Abstract

As an outsider looking in, I can confidently say that UHN has done a