pre-live super user and managers briefing you can download a copy of this presentation at:

Pre-Live Super User

and Managers Briefing

You can download a copy of this Presentation at: http://my-ehospital.org/support/information-super-users

Our largest ever investment in improving healthcare quality

Agenda and Introductions

Executive welcome

Introductions and check-up

Briefing

Q & A


How are you getting on with becoming Super?1. The 'Art of being a Super User' guidance booklet 2. Your eLearning modules 3. Your Electronic Patient Record training4. Sitting in as a 'classroom assistant' on further

training5. Further eLearning modules 6. Practice and embed your new skills in the

'playground‘7. For doctors and clinical nurse specialists there will

be personalisation labs8. Participating in Dress Rehearsals 9. Attend a pre-live Super User/Managers briefing10. Keeping up to date


Information for all staff

Payslip attachment Staff Q&A session(s)

eHospital Times


Super User / Management Briefing – what we’ll cover

Goals for SupportOverview of SupportWhat is the Bronze CAM (eHospital Command Centre)Roles and ResponsibilitiesBe a Great Super UserZone Support – How to engage your Floor WalkersPrioritising Incident TicketsReporting Options and Online Ticket EntryPatient SafetyOverview of CutoverOperations Issues – Bronze, Silver, Gold Command (Major Incident)



Go Live Support Goals

• Smooth transition from the current processes to Epic• Solid Epic readiness• Appropriate plan/processes/structure for managing transition• Solid end-user and physician support structure

• Identify and manage issues• Timely response to issues• Maintain strict Change Control process• Communicate to the organisation and our peers appropriately

And, above all Minimise the risk to patients, as well as the organisation’s

operations by providing quality 24 x 7 support and transition management.


Days 1-3: ◦ Security, printing, and general workflow reinforcement

Days 5-7: ◦ There may be an increase in frustration on the part of users if

issues are not resolved in a timely manner or support is not sufficient

Days 7-10: ◦ The excitement of go-live wears off; be prepared for staff and

project team fatigue In general, you will hear different perspectives from users, making it

difficult to establish the “facts” Focus on the root cause instead of the symptoms

The First 10 Days of Go-Live You Should Expect


Happiness Curve for Implementation


Before Go-Live

The organisation as a whole will be increasingly anxious

Some individuals will be outspoken in opposition to the project and/or the go-live date

The project team will feel overwhelmed

You will see some end user resistance to training

People will question your scope or sequence


Overview of SupportBronze CAM Command Center Support Staff – Located in the Deakin Centre

Project Leadership, Application Functionality support, SecurityInfrastructure, Production Applications, EDIPC/Printer Support, Systems/Network Security and HP

Support RolesSuper Users – Support End UsersFloor Walker – Float Support for Super UsersZone Leader – Support Floor Walkers in their assigned Zone (Territory)Bronze CAM Commander w/ DeputySilver CommandGold Command

24 X 7 scheduled from 23-10-14 thru 28-11-14Daily Communication schedule

06:45 and 18:45 Shift Transition Meeting for Inpatient areas09:30 and 21:30 Silver Leadership Meeting10:00 Outpatient Leadership Huddle (M-F) TBD

Floor Walker and Command Center staff will have pagers and phones for communication as assigned.

Incident management ticketing system is called SAMANAGE for tracking issues and resolution


Bronze CAMeHospital’s Command Centre

11


Bronze CAM (Deakin Command Centre)

• Purpose is to provide support and issue resolution over the go-live period. Reports in to Silver Command.

• The issues reported in by Super Users and Floor Walker are tracked and resolved as Incident Tickets.

• Level 3 of the Deakin Centre

• 24/7 Operation planned from 24 Oct to end Nov

• Designed to seat 150 staff covering Leadership from CUH Epic Corporation Experts CUH Builder (Ticket Resolver) Teams HP A Priority 1 Call-In Service Desk.

ASAP EDBeacon Cancer Beaker Pathology Bridges Interfacing Clin Doc/Stork/ICU Clinical doucmentation including ICU and Obstetrics Cupid Cardiology HIM Coding, Chart and Film TrackingInpatient Orders Orders Kaleidoscope OphthalmologyOpTime/Anesthesia Theatres Outpatient Clinicals OutpatientsPAS Patient AdministrationPhoenix Transplant Radiant Radiology Willow Pharmacy

