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UHN Fast Facts Canada’s leading research and academic hospital 4 Sites: Toronto Western Hospital

The Implementation of Advanced Clinical Documentation for Bariatric Services at University Health Network: Lessons From the Field Vicky Ramirez, Giuseppe Cammisa e-Health 2013: Accelerating Change May 27, 2013. UHN Fast Facts Canada’s leading research and academic hospital 4 Sites:

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UHN Fast Facts Canada’s leading research and academic hospital 4 Sites: Toronto Western Hospital

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  1. The Implementation of Advanced Clinical Documentation for Bariatric Services at University Health Network: Lessons From the FieldVicky Ramirez, Giuseppe Cammisa e-Health 2013: Accelerating ChangeMay 27, 2013

  2. UHN Fast Facts • Canada’s leading research and academic hospital • 4 Sites: • Toronto Western Hospital • Toronto General Hospital • Princess Margaret Cancer Centre • Toronto Rehab Institute • $1.8B revenue • 762 beds • 1,400 physicians • 12,000 employees • 966,000 amb visits • $265M in research • 4,465 OR visits 2

  3. UHN Advanced Clinical Documentation Strategy

  4. In support of UHN’s ACD strategic goals… UHN will be a global leader in reporting on patient outcomes Research hospital of the future road map will be developed and implemented 4

  5. ACD IP EPR ACD OP EPR ACD Bariatric Assessment Notes 5

  6. Program Overview

  7. Nurse Practitioners Social Workers Registered Dietitians Surgeons Psychologists Psychiatrists Psychometrists Support Staff Data Analysts Internists Endocrinologists 7

  8. The Team

  9. Project Team Privacy The Team Clinicians Mobility Partner • Human Factors Security Technical Teams 9

  10. Life before the iPad

  11. 12

  12. And the aftermath… 13

  13. Challenges • Patients repeatedly answering the same questions • Clinicians’ persistent difficulties locating charts or finding information in a chart • Other challenges: • Interdisciplinary rounds • Diminished productivity • Outcomes monitoring • Leveraging data for research 14

  14. The Solution

  15. 16

  16. Methodology

  17. Where we started Mapping the data flow Focus on outcome indicators Device & usability assessment 18

  18. Design Philosophy

  19. Agile and responsive development iOS design driving clear, standard documentation Free-text to synoptic Function (Human Factors) vs. flash Multidisciplinary lens – enable the breakdown of care silos 20

  20. Common Framework Elements 21

  21. Benefits

  22. Workflow: Before & After Early results: Summary report allows time at end of day to be used for other purposes The problem: Back to back assessments resulted in charting being stockpiled until the end of day ~30 minutes saved per clinician per day! 23

  23. Measuring Success: An Outcomes Approach • Baseline surveys and observations • Post-implementation surveys and observations Improving the ability to monitor and report on: Pre-Surgery Post-Surgery Health Status Time to Care Patient Errors Health Sustainability Patient & Clinician Satisfaction Data Collection & Access Cost Measures 24

  24. Start small → gather learnings → grow access The Bariatric Journey

  25. Critical Success Factors Leading edge technology; the ‘fun’ factor End to end change management Rapid prototyping/Agile documentation Improving data collection & access Sustainability model (leveraging existing infrastructure, MDM strategy) 26

  26. Bariatric Assessment Notes Demo 27

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