Project Methodology Date: September 25, 2018 (b) (6) (b) (6) (b) (6) www.ehrm.va.gov www.ehrm.va.gov National Workshops Description During the national workshops Cerner educates on the individual workflows and topics (e.g., roles, look and feel) of the new system with the functional councils. Over the multiple, three to four-day workshops the functional councils gain a deeper understanding of the commercial workflows and topics, while identifying gaps. After, data is collected to further configure and validate the newly established national standard design to ensure it reflects the Department of Veterans Affairs (VA) specific needs. It is important to note there are thirteen total national workshops: eight numerical and five additional to supplement more complex, cross-departmental workflows. Workshop topics are focused on how the functional councils are clinically broken out and build on one another. Objectives Participants at the national workshops will: • Understand the workflows and topics (e.g., roles, look and feel) of the commercial model. • Validate the commercial model to identify workflows and topics needing initial design and development. • Define the national standard workflows and make decisions on agency level topics. • Collect data to configure EHRM. Logistics Location Cerner Campuses in Kansas City, Missouri. The national workshops are in-person events. Requests to dial in remotely need OEHRM approval. Participants Cerner project executives and project management. VA project executives and project management. National functional councils. Cerner solution teams. After the Event When the national workshops are complete, participants will: • Ensure data is collected to configure EHRM. • Confirm workflows reflect the EHRM configuration. • Validate the configuration of EHRM reflects the VA specific decisions and workflows. Next Steps The next steps in the Electronic Health Record Modernization (EHRM) project are: • Be in close contact with Cerner and VA counterparts to complete the design and data collection needed for configuration. • Prepare for the subsequent national and local workshops, and the national and local workshop reviews. VA Electronic Health Record Modernization 3 Council Roles and Responsibilities Role Responsibilities Example: Pharmacy National Councils (18) • Provide agency level decisions on content, rules, privileges, preferences and positions. • Make decisions on standard workflows • Guide policy and procedures • Drug file, order sentences and synonyms • Home medication review VISN Councils (18) • • • • • • Review pharmacy positions, roles and needs • Define pharmacy user roles • Determine if standard pharmacy workflows meets local/VISN needs Local Subject Matter Experts (Based on Need) Advocate VISN needs to national councils Determine if local/VISN priorities and needs are met Create and socialize standard workflows Support metrics and analytics Resolve interfacility issues • Complete data collection • Educate staff on adopting workflow standards • Provide local configuration VA Electronic Health Record Modernization • Collect pharmacy data, virtual view orders and identify any missing • Complete local configuration of IV label prints • Provide education for adoption of new pharmacy workflows 5 National and Local Workshop Sprints 5 weeks 5 weeks 5 weeks 5 weeks 6 weeks VA Electronic Health Record Modernization 5 weeks 5 weeks 6 weeks 6 National vs. Local Agenda Examples National Workshop • Drug File Design (28 hours) • Frequencies (3 hours) • Therapeutic Substitutions (8 hours) • Pharmacy and CPOE IV Sets (10 hours) Local Workshop • Validate Drug File Design Review (1 hour) • Validate Frequencies (30 minutes) • Validate Therapeutic Substitution (2 hours) • Validate Pharmacy and CPOE IV Sets (2 hours) • Unit Based Cabinets and Advanced Dispense Routing (3 hours) • Fill Batches (2 hours) VA Electronic Health Record Modernization 7 OEHRM Process Approval Date: Sept 26th, 2018 (b) (6) (b) (6) www.ehrm.va.gov OEHRM Process Approval Content • VA Standardizations • Workflow: Background • Workflow Documentation at Cerner • Decisions (Majority at Workshop Level) • High-Level Approval Process • Workflow Designer Details • EHRM Governance Process • Coordinating Integrated Areas • Council Support Tools and Processes VA Electronic Health Record Modernization 9 VA Standardization The magnitude of change and collaboration required to make the OEHRM Program successful is immense. The integration among the national and VISN team is something that the Department of Veterans Affairs has never before experienced. 1 Why do we standardize processes? Standardizing VA processes can minimize design variance that could impact the project schedule, budget and quality. But it will also improve our Veteran’s health. • Better outcomes for Veterans: 50% of all surgical site infections can be prevented if antibiotics are administered in preoperative care. • Cost reduction: in the US, surgical site infections cost the health care system~$3 billion. 