Ticket Resolver Teams – Will involved HP, Security, Epic

application modules


Bronze CAM layout


End User Support Flow

End User needshelp with Epic

Super Userprovides support

If Super Userisn’t available or

can’t resolve

Floorwalkerprovides support

If Floorwalkerisn’t available or

can’t resolve

Online incident ticket is created. If necessary, a Priority 1 phone call is

raised with Bronze CAM service desk


Roles and Responsibilities

15


Roles & Responsibilities, Super User Provide courteous, calm and reassuring support to end users during shift. Frontline support and frontline champion for Epic in your department. Reduce fear and anxiety– Epic is a tool, it does not replace thinking and

judgment• Patient safety and good clinical practice must prevail

Answer questions and provide workflow assistance. Consult Floor Walker if unable to resolve end user concerns Huddle with Floor Walker for updates as they make rounds after the Shift

Transition meetings 06:45 and 18:45. Shift meeting minutes and new tips and tricks online should be posted by 09:00 and 21:00.

Consult the eHospital website for latest tip and tricks, project updates and other information. Communicate, Review and Post daily Go-live Updates in department

Identify trends and communicate with your Floor Walker Document Enhancement suggestions and review with Manager. Wear eHospital armbands for easy identification.


Art of Being a Super UserFull Copy Available At: http://my-ehospital.org/support/information-super-users

There are several types of people that you will want to look out for during the go live period:

Those who are asking others for help Those who appear hesitant or lost Those who are expressing frustration or anger Those with a negative attitude towards the implementation of the eHospital EPR Those who appear just fine

Expect to See:oResenters oHecklers oGripers oExperts oQuiet types

Troubleshoot issues and enter online and Priority 1 call in tickets with Service Desk Provide one-on-one support to your hospital colleagues. with an understanding that this is not easy for everyone. Have empathy and support for your peers and convey the long-term benefits of the system. Act as an ambassador for eHospital and the introduction of the EPR.Communicate with the Floor Walker and ManagersStay Busy, Move Quickly from One End User to Another.


If All Else Fails......


Who: Credentialed Trainers, Instructional Design staff , specialist staff from Epic Corporation. Floor Walkers will attend morning and evening Shift Transition meetings (06:45/18:45) At the end of each transition meeting, Floor Walkers will meet with Zone Lead at a designated

location to receive assignments and pagers. Introduce yourself to Ward and Clinic leadership, Super Users and end users on assigned units and

make sure they know how to reach you Post your name and confirm your pager number in each location you are responsible for covering;

post when you are on break or away from designated area Continually walk through assigned coverage areas and seek out end users and Super Users and

offer assistance, answer questions and troubleshoot issues Provide courteous, calm and reassuring support to end users and super users If an end user approaches you, ask if they have approached their super user first….ask an available

super user to join you in helping the end user to ensure the super user is part of the solution to enhance their troubleshooting / training skills

If you are unable to resolve a question or issue, follow the documented Support Workflow Participate in Issue Review Sessions with Application Teams (2pm / 2am) – Inpatient Only

(Outpatient Floor Support will participate in 10am OP Leadership Huddle) Enter Enhancement suggestions via online Web Ticket with Priority 5 Identify and document trends and communicate at daily Transition & Issue Review meetings Communicate daily Go-live updates with end users and Super users Wear a myEpic t-shirts and badges for easy identification.

Roles & Responsibilities, Floor Walker

19


Zone Support Example

Zone 4 Zone 3 Zone 2 Zone 1

End User

Super User

Floor Walker

I’m here to help too.. Just Dial my

Bleeper

Don’t worry. I am Here for end users

on the Ward

Zone Leaders Support Floor Walkers and Arrange Support


Floor Walker Zones

Zone 1 - ATC, CDC, ACCI/GSK and S BlockZone 2 - Rosie and Breast UnitZone 3 - Theatres, K Wards, Dialysis and PharmacyZone 4 - Wards - C&D, EAUZone 5 - Wards - F&G, J, N, RZone 6 - ED, Labs, A WardsZone 7 - Oncology & Haematology, RadiologyZone 8 - Main Outpatients and Medical Records

21 2

3

45

67

8

Hospital Main Entrance


Support Call Priority

URGENCY:

When does the incident need to be resolved?

High (“Immediately”)

Medium (“At the next regular,

available opportunity”)

Low (“When you have time/No

rush”)

High (Patient care issue;

work cannot be done; enterprise service

unavailable)

P1 P2 P3

Medium (Workaround

available) P2 P3 P4

IMP

AC

T:

Wh

at is

th

e s

co

pe

of

the

eff

ect

on

th

e b

us

ines

s?

Low (Service affected is not business-critical; only

affects 1 person; enhancement request,

etc.)

