Implementation of Order Sets and Care Planning at HMG Sehat Al Suwaidi Hospital
Hospital achieves HIMSS Stage Six accreditation
The Dr. Sulaiman Al Habib Medical Group (HMG) is the largest private hospital group in Saudi Arabia. The organisation’s mission is to develop state of the art medical facilities and provide innovative healthcare services that deliver value to its population. HMG has its own, internally developed Electronic Heath Record (EHR) known as VIDA.
In July 2017, Elsevier's clinical decisions support (CDS) solutions were integrated at the Sehat Al Suwaidi Hospital site. Shortly afterwards, HMG achieved HIMSS EMRAM Stage Six.
Although HMG facilities have an excellent track record, client challenges included:
- A continuous need to improve the quality of care provided by care givers
- Requirement for intelligent EHR and CDS deployment across nine of their hospital sites, supported by clinical transformation and behavioral change
- Upcoming assessment by HIMSS EMRAM for Stage Six accreditation creating a time constrained environment for deployment of CDS solutions
The project was driven by a desire to:
- Standardise care in light of challenges associated with a multi-cultural, multi-lingual clinical staff base
- Reduce preventable complications, errors, and extended patient stay for most common complaints
- Establish a standard framework for ordering services, decreasing the number of unnecessary tests and treatments
- Ensure patient-centered, interdisciplinary care, facilitating preventative measures through patient-specific clinical guidance and alerting
A goal was set to achieve the above within three months of decision, standardising care through EHR integration of an external, experienced and evidence-based content source with the capacity to customise so it could reflect local policy and practice. The Sehat Al Suwaidi Hospital was to function as an initial pilot for the project.
The Dr. Sulaiman Al Habib Medical Group team with HIMSS EMRAM Stage Six award
Al Habib chose to partner with Elsevier to implement their Care Planning and Order Set solutions. Prior to implementation, Elsevier worked with HMG Subject Matter Experts to review, localise and approve order sets via the solutions content management system. The Elsevier team fine-tuned the Care Planning documentation requirements for Al Habib after observing workflows and discussing practice requirements with the HMG Suwaidi Clinical leadership team.
Successful design, confguration and implementation of the Elsevier solutions occurred over a three-month period and facilitated by support from Elsevier’s Health Informatics team, working with the client to ensure clinician involvement throughout the process.
This implementation is a best-in-class example of how delivering such a programme, even under considerable time constraints, can help a hospital achieve greater utilisation of its EHR for the benefit of clinical staff and patients.
-Nasser Al Huqbani, CEO & President of HMG
Strategy and project management:
- Requirements gathering via stakeholder working groups; Elsevier worked with HMG to establish a project plan, taking account of existing objectives and goals
- Executive and physician alignment to ensure support from key stakeholders
- Physician communication strategy established to promote awareness and buy-in
Implementation – Go live support:
- Initial implementation saw existing EHR catalogue mapped to Elsevier’s content, with 53 Elsevier Order Sets and 14 Care Plans loaded into VIDA. Due to the quick adoption, 400+ care plans and 300+ order sets were imported and made available within a matter of weeks
- A further eight hospitals and clinics will implement Order Sets and Care Planning over the next 12 months
Clinical education and training:
- Training sessions to 25+ physicians and 75 nurses provided on go-live
- Train the trainer approach taken for end-user education. Training conducted with the client's education leads, trainers, and core group of super users. The training schedule aligned with the hospital roll out plan as per mutual agreement
Benefits to Date
High usage of both solutions have been reported. Immediate impact has been a reduction of errors by care givers and an increased physician satisfaction with HIS functionality to assist effective and efficient care delivery.
As a doctor you rely on this evidence-based content, providing you with the confidence to get your job done. No more error of oral
instruction when communicating with the staff.
-Emergency Room Doctor, Sehat Al Suwaidi Hospital
The ordering process previously meant doctors had to progress through four or five screens to order. Selection of items now occur on a single screen.
Comprehensive care process:
- Degree of data added to the care plan has been reduced greatly, with most data now available through click and select interface
- Care givers are being introduced to actions they may not have considered, decreasing errors of omission
- Clinicians update outcomes at the end of their shifts, reducing the need to write lengthy progress notes. Emphasis on professional exchange ensures effective transfer of knowledge and responsibility between clinicians
The highest risk of errors happens during shifts. With the care planning system, we can easily check a patient’s status during shi
change, reducing the change of miscommunication or errors.
-Staff Nurse, Sehat Al Suwaidi Hospital
The use of order sets has shown to improve the quality and efficiency of care, ensuring critical steps are not missed during a given care process.
Metrics for tracking process execution:
Free-text options in the EHR limited opportunity for KPI tracking. Care Planning and Order Sets offer analytic capabilities with standard content that supports quality metrics, acting as an input to a smart alerting system.
The Elsevier care planning system helps nurses prioritise the most pressing patient issue to deal with; the system also notifies you of associated problems and risks, ensuring you know about these outliers.
-Staff Nurse, Sehat Al Suwaidi Hospital
- Eliminated the need for physicians to enter desired orders ‘from memory’, reinforcing evidence-based practice and making it easier to standardise care delivery for common complaints
- Supports individualised, patient-centered care delivery, with assessments and observations specific to the patient condition
Having standardization with order sets, we now don’t rely on physician’s opinion but instead evidence-based content.
-Head Nurse, Sehat Al Suwaidi Hospital
Return On Investment:
Solutions will ensure optimal reimbursement under value-based parameters as one criteria for claim rejection is over-ordering and over-prescription.
In August 2017 AHMG achieved HIMSS EMRAM Stage Six certification at the Sehat Al Suwaidi Hospital site, an important milestone for the identifying the level of EHR capabilities globally.
The breadth of our structured CDS content solutions will facilitate implementation across the entire hospital, leveraging the full functionality of the EHR and creating the necessary automation, logic and rules for the most advanced CDS (EMRAM Stage Seven).
Throughout the implementation process HMG were continually impressed by Elsevier’s flexibility, expertise and level of engagement.
About Clinical Solutions
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