Pediatric Anesthesiology 2012

Implementing Epic’s Anesthesia System: From soup to nuts

This series tells the story of the anesthesiologists at Children’s Hospital Colorado and their implementation of Epic’s anesthesia information management system.

Dr. Patrick GuffeyBy Patrick Guffey, MD
Children’s Hospital Colorado

Chapter 1 - The Decision and the Team

March 2010, a conference room at the hospital. All the key stakeholders were assembled. A thorough analysis of all options was completed and Epic’s system was chosen as the best solution for our institution. Now, it was time to plot the way forward. What would the timeline be? The members of the team? The budget? How would this affect our workflows and processes? More questions than answers! The next few months would be focused on changing that. Or so we thought…

As the physician leading the effort for our department, I received much advice from many, and in retrospect, one stands out above the rest. “The success of your implementation will hinge on the engagement of your clinicians.” We have one of the leading Information Technology departments in the country, if not the world.  We were the first freestanding pediatric hospital in the US to fully implement an electronic health record, so I knew we would have all the support we needed and then some. The key question quickly became how to make sure our clinicians were engaged and satisfied with the end result.

That became the question that kept me up at night. When you’re moving from a paper record, a tool honed over a century of use, to one hinging on a PC running Windows, some amount of fear is to be expected. There have been many who came before us – but one of the quickest paths to failure would be to copy another implementation and if it did not accommodate our practice, tell our users to adapt. This was not a good option.

There are thousands of configuration points in the anesthesia system. Every screen can be customized, every button renamed, and every piece of data recorded must be considered. And for every choice a poll of the department might reveal more opinions than members! Yes, this was going to take a team to be successful.

A typical implementation will include a project manager – a professional organizer with an uncanny ability to hold the implementation to a schedule and in the black. We all quickly learned about Gantt charts and budget burn rates.  Next there will be at least one, if not more, analysts. These are the individuals who are trained to analyze the needs of the users and actually build the system. They work to determine how best to configure all of the choices and accommodate the workflows and processes. Finally, there will be a trainer who will work up the plan and execute the training of everyone to become proficient with the system. Finally, there will be support staff assigned from the software company to guide you though the process, help you avoid the pitfalls of those before you, and help you troubleshoot any problems you find.

Over the course of the following year – I became very close with all of them. They were my friends, my support system, and their tireless effort is why we were ultimately successful. However, the key here is that those roles were already chosen. What we needed to determine is who would represent the Department.

One of the first decisions we made was to form an advisory committee of anesthesiologists that would make the critical decisions throughout the process.  The second decision is that this same group would become the superusers. Who better to help our department learn the system than the very people who helped decide how the software would function?

We needed a diverse group of interested, motivated, experienced clinicians who were not afraid to challenge us and provide a broad representation. We chose a total of 4, or approximately 10% of the attending physicians to serve in this role.

The first choice was straightforward. My official role in the department is the Director of Process Improvement and the Associate Clinical Director. Naturally, I went straight to my mentor and asked him to join – the Clinical Director of the Department. This turned out to be a critical decision. One of the things I quickly discovered is how much of an effect the implementation can have on other departments and the hospital as a whole. Having a member of the team who understood these dependencies and relationships was absolutely critical.

Next, the most interested member of the Department, and also the Director of the Pain Service, was an obvious choice. He has a combination of experience and knowledge in informatics unparalleled at our institution. The fact he also directs our liver transplantation service was a definite plus.

Ultimately, a primary goal of installing an AIMS (anesthesia information management system) at an academic institution is to facilitate research – so who better to ask to join than our Director of Research. As a side benefit, he also happened to be an expert in pharmacology and chairs our Pharmacy and Therapeutics Committee. Who better to have when you’re deciding which medications to include and how to present them to the users?

That means we had experts in informatics, pharmacy, hospital operations, the pain service, and who performed some of the most complex cases at a pediatric institution. Who were we missing?

How to document a pump run…deep hypothermic circulatory arrest…yes, we absolutely needed a cardiac anesthesiologist.  We just happened to have one who was not only a philosopher at heart, but also one who had prior experience performing cardiac anesthetics at an institution with an AIMS system. A diverse group of motivated, highly skilled partners who represented virtually every area of our department – that’s exactly the formula for how to drive clinician engagement.

Now that we have our team, in the next article we’ll start from the beginning. The reinvention of the preoperative assessment.

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