P3 P4 P4


Severity Description

Priority 1 Incident (Emergency) An incident exists that results in a total loss of service or functionality affecting the entire organization:

Non- exhaustive examples: Critical system/service down i.e. Hyperspace

A service affecting treatment is down Incident directly affects patient safety

EpicCare Inpatient: patient facing user reports that a report is displaying incorrect data. i.e. Facesheet. EpicCare Outpatient: orders are showing incorrect default dosages/instructions. Weight-based dosages incorrect. ADT/Prelude: Users are not able to admit patients.

Priority 2 Incident (High) An incident exists that results in a partial loss of service or functionality across the estate or within a significant user population

Non-exhaustive examples:

Partial loss of service or functionality across the organization. Large number of users affected. EpicCare Inpatient: patient facing users report long response times for data intensive reports. EpicCare Outpatient: Order Transmittal not working as expected. Cadence: Appointments are not displaying in the DAR.

Priority 3 Incident (Normal) An incident exists that result in a partial loss of service or functionality with no immediate business impact.

Non-exhaustive examples: Partial loss of service or functionality

Individual user/Small number of users affected EpicCare Inpatient: patient facing user requests additional information for reports. EpicCare Outpatient: SmartLink no longer working. Cadence: Copay stops appearing in the check-in/check-out flow.

Priority 4 Incident (Low) An incident exists that result in a partial loss of service or functionality with no immediate business impact and for which an alternative is available.

Non-exhaustive examples: Minor software bugs

Individual user has problems accessing a non-critical function EpicCare Inpatient: user requests changes to the organization of reports. EpicCare Outpatient: User requests additional items to be added to the History navigator section.

Priority 5 Incident Requests for information / Optimization / EnhancementRequests to be resolved with next Epic SU or upgrade.Requests requiring review by organization for viability.New report requests


Incident Reporting Options

Priority 1 IncidentPhone Call

To the Service Deskx2757

Priority 2, 3, 4, 5 Incidents

Create Incident Ticketfrom the internet.

Link is available on the project homepage

Answered by Epic Support TeamsOption 9 = For all Urgent Priority 1

eHospital IssuesOption 1 = Password/ Access issuesOption 3 = Printing issues

Answered by HP Support TeamsOption 6 = WP360 issue (Hidden)Option 4 = Any other IT issue

For other lower priority Epic issues, please log the incident online via the

eHospital project page.

Only Super Users or Floorwalkersare authorised to create incident tickets online.

https://cambridgeuniversityhospitalsnhsfoundationtrust.samanage.com/login


How to Enter a Ticket Go to the eHospital Project Home Page Click on the link: Enter an eHospital Incident Ticket Enter your User Name and Password Complete the fields accurately and with explicit detail of the issue

effecting the end user. Using your best judgment – Select a priority for the ticket and the

correct resolver group.


Drop Down Menu

I DON’T KNOW

PRINTING ISSUE

PASSWORD ISSUE

SECURITY/ ACCESS ISSUE

TRAINING ISSUE

CUTOVER ISSUE

Go-Live RESOURCES ISSUE

OTHER -Please Specify

ASAP (A&E)

Beacon (Cancer)

Beaker (Pathology)

Clin Doc

Cupid (Cardiology)

HIM

Kaleidoscope (Ophthalmology)

OP Clinical (OutPatient)

Optesia (Theatres)

Orders

PAS

Phoenix (Transplant)

Radiant (Radiology)

Reporting

Stork (Maternity)

Willow (Pharmacy)

Application / Service Effected


Where do I find the MRN#?

Patient Safety and the Electronic Patient Record.


Patient Safety & the Electronic Patient Record

1. Enter information into the software accurately and completely.

2. Read information displayed carefully.

3. Confirm the accuracy of critically important medical information (e.g. allergies, medications, relevant histories, problems, lab pathology results, radiology results) presented by the software, just as one would with paper records


Patient Safety & the Electronic Patient Record

4. Use the software only in the way designed – do not try and use fields / screens in a way that they not intended to be used

5. Please remember, the care of the patient is paramount – if the computer “won’t let you” then ignore it and carry on caring for the patient.


Reporting Potential Patient SafetyIncidents at Go-Live

1.Tell your Super User or eHospital Floor walker •They will triage the incident to establish if the issue involves eHospital.•If yes – they will make a PRIORITY 1 call to the eHospital command centre to be escalated.

AND

2.Follow existing Incident Measures•Inform the person in charge.•Take appropriate immediate action•Inform your senior management staff•Submit an RMIS (Risk Management Information System) incident form.


