Pediatric Informatics: Computer Applications in Child Health (Health ...

17 Aligning Pediatric Ambulatory Needs with Health IT 251
17.7.5 Support and Training Infrastructure
A computer-based training program was created, as well as a required formal
classroom training curriculum. Training took place in multiple 4-h instructor-led
training sessions over a 6 week period. Physicians, nurses, medical assistants, and
front desk staff were scheduled to be in classes by clinic, promoting multidisciplinary
team building. Instruction covered both the system and the new processes needed to
support it.
During go-live the project team was available around the clock. This high level
of support ensured that end users would be able to care for their patients with
minimal inconvenience. Go-live team members included clinicians, system analysts
(both internal and vendor-provided), and project and hospital leadership. Divisional
super-users assisted with the initial training, and continued to provide ongoing support
after go-live.
17.7.6 Results
Successful construction and deployment of several hundred disease- and
specialty-specific order sets to help facilitate efficient, consistent, and consensus/
evidence based practice
Clinical decision support provided, including pediatric-appropriate alerts and
dose range checking
Over 1,000 users successfully trained and using the system
All orders including future visit orders and order management between clinic
visits were online and available for any user to see
17.7.7 Lessons Learned
Training, communication, and organizational support to shepherd the culture
change were critical to the success of this project.
The most difficult aspect of the project was developing standards and consistencies
within the organization from nonstandardized ambulatory processes,
which differed between clinics. Health IT systems do not handle ambiguity well
and cannot be relied upon to correct broken or inconsistent processes. ACPOE
helped to stimulate discussion and planning towards standardizing best practices
at Children’s.
Ambulatory care by definition occurs in fragmented intervals over time, and this
episodic care formed the basis of the system’s data models. However, patients
live and take actions in-between these episodes. Providers need a system that
supports patients whenever they need care (e.g., lab draws between visits).