National Institutes of Health, Clinical CenterHCIC Project Example: Operating Room

Requirements and Implementation Planning and Management 

National Institutes of Health, Clinical Center
Department of Anesthesia and Surgical Services (DASS) - Bethesda, Maryland 

Situation:

The Clinical Center of the National Institutes of Health (NIH), after twenty-five years of using its present Medical Information System (MIS), desired a strategy for a replacement system and guidance through the selection and evaluation process. In addition to replacing the base functionality for physician ordering, results retrieval and charting functions for all NIH inpatient and outpatient visits, they needed to fill gaps in their ancillary systems to support the clinical research mission of NIH, including surgery and anesthesia services.

The DASS had previously never implemented an Operating Room and Anesthesia Management System. Critical departmental data and statistics were gathered manually and data entered into a database for management reporting. In addition, the vast majority of surgical and anesthesia supplies are ordered directly by the OR staff via manual requisitions, as the NIH Materials Management department handles less 2000 of the OR inventory items on a PAR stock method. Perioperative documentation was electronic via intra-operative charting. However, the documentation was in a “progress note” format and entered into the Hospital wide documentation system.

The DASS sought to procure a fully integrated Operating Room and Anesthesia Management system. Key requirements included: comprehensive scheduling, preference cards, nursing documentation, supply chain (perpetual inventory), full integration between the Nursing and Anesthesia documentation, and interoperability with the Enterprise Clinical Information System.

Solution:

HCIC’s support of the NIH Clinical Center’s Department of Anesthesia and Surgical Services was instrumental in three key areas: (1) for requirements definition, HCIC used our knowledge and experience in the industry to assist the department staff to clearly articulate the detailed requirements that would enhance the efficiencies and effectiveness of the department operations for both Anesthesia and Surgical Services. We integrated the requirements into the overall programs for information at NIH which is their Clinical Research Informatics System (CRIS); (2) for process design and documentation,

HCIC’s knowledge of how technology can enhance and expedite Anesthesia and Surgical Services’ business processes and our approach to process documentation enabled this phase to be completed in one month; and (3) HCIC’s knowledge and experience in managing projects of this scope allow us to develop a work plan by which all system implementation approaches could be evaluated and subsequently used to setup the system. We subsequently managed a portion of the implementation using this plan and our knowledge of the department, the staff and the tasks. We developed new procedures, training materials and documented processes. The system was put into operation per the schedule established in the work plan.

Specifically HCIC performed the following activities:

  • HCIC lead the requirements gathering process and developed a Perioperative requirements document based on technical, operational, clinical and intra-operability requirements identified by NIH personnel and identified by HCIC as best practice.
  • HCIC developed a detailed Request for Proposal, adhering to Federal Acquisition Requirements (FAR) regulations, as well as industry standard practices for system procurement.
  • HCIC facilitated the system evaluation, selection and contracting for the Perioperative Solution.
  • Once the system procurement was complete, HCIC developed the system implementation approach and plan for the software, hardware and operational change management. The project was designed with two phases: basic implementation and the addition of clinical documentation and instrument interfaces.
  • HCIC provided project management and subject matter expertise for the supply chain portion of the system design, implementation and workflow design and successfully implemented perpetual inventory management.
  • HCIC continues to provide periodic consultation to evaluate and improve post implementation system utilization.