ZNA and GZA case study

As soon as hospitals complete the process of selecting an EHR and choose HiX, they will start preparing for the implementation. This preparatory phase has its own specific challenges for Hospital Network ZNA and hospital organisation GasthuisZusters Antwerp (ZNA and GZA, websites in Dutch), which have started the implementation of a shared electronic health record. Dr. Mark Helbert (CMIO and nephrologist at ZNA), Wim Niewold (CNIO at ZNA), Annick  Wauters (Managing Director Quality & Innovation at ZNA), and Dr. Thomas Adams (urologist at GZA, process owner, and work group chair) tell us how their hospitals are preparing for the new EHR.

Project phases

The entire implementation process of an EHR always proceeds through a number of phases: the preparation (or inventory phase), the implementation and testing phases, the freeze, the training phase, the go-live, and, finally, the post-implementation support phase. The preparatory phase lays the groundwork for a smooth implementation. During this first phase, GZA and NZA map out their care processes, which allows project staff at both organisations to familiarise themselves with each other and with each other's processes. This also allows them to harmonise those processes and to translate them into the optimal configuration.

Starting a project and informing everyone involved

The preparatory phase consists of several elements. It begins with making all project agreements and defining the final scope of the project. Fieke Vermeer (project manager at ChipSoft) explains what this means: 'Together with the hospitals, we decide what modules are going to be implemented, we explain more about what we do on the project days and why, and we explain the project schedule for the various work groups. A well-defined scope is essential to allow project staff to know what preparations they should make and what their role in the project entails.'

ZNA and GZA have chosen to inform not only the project staff, but also all other future end users well in advance about the project. Annick Wauters: 'We're organising quite a lot of demo sessions together with ChipSoft, where we address the most common questions and concerns.' These demonstrations give the end users a clear picture of their record in HiX, ChipSoft's EHR, which helps increase their involvement and boost their confidence.


Timely scheduling resources

The next step is for the hospitals to schedule the project resources, such as personnel, rooms, project days, and hardware. The hospitals also assemble work groups that will work out the configuration of the record on the basis of their requirements and wishes, while taking into account what the standard open content has to offer and what is possible within that content. Think of the nursing record, for example. Mark Helbert: 'The final configuration must be compatible with the principles we defined as guidelines for our new EHR.'

Assembling the work groups in time gives the participants the chance to get to know each other and the work processes used in the other hospital. ZNA and GZA have over six hundred work group members from many different departments, which helps build support for the project decisions. 'We made sure that the work groups are a perfect combination of people with different profiles that complement each other', Thomas Adams explains.


Training courses

Then, the project staff start with the e-learning courses that introduce them to HiX, and with the project training courses in which they also begin configuring the system. Vermeer: 'In order to support the project staff as well as possible, various courses prepare them for their roles. The project management and the work group chairs, for example, follow a course in project management in order to help them lead the project effectively and efficiently.'


Setting up the project environment

For the preparation to be successful, the hospitals need to set up the hardware infrastructure for the project environment well in time. ChipSoft provides them with the required specifications and manuals for this hardware. The hospitals also have to make a minimal selection of peripheral equipment available, such as scanners, printers, and bedside computers, so that the project staff can test whether all processes actually work in practice.

The data migration from old software also starts during this phase, in order to allow project staff to work with a populated EHR in the next phase. This way, the staff can work with a test environment that feels as real as possible, and they can get used to the new EHR throughout the implementation.


Harmonising work processes

Other project preparations are conducted parallel to setting up the production environment, such as listing and developing uniform work processes. In the case of GZA and NZA, this is a joint effort, because GZA and ZNA intend to cooperate very closely. Harmonisation decisions (also called 'process decisions') will be made about all the various work processes, for example about the processes in the different emergency departments. These decisions will take into account the way in which HiX functions, and will be translated into software configuration during the implementation phase.

The process decisions are documented by process owners, who look at and compare the work processes across both hospitals. 'The care record was our focus point,' Adams says. 'Both partner organisations defined their care processes and marked the differences in them. We then harmonised those processes in order to prepare for a correct implementation of HiX in both hospitals.'

Niewold explains how: 'Over the course of about eighty workshops, we took the first steps: mapping out all processes. The next step was to convert the information into process decisions, together with the 16 process owners, to bridge the gap between GZA's and ZNA's care processes.' For example, the hospitals agreed on what user roles can prescribe medication in the EHR, who can schedule operations, etc.


Guidance and support

This large-scale project affects all processes in both organisations. ZNA and GZA fully realise the scale of the adjustments. Niewold: 'We are not just going to implement a patient record, but a whole new way of doing things. This is something we need to motivate our colleagues for.' They do this by paying a lot of attention to communication and change management, so that staff and managers can prepare for the new working processes. This will contribute to a positive reception of the EHR and it will allow end users to make optimal use of the benefits of the EHR.


A thorough preparation is key

A smart approach to the preparatory phase will save hospitals a lot of trouble and uncertainties further down the line. Vermeer: 'The hospitals play a prominent part in the project organisation. They timely assembled the required people for the work groups. They regularly update the work groups on important matters and they continuously monitor the progress. In doing so, ZNA and GZA make sure they coordinate the entire process in a structured manner. To make a long story short: we work together very well.'

'We have our hands full with the implementation, but we managed to establish a great partnership with ChipSoft,' Niewold agrees. This cooperation and open communication with the IT partner is important in every phase of the process.


Future expectations

That the EHR will be the catalyst of major changes is clear for everyone at GZA and ZNA. Adams: 'HiX is a totally new concept for us. There is much to discover because it encompasses so much, but at the same time it is a very clear health record that gives you a complete picture of the patient.' Wauters agrees: 'The EHR will save our staff a lot of time, because they will no longer have to search for information as much as they used to. They can now spend this time on care for the patient.'