate access anywhere, using multiple

devices, and in a secure manner.

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How we got there:How we got there:• Vendor selection process…close call: many years in the making.

• Cerner ASC approach – Why? The Cerner Accelerated Solutions Center (ASC), located in Kansas City, MO specializes in the fast delivery of standard Cerner Millennium™ solutions using the following methodology: Design–Build–Test–Train–Convert .

• PIT teams: Project Implementation teams; Clinical and non-clinical; managers and staff working together for a common goal. Included Pharmacy, Lab, Clin Doc, Med Admin, Training and Ed, ED, Medical Records, IS

• Kansas City – Memorial Hospital staff participants made 5 trips to the ASC in Kansas City over 6 months to work with Cerner's staff to prepare for an initial April, 2006 implementation of the basic automated medical record.

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End-User TrainingDesign Process

Post-Conversion Assessment

ProjectPlanning

Super User Training

End User Training

End User Training

DataCollection

ProcessDesign

WindowsAssessment

TrainersEducation

WBTDevelopment

Pre-DesignAssessment

May 2005 July 2005 July 2005 Oct 2005Sept 2005 Jan 2006 Feb 2006 Mar 2006

Feb - March 2006

April-May 2005Mar-May 05

E-CLIPS Project Phase 1 Implementation

March, 2005 March, 2006

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EE--CLIPS Training Logistics CLIPS Training Logistics

GOAL: Train 3000 users with many different job positions on many different applications in a 10 week period before go live.

Arnie Park

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• Windows assessment for staff• Windows 2000 basic skills review on our

intranet• Windows 2000 test and classes

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Determined classes needed and number of “seat hours” for all employees from a spreadsheet designed by Cerner.

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• Created multiple class schedules• Created registration portal on our intranet

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EE--CLIPS Training Logistics CLIPS Training Logistics and Coordinationand Coordination

E-CLIPS Introduction CBT (computer-based training) to be taken before attending class.

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End-user training for approximately 3000 employees taking multiple sequential classes. 4 training rooms running 8 am to 10 pm, 6 days a week for 10 weeks.

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• Physician training for 500 physicians included CBT, classroom, one-on-one scheduled and drop-in training in Physician Lounge.

April 2006• Go live 4/4/06 • Implemented post go-live

training.

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Role of Training CoordinatorRole of Training Coordinator

ClassRegistration

TrainerSchedule

ClassSchedule

Communication

ClassRosters

TrainingMaterials

Class Attendance & Evaluation

ClassCoverage

Auditing Classes, Feedback, Meetings, Reports, Updates, …

RecognitionLuncheon

Victoria del Valle

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Training MethodologyTraining Methodology

1. Teach Functions2. Cascade Learning

ASC Nurses/Therapists

Trainers

End Users

Super Users

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Selection of Nurse Trainers andSelection of Nurse Trainers andSuper UsersSuper Users

• Gap Analysis• Selection Criteria• Actual Numbers• Educational Consulting Firm

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Curriculum Development Curriculum Development Customized Training ToolsCustomized Training Tools

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Train the TrainersTrain the Trainers

• December 2005• 1-week Classroom Hands-on Training• Practice Time• Testing• Train Domain (environment)• Training Consistency

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MHS EMHS E--CLIPS TrainersCLIPS Trainers

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Super User TrainingSuper User Training

• January 2006• 2-day Classroom Functional Hands-on Training• Unit-specific Super User Training/Practice• System/Process Update Dissemination• Quick Reference Guides

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End User Training, Support, & End User Training, Support, & CompetenceCompetence

• 1/31/06 – 3/31/06• 2, 4, and/or 5 hr Classroom Hands-on

Instruction• Practice Lab (up to 8-hr paid time) • Clinical unit poster board for tracking staff

training completion• Homework• Unit-Specific Workflow Process

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A NurseA Nurse’’s Perspectives Perspective

Shanna Bock

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What nurses were projecting:• Never used a computer or a clinical

documentation program• Intimidation of the technology• Learning a new language (computer talk)• Anxiety of the conversion

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Kubler-Ross Grieving Stages 1. Denial (this isn't happening to me!)2. Anger (why is this happening to me?)3. Bargaining (I promise I'll be a better person if...)4. Depression (I don't care anymore)5. Acceptance (I'm ready for whatever comes)

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Denial• “This isn’t going to happen!”• “Memorial won’t invest in something like

this.”• “I have heard of them doing this before

and it never went through.”

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Anger• Numbness and shock!• “Why are they doing this to me?”• “They can’t make me change the way I

document!”

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Bargaining• “If you stop this, I will do my charting

better.”• “I might have to find another job if they go

through with this.”

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Depression• “My career is over as I know it!”• “I don’t know how to use a computer!”• “They are going to fire me!”

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Acceptance• “I really like this computerized charting!”• “It is easy to find the information in the chart!”• “I don’t have to wait or go looking for a chart

now!”

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• “It is easy working within this program!”• “The support was great!”• “All the information is only a click away!”• “Going back to paper is not an option!”

More Acceptance

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Gearing up for GoGearing up for Go--Live: what Live: what happenedhappened……

• Feelings of anxiety • Observing the excitement of other staff

members. • Seeing the equipment being placed on the units.

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PracticePractice……PracticePractice……PracticePractice

• 8 hours of practice time allotted • Practice labs • Completing required homework and

practicing…

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• Nurse Responsibilities– Mandatory use of system – Assisting other care givers with

documentation or to locate information• Super users roamed units helping end

users with tasks and documentation.• Nursing staff / patient ratio reduced on

most units

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• Trainers rounded hospital units wearing yellow vests assisting with training issues.

• Cerner team wore red vests. • Hospital was decorated with our mascot,

‘sun guy’, to make Go Live activities fun.• Food, souvenirs

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Post GoPost Go--Live AssessmentLive Assessment

• Transition was relatively smooth.• Total support from management• Dedicated and flexible staff.• Clinical managers involved in decision-making.• Needed more age-specific practice scenarios • Needed more practice with / testing devices

MaryLee Newman

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BENEFITSBENEFITS• Staff well-prepared for Go-Live• Staff positive about system• Nurses don’t have to stand in line waiting for a

chart• No more department silos• Patient care can be reviewed prior to transfer /

admit• Capturing more statistics• Greater staff retention • A number of nurses have returned to school

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Looking forwardLooking forward

Communication tools broadened Continue to involve nurse trainers / super usersStandard training for new employees, additional

applicationsErgonomic assessmentsPowerForms redesign groups BPOC and CPOE later this year (07)

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The hardest part is over...

E-Clips Physician training

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