Although a comprehensive electronic medical record (EMR) is implemented in an organization to improve quality of care, patient safety, and efficiency of healthcare delivery, continuous updates and modifications are requested by users (Pare et al, 2011; Yoo et al, 2012). Opportunities to improve usability and efficiency remain, and users propose new requirements after implementation (Yoo et al., 2012). The goals of this project are to (1) review repeatable processes “Life Cycle of a Service Request” implemented by our clinical informatics team (CIT) to minimize risk when making changes to the EMR; (2) ensure proposed changes are consistent with regulatory requirements, support best practice, and optimize use of clinical systems for patient safety and staff engagement; and (3) collect and analyze qualitative user feedback related to processes. Prior to March 2012, the CIT did not consistently request end-user verification after making changes to production; not all change requests were reviewed with our Clinical Informatics Council (CIC), and test scripts and time of day for changes were not standardized. Following a series of unintended consequences, we implemented process improvements including review by the CIC, no changes to production after 12 PM, standard test scripts, and verification by the end-user/requestor immediately post live.Methods/process/procedures
Retrospective review of new service requests (SRs) completed by our CIT between March 2012 and February 2013 was done from our SR database. Requests for minor text edits were excluded. Information retrieved included requestor’s name/title, request summary and detail, and priority category (safety, regulatory, revenue). Minutes from CIC meetings during the same timeframe have been reviewed and indexed by request and nature of feedback. An online survey is being distributed to staff to assess perceptions related to process and outcomes of each SR.Results
During the period from March 2012 to February 2013, all SRs followed its standard life cycle: (1) a request is submitted via SR application; (2) SR is presented to the CIC to ensure agreement on the approach prior to design and post–design/build in test; (3) a clinical information analyst in CIT conducts testing, and its requestor reviews and tests the service in a testing environment; (4) its approval is granted by Information Services Change Control committee; (5) its change is made to production; (6) the requestor reviews and tests for unintended consequences; (7) users are notified production update/change and trained; (8) CIT assesses its effectiveness, consequences, and perception through CIC meetings. There were no unintended consequences as a result of changes to the system. The survey will be analyzed in April 2013 to evaluate if changes made to the EMR comply with regulatory requirements, support best practices, and optimize use of clinical informatics systems for patient safety and staff engagement, as well as to acquire feedback related to SR processes.Discussion/outcomes
This presentation will share our repeatable change management process that supports consistency of the life cycle of a change request with numerous end-user feedback checkpoints and the results of our end-user survey, as well as recommendations by our CIC, which have guided our change management process over the past year.