Do Not Send Training Questions to the Service Desk

(Phone Support is for Priority 1 Ticketing Only)

Priority 1 issues must be called into the Service Desk

Super Users Overview of Cutover


Terminology• Conversions

The process of historical data conversion for all patient information held in legacy systems, to be conducted in the days and weeks prior to go live

A mixture of automatic conversions and manual conversions. Trust resources will be required to assist with manual conversions

• Cutover The manual input of data in the immediate hours leading up to go live,

for live in-patients at the time of go live and those that will attend outpatients in the first 2 weeks after go live

Trust resources will be required to assist with entering cutover data


Inpatient Cutover Sequence

6) Rolling C

hanges/Sw

eeper Team

s- F

riday pm - S

aturday morning


What happens after Cutover?

• 12midnight – 2am Saturday 25 October– Cease entering data into Epic. Complete ‘Assurance Checks’ that we have the

data we expect to have in Epic, all interfaces are switched over etc etc and we are safe to go live

• ‘At First Logon’– Users are requested to perform a series of ‘at first logon’, and at varies stages

within the first few hours. These range from assurance checks to data entry.– Super users are asked to be familiar with these requirements and assist staff with

these checks as required. ‘Tip sheets’ will be provided on the eHospital Project Page


Example ‘Nurse At First Login’Assurance Checks – Nursing Staff

Ensure the following have been completed:

The latest height has been entered into Epic for the patient (if applicable) – if not present, add this.

A weight from has been entered into Epic for the patient, including type of weight (i.e. dry weight) – if not present add this

Patient allergies, as described on the paper Medicine Administration chart, have been added to Epic – if not present, add this

Patient current inpatient medications have been entered into Epic, including IV infusions, Insulin regimes, Immunosuppression, feeding prescriptions – if not present advise a member of the patients treatment team

UFTO has been entered into Epic – if not present advise a member of the patients treatment team

Treatment Team (Consultant, Specialty, Junior team i.e. renal team) has been assigned in Epic

Radiology and Pathology orders for Saturday 25, Sunday 26 and Monday 27 October have been entered into Epic – if not present and you are unable to enter the orders, advise a member of the patients treatment team

Within first hour of go live – Nursing Staff

Document midnight cumulative input and output for patient in Epic (create an entry for midnight and back enter this balance). Add any input or output since midnight into relevant (hourly) columns = this will create a correct running balance for your patient

Check, enter or remove lines, drains, airways for patient

Within First Shift – Nursing Staff

Commence documenting all nursing information in Epic, inclusive of:

Vital signs and other observations assessments

Medication administration

Input and Output

Care plans

Isolation

When next due – Nursing Staff

All weekly nursing assessments


Major IncidentHow will Bronze / Silver / Gold Command Work?

Our largest ever investment in improving healthcare qualityInnovation and excellence in health and care

Command and Control

GOLDStrategic Coordination

‘Hands Off’

SILVERTactical Management

‘Hands On’

BRONZEOperational Delivery

‘Hands In’

RE

SO

LUT

ION

DIR

EC

TIO

N


Command and Control

GOLDStrategic Coordination

‘Hands Off’

SILVERTactical Management

‘Hands On’

BRONZEOperational Delivery

‘Hands In’

Fran Cousins Dr Keith McNeilDr Jag Ahluwalia

On Call Director On Call Manager 24/7 in the Boardroom

Deakin Bronze CAMOperational Areas


Operations Escalation

41

If an end users discovers an operational issue, they should check in with the super user to see if it potentially involves Epic.

If so, the super user needs to enter a ticket online with eHospital

The end user will then escalate the operational issue to the person in charge on their ward or clinic. Following normal procedures.


Operational Workflow Escalation

Silver Command to;• Prioritise• Instruct correct action • Obtain ETA for resolution – feedback • Communicate to the wider organisation

ES

CA

LAT

ION

Immediate resolution is required or unable to resolve through normal means.

Action: Escalate to Silver Command

Unable to resolve through normal meansAction: Escalate to line manager

End user identifies operational issueAction: Review with super user


• Complete Your Training• Attend Secondary Training (x4118)• Spend Plenty of Time in the Playground• Keep Up to Date

• (eHT, My-eHospital.org, Super User News)

• Become a Champion for your Ward• Encourage Others• Share the Long-Term Benefits of Epic

Be Super and Be Seen as Super..

What Happens Next….


pre-live super user and managers briefing you can download a copy of this presentation at:

Documents

healthcare quality days

healthcare quality information

healthcare quality agenda

date slide

implementation slide

sequence slide

support overview of

prelive super user