2 How will we facilitate standardization? • Common definition for what it means to approve workflow design. • Define guidelines for the level of detail and workflows necessary for project completion. • Define Key roles and teams involved in the process: council chair, VA solution expert, council members, industry best practice, council project management. • Develop procedures to support tracking workflow approvals. • Provide transparency in the process and highlight the responsibility of each person or team involved in the process. VA Electronic Health Record Modernization 10 Workflow: Background • Workflows are process maps that describe key steps in a business or clinical process. They document: ▪ ▪ ▪ ▪ Key tasks and role performing them Beginning and end Decisions Key documents • Initial workflows are based off Cerner’s model content and include commercial best practices. These will be the basis for VA process redesign. VA Electronic Health Record Modernization 11 Build and Design Breakdown Workflows Business and Clinical Processes Reengineering System Configuration Settings • • • Rules Security Alerts Work Steps Content • • • Forms & order sets Auto text & formulary Compendium • Patient presents at pharmacy • Patient enters triage • Select procedure order VA Electronic Health Record Modernization 12 Workflow Documentation at Cerner VA Electronic Health Record Modernization 13 Workflow Designer • • • • Councils Member Assigned Approval of workflows and configuration will be the responsibility of the accountable leader on the council. The accountable leader will be a VA representative either in the role of a council chair or VA solution expert. Workflow updates, creation and approval will be captured in Cerner’s Workflow Designer tool. • Approval date/time • Names of the solution workflow approvers • Requested modifications or other supporting details Targeted approval date(s) for workshop products will vary based on type; the goal will be to approve in advance of the next workshop. VA Electronic Health Record Modernization 14 EHRM Governance Process Joint Governance Boards Senior Stakeholder Group Steering Committee (SC) Governance Integration Board (GIB) VA Governance Boards Functional Governance Board (FGB) EHR Councils ------(EHRCs) Technical Governance Board (TGB) Legacy-EHRM Pivot Working Group (LEPWG)* Examples of Escalation • Unable to make decisions • Impacts enterprise (affects DoD and VA) • Reversal of existing decision (change control) • Risk mitigation • Requires additional interdisciplinary review (examples on next slide) • Policy directives • Scope of practice; users will be able to do tasks they were previously unable to perform • Decision requires ethics advisory committee input/review EHRC Councils VA Electronic Health Record Modernization 15 Interdisciplinary Design Requirements Example 1: Applying Ethics to Avoid Stigma Patient record flags To respect our Veteran’s privacy, avoid stigmatizing labels and honor VA’s commitment to patientcentered care. VA policy (2010-053) requires: • Use of a patient record flag only for a compelling safety reason that outweighs these ethical concerns. Seeking Cerner workflow design to prevent inappropriate assignment of patient record flags Example 2: Policy Input Required Nurse witness required for medication administration During barcode medication administration; IV insulin is a high alert substance that can require credentials from a second clinician. Current State: Often, in the VA, VistA instances would be configured to support a specific role (e.g., nurse medication administration activities require dual signoff.) Design Session Needs: Cerner configuration may allow for users to perform functions outside of their scope of practice at a facility. Policy teams will need to be engaged during the design process to evaluate, document, and communicate changes. VA Electronic Health Record Modernization 16 Workgroup Activity Continues Outside Workshops Week 1 • Onboarding • Review Education Series Week 2 Week 3 • Participate in workgroup and council meetings *** Note: many consultants will participate in several workshops Week 4: Workshop Week 5 Week 6 Week 7 • Participate in workgroup and council meetings • Document findings and recommendations • Present decisions to Council Week 8 •Off-boarding • Attend sessions • Learn about development stories • Assist with decisions making VA Electronic Health Record Modernization 17 Cerner Project Portal Date: Sept 26th, 2018 (b) (6) (b) (6) www.ehrm.va.gov Cerner Project Portal • Sharepoint architecture; primary project management tool for Cerner projects. • Central storage and collaboration site for intra-project activities to include: ▪ ▪ ▪ ▪ ▪ ▪ Document collaboration Data Collection Design decision capture Risk Register (Cerner risk capture) Workflow design tool Project, Configuration and Testing issues • Ability to limit access to only Cerner and VA POCs VA Electronic Health Record Modernization 19 Cerner Project Portal Home Page • Links to tools on left pane (within red outline) • High-level events and milestones (“Key Dates”) in the Center view (blue arrow) • Not all VA representatives are required for each major Key Date • Cerner view is different from VA view (b) (6) VA Electronic Health Record Modernization 20 Cerner Project Portal Design Decision Tracker • Captures COTS design recommendation vs VA design decision • Rolled up view by solution of % complete & Complete/Total (below) (b) (6) VA Electronic Health Record Modernization 21 Cerner Project Portal Issues • Captures deployment configuration and testing issues • Captures project issues • Sharepoint issue form (below) (b) (6) VA Electronic Health Record Modernization 22 Cerner Project Portal (b) (6) Documents • Storage for deployment required documents (examples): • Data collection (i.e., charge codes) • Specific design artifacts • Meeting agendas • Ability for VA and Cerner to collaborate within documents • Check-in /check-out functionality (b) (6) VA Electronic Health Record Modernization 23 Cerner Project Portal Workflow Designer • Captures workflow in a consumable format to be used as a project artifact reference • Microsoft Visio-like experience • Ability for VA and Cerner to collaborate within tool (b) (6) VA Electronic Health Record Modernization 24 Cerner Project Portal Go-Live Readiness • Captures relative COTS content and status per work group/solution for IOC go-live readiness activities • Updated by Cerner POCs prior to IOC go-live prep activities (b) (6) VA Electronic Health Record Modernization 25 Questions? 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