Pre-Live Super User and Managers Briefing You can download a copy of this Presentation at: .
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Transcript of 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
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Agenda and Introductions
Executive welcome
Introductions and check-up
Briefing
Q & A
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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
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Information for all staff
Payslip attachment Staff Q&A session(s)
eHospital Times
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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)
You can download a copy of this Presentation at: http://my-ehospital.org/support/information-super-users
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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.
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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
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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
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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
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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
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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
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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.
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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.
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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
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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
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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
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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
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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
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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
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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.
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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
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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
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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.
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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.
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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
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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
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Inpatient Cutover Sequence
6) Rolling C
hanges/Sw
eeper Team
s- F
riday pm - S
aturday morning
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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
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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
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Major IncidentHow will Bronze / Silver / Gold Command Work?
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Command and Control
GOLDStrategic Coordination
‘Hands Off’
SILVERTactical Management
‘Hands On’
BRONZEOperational Delivery
‘Hands In’
RE
SO
LUT
ION
DIR
EC
TIO
N
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’
Fran Cousins Dr Keith McNeilDr Jag Ahluwalia
On Call Director On Call Manager 24/7 in the Boardroom
Deakin Bronze CAMOperational Areas
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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.
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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
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• 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….
You can download a copy of this Presentation at: http://my-ehospital.org/support/information-super-users