Scheduling/Registration Workload Assessment after Cerner Implementation: Lesson Learned
e-Health ePoster Library. Meraw D. Jun 6, 2017; 167110; EP06.04
Mr. Daniel Meraw
Mr. Daniel Meraw
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Abstract
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Purpose/Objectives: Orillia Soldiers’ Memorial Hospital (OSMH) is a community based hospital in North Simcoe Muskoka. The hospital recently implemented a Cerner Electronic Medical Record (EMR). The new system replaced paper charting as well as a home grown application used for Scheduling and Registration. In addition, some areas within the hospital had previously been using a manual booking procedure. The Project Management Office (PMO) and the Health Records Department developed a staff survey 4 months after implementation of the system, in order to assess the impact of the new EMR on clerks’ workload across various service areas in the hospital.

Methodology/Approach: The survey was circulated to 123 clerks with 75 (61.0%) responding Participants were from the following areas; ambulatory care 34 (45.3%), admission/preadmission clinic 11 (14.7%), cardiorespiratory service 9 (12.0%), diagnostic Imaging (DI) 7(9.3%), Day Surgery/OR 6 (8.0%), Emergency Department 5 (6.7%) and Dialysis 3(4.0%).

Finding/Results: Scheduling time was significantly higher in the new system compared to the previous one (7.9 ± 2.9) versus (3.3 ± 1.9) minutes P=0.001; respectively. A similar observation was found in registration (7.8 ± 3.7) versus (3.0 ± 1.8) minutes P=0.001; respectively. Ten users were using the new system for billing. The average workload duration of billing was significantly higher in the new system compared to the old one; (5.0 ± 4.3) versus (2.4 ± 1.8) minutes (P=0.017). 37 out of 75 (49.3%) users acquired new task(s). The average number of additional tasks was found to be 1.4 ± 0.64; range (1-3). Scanning documents was the most frequently added task at 15.0, with billing at 10.0 and the Wait Time Information System (WTIS) activity in OR and in Diagnostic Imaging at 5. Additional tasks were related to booking for more than one service areas or helping other end users. Time needed to scan documents varied considerably from 10 seconds to 15 minutes, based on the number of documents and the complexity of the task. No significant difference in the time needed to schedule or register cases between the different service areas had been observed (P>0.05).

Conclusion/Implication/Recommendations: The transformation resulted in an increase in OSMH’s EMR Adoption Model (EMRAM) hospital score from 2.065 to 3.17 (OSMH). Increases in workload is believed to be related to: (1) complexity of the new system, the previous system was more streamlined in terms of data entry efficiency; (2) none of the service areas has implemented CPOE yet (HIMSS level 4); therefore, additional scanning of requisitions was now required; (3) additional tasks related to billing and WTIS could be contributing factor(s); (4) The time needed for users to master the new system (study was conducted 4 months post go live). It is anticipated that the numbers would be slightly reduced if this survey were repeated in 6 months. Senior executives and managers may use the information in this study to set up effective strategies prior to go live such as conducting time studies with their current health information system to determine if they need to adjust the resourcing during the interim/ongoing operation.

140 Character Summary: Workload impact on clerical staff is a significant issue following a hospital wide EMR adoption. Planning prior to go live is critical to ensure seamless transition.
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