What is Advanced Clinical Information System (ACIS)?

• IT system that combines patient information from the bedside, laboratory, pharmacy, nurse’s station and emergency department.
• A clinical tool that will enhance patient safety.
• Includes hardware, software, applications and infrastructure for storing and networking advanced clinical and patient information.

Enable Clinicians to use a computerized patient record that supports:

• Electronic medication administration.
• Computer-based Physician Order Entry (CPOE).
• Clinical tools that aid in decision making.

Why is CHI implementing ACIS

• Increase patient safety.
• Assist in adherence to industry regulations.
• Meet national quality requirements.

Who will use ACIS

• Anyone providing care to a patient who has a need for patient information.
• The main areas: clinical (bedside and emergency department), pharmacy, laboratory and scheduling.

When will we begin using Phase I of ACIS

• Design begins as soon as possible.

How will ACIS affect clinicians

• Allow physicians and clinicians to make more informed decisions.
• Reduce redundancy in charting.

What benefits will ACIS bring to our patients

• Reduces expenses associated with longer patient stays.
• Reduces redundant charting and patient registration.
• Ensures efficient team care and communication.
• Real-time access to cross-disciplinary patient information.

What benefits will ACIS bring to our MBO

• Enables clinicians to link directly with the pharmacy.
• Reduces adverse drug events.
• Coordinates the emergency department information flow.
• Manages pharmacy operations, including drug ordering.

What benefits will ACIS bring to our MBO

• Enables clinicians to save time inputting chart data, coordinating physician orders and other routine tasks, as well as ensure documentation accuracy.
• Enables clinicians to track trends and patient outcomes.

How and when will clinicians learn to use ACIS

• Customized training begins 6-8 weeks prior to the Phase I Go Live.
• ACIS is Windows-based and designed for internal work processes.

Standardization

Insist on user friendly standardization – “the terms our lab and radiology departments use for tests are vastly different from what clinicians use.  It is a big problem.  We have had to go back and fight.”

Document standardization needs to be multidisciplinary:

• Nursing
• Physical Therapy
• Respiratory Therapy
• Social Services
• Dietary

Training

• Have a full time person to facilitate physician training
• Train nurses and ancillary staff separately
• Include your health unit coordinators “We forgot this and had to back up.”
• Make sure managers support staff attendance.
• The departments or nursing units would be busy and the managers would decide to cancel attendance.  We published weekly statistics on cancellation to target our problem managers.”
• On site support (Superusers) – Give superusers low or no patient loads. “Superusers are of no value if they are given a full load and are too busy to help anyone.”
• Have on-line registration for classes

• Modification Moratorium –
  •  Use it six months before modifying. “We used to be responsive to modifications only to find we would be cycle back to the way we had it in the beginning.  After not learning our lesson and doing this way to many times, we got smarter.”
• Communication – regions meet quarterly to discuss and review usage
• Policies and Procedures
  • Email all nurses have email accounts
  • Policy and procedures are posted on an Internet site Kickoff
• Wireless Devices
  • Laptops on carts RF devices

• Establish clinical identify
  • Clinical Nursing Information Specialists are assigned to each hospital.  They work directly with the end users, interface with IT, take requests for enhancements, formulate requirements, and provide support.  They report to nursing, not IT
• Get help with EMPI cleanup
  • Hire an organization to help you
•  Head toward paperless
  • Turn off paper – turn off printing
•  Have downtime backup
  • Print patient census list, activity worksheet, Kardex, flowsheets, graphics for I & O and keep in a binder for computer downtime
•  Include clerk order entry in Phase I
•  Include your chart of accounts
• Determine:
  • How you handle bed transfers — Bed transfer was a problem.  “We lost data.”
  • How you will handle a combination of 8 and 12 hour shifts?  “We can not have both 8 and 12 hour shifts.  In Cerner it is invalid.”

Lessons Learned

• Insist that clinicians lead – “In our pilots we found the clinicians would not lead. When this happened, IT took over.  We had to correct this by finding committed clinical components.  We have a profile of the characteristics needed for clinical leaders –they have to evangelize and believe it is the critical success factor”
• Pay physician leaders – “We pay them a ¼ time FTE rate.  If you don’t pay them they will back away when wrinkles develop”
• Nurse Informaticist required – “We learned that we need full time nurse informatictist at each hospital to work with users and IT team to do validation and testing.  They do requirements and business specifications.”
• Include your chart of accounts
• It is a big effort to get people to buy into the need for standardization.  “We wanted to standardize lab glucoses to use a standard set of rules.  It took six to nine months to do this.  It helped having an outside group come in to assist with standards.”
• Carefully guard change control
• Our pharmacy person deals directly with Cerner’s pharmacy person.  This is important to do before there is a crisis situation. We keep a dashboard of enhancements that we have requested and track their progress.”