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Erfaringer fra Kaiser Permanente

Erfaringer fra Kaiser Permanente. Nina Petersen, Deloitte Business Consulting nipetersen@deloitte.dk. Indhold. Introduktion til Kaiser Permanente og HealthConnect Designprocessen involverede de implementerings- ansvarlige Kaisers implementeringsprogrammer (Technology Adoption Programs)

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Erfaringer fra Kaiser Permanente

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  1. Erfaringer fra Kaiser Permanente Nina Petersen, Deloitte Business Consulting nipetersen@deloitte.dk Internal Use Only

  2. Indhold • Introduktion til Kaiser Permanente og HealthConnect • Designprocessen involverede de implementerings- ansvarlige • Kaisers implementeringsprogrammer (Technology Adoption Programs) • Regional implementering Internal Use Only

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  8. Den valgte IT-løsning June 3, 2004 Deloitte Internal Use Only

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  11. Designprocessen involverede de implementeringsansvarlige Internal Use Only

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  13. The Collaborative Build – Strategy The Challenge: To deploy the Epic suite of products in a multi-facility, multi-state system within 3 years System capability needed to: • Maintain and update content once for all deployments (ICD9, CPT4,Demographic codes, etc.) • Share data and move information across the multiple instances for the CA regions • Provide a consistent data model to populate a national data repository to support all reporting needs with the ability to sustain common data across all instances • Reduce variation and provide evidenced-based clinical decision support and documentation • Disseminate successful work practices across the country by streamlining internal processes and reducing work variation • Epic Enhancements that can be designed and developed once for all deployments (GL string creation and extract) Internal Use Only

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  15. The Collaborative Build – Definition • The Collaborative Build defines the degree of “sameness” across regions and deployments within KP HealthConnect The Collaborative Build (CB) is fundamentally the collection of decisions and content that is standard across the enterprise within KP HealthConnect • When implemented in each region, KP HealthConnect is the sum of the Collaborative Build and the regional build Internal Use Only

  16. The Collaborative Build – Development Process • To implement KP HealthConnect, two levels of build must be completed: • The Collaborative Build • The regional build • To develop these two portions of the build, a sequential design process was undertaken • First, inter-regional design, build and validate sessions were convened to define the content that would constitute the collaborative portion of the system • Inter-regional participation and decision making • Then, regional design sessions were held to validate the collaborative content and to define and build the balance of the Epic applications • Regional participation and decision making Internal Use Only

  17. Deltagere i Collaborative Build Processen • Deltagere fra det centrale udviklingsprojekt • Procesejere fra alle regioner • Testpersoner fra de relevante moduler og arbejdsprocesser • Uddannelsesfolk • Forandringsledelsesfolk Internal Use Only

  18. Udviklingen i collaborative build-processen og de efterfølgende valideringsprocesser • I begyndelsen blev DBV (Design, Build Validate) processen grebet an som en skrivebordsproces, der involverede de rette faggrupper • Pga. manglende forståelse for konsekvensen af de beslutninger, man traf, ændredes valideringskonceptet således, at man opstillede en muck up af en fysisk klinisk arbejdsplads og gennemgik forslagene til design i forbindelse med en gennemgang af den faktiske arbejdsgang inkluderende patienter og de relevante fagpersoner. • De enkelte teams validerede ved at observere de faktiske forløb og komme med forslag til ændringer Internal Use Only

  19. Technology Adoption ProgramForandringsledelse, træning og kommunikation Internal Use Only

  20. Shared Tools Technology Adoption Programs - Overview • Four technology adoption programs have been developed to respond to the specific needs of physicians and clinicians in both the ambulatory and inpatient environments Technology Adoption Programs Physician (PTAP) Physician (PTAP) Ambulatory Inpatient Current focus of development Clinician Clinician Development is currently underway to deploy a consolidated IP Technology Adoption Program on the KP HealthConnect Intranet that integrates both the physician and clinician components. This will facilitate the role of staff readiness resources who often develop and implement comprehensive and integrated plans for both physician and clinician end users Internal Use Only

  21. Technology Adoption Programs • Technology Adoption is the most critical success factor for the KP HealthConnect implementation. To achieve Technology Adoption at the national / regional / local level a seamless integrated approach is required for medical center / facility staff. Internal Use Only

  22. TAP Objective • To respond to the needs and challenges that staff readiness resources are facing as they deploy KP HealthConnect, an integrated Technology Adoption Program has been developed • The objective of the IP TAP is to support the regions and facilities as they: • Create a program to adequately prepare physicians and clinical staff to use KP HealthConnect at go-live in the daily process of providing quality interdisciplinary team-based patient care • Promote collaborative interdisciplinary leadership between regional and local change leaders to anticipate, acknowledge, and manage cultural and social changes that occur with KP HealthConnect • Over time increase proficiency to fully utilize the system’s capabilities Internal Use Only

  23. IP TAP Dimensions Inpatient Technology Adoption Program 6 Dimensions • The IP TAP toolkit is based upon literature, external information, and adoption practices and strategies from across all Kaiser Permanente regions • The program is structured into a self-service format. Tools and materials have been identified across 6 dimensions TAP Activation & Oversight Communications Workflow & Clinical Content User Readiness Deployment Preparation & Go-Live Support Post-Implementation & Optimization Internal Use Only

  24. IP TAP Overview – Deployment Roadmap • The IP TAP is intended to provide support throughout each deployment stage prior to 180 days before go-live to post-implementation Go-Live -180 Days -120 Days -90 Days -60 Days Post -30 Days TAP Activation & Oversight Communications Workflow & Clinical Content User Readiness Deployment Preparation & Go-Live Support Post-Implementation & Optimization Note: The timeframe reflects tentative due dates and should be modified to regional deployment schedules. The roadmap reflects the dimensions’ period of highest development and planning activity. Internal Use Only

  25. IP TAP Overview – Dimension Overview • TAP Activation & Oversight • TAP leadership; TAP implementation; Change readiness; Sponsorship; Recognition program; Awareness activities; Best practices • Communications • Communications Workplan; Communication network; Feedback mechanisms; Member/patient communications • Workflow & Clinical Content • Workflow design approach; Communicate workflow changes; Clinical content design approach; Communicate clinical content changes; Inpatient system functionality; Interdisciplinary team-based care • User Readiness • Training org./team structure; Review training content and approach; Training logistics; Communicate and monitor training activities; Validate system design; User acceptance testing; Dress rehearsals; End user readiness; Cultural readiness • Deployment Preparation & Go-Live Support • Deployment org./team structure; Deployment strategies; Workforce management plans; System downtime procedures; Communicate deployment information; Support materials and resources; End user on-site support; Preserve the patient relationship • Post-Implementation and Optimization • End user proficiency; User impact assessment; Implementation, utilization, and operational metrics; Post-implementation support; Knowledge sharing Internal Use Only

  26. IP TAP Overview – Key Components • The IP TAP toolkit is composed of several key tools that are coordinated and integrated: IP TAP Workplan: A tactical step-by-step approach to physician and clinical staff technology adoption activities across 6 dimensions throughout the implementation life-cycle Facility Change Leader (FCL) Checklist: Contains key questions to help gauge and monitor regional end user technology adoption Communications Workplan: Details the timing, medium, responsible person, and target audience for communications Internal Use Only

  27. Implementeringsorganisationen – Det centrale projekt • Implementeringschefen og implementeringsprogramlederne fra hver region udgør implementeringsprogrammets ledelse • Implementeringsprogrammet refererer til programmets overordnede programdirektør og styregruppen, som består af repræsentanter fra alle regioner • Den regionale programleder har en tosidig rolle – med at repræsentere det centrale program regionalt og være regionens talerør ind i det centrale projekt • Der er etableret et centralt projekt bestående af følgende delprojekter: collaborative build, the technology adoption program, benefit-realisering, teknologisk implementering og etablering af supportmodel • Hertil kommer løbende udvikling af klassifikationer og begreber Internal Use Only

  28. Implementeringsorganisationen – De decentrale projekter • I hver region etableres et decentralt projekt, som afvikler alle aktiviteter i henhold til den overordnede køreplan • 70-75% af det centralt udviklede materiale kan bruges umiddelbart, ca. 15% kan bruges efter lokal tilretning og ca. 10% er blevet ændret/nyudviklet regionalt Internal Use Only

  29. The Perfect Ambulatory Implementation?How we “done it” at Kaiser Permanente Northern California

  30. Conduct workflow reviews with departments, validate, identify training and resource strategy, prepare clinics for go-live, build final workflows Outpatient Lead engages the facility and begins high-level pre-implementation planning including communications, sequencing, and access plans 4 Months 0 – 4 Months Before Go-Live 6 -9 months (Depending on size of medical center) Provide go-live support for providers and support staff, triage application problems, track implementation metrics 4 + weeks after go-live Provide application support, identify workflow inefficiencies, opportunities for improvement and conduct lunch and learn sessions Medical Center Implementation Approach Ambulatory Implementation Stage Progression Stage 4 Post Go-Live Support Stage 1 Project Organization Stage 2 Implementation Planning Stage 3 Go-Live Timing Description of Stages Organization Planning Planning Go-Live Support

  31. Site Implementation Team Structure and Roles

  32. Departmental Go-Live Strategy Documentation Go-Live Orders Go-Live Post Go-Live Support Implementation Planning -12 -4 -3 -2 -1 0 +2 +3 +1 +4 Week Staffing Ratio 1 Application Support FTE : 5 Providers 1 : 2.5 Providers 1:5 to 1 : 7.5 - Core Workflow 1: Basic Ambulatory workflows (documenting an allergy, etc) and functionality - Core Workflow 2: Additional basic Ambulatory workflows and ordering functionality Training Sequence - Charting Tools: This course provides an overview of the application and detailed information on smart tools - Advanced Workflow: Advanced Ambulatory workflows (Telephone encounters) and documentation functionality - Ongoing lunch and learn sessions

  33. Sample Tools – “The Waterfall Diagram” The following tool is used at each facility to map out an implementation sequence for Epic departments, identify the number of support staff resources required, and the anticipated impact on lost appointments during the go-live

  34. Uddannelsesindsatsen • Kaiser Permanente afsætter efter danske normer enorme ressourcer til uddannelse og træning • I forbindelse med go live var der applikationskonsulenter i alle undersøgelsesrum/konsultationsrum • De første 14 dage blev der holdt fælles frokost møder (lunch and learn sessions) hver dag mhp. at samle op på manglende viden, frustrationer, yderligere træningsbehov etc. Internal Use Only

  35. Har du spørgsmål er du velkommen til kontakte: • Nina Petersen, Deloitte Business Consulting • Weidekampsgade 6 • 2300 København S • Telefon: 36102030 eller mobil 40593976 • Mail: nipetersen@deloitte.dk Internal Use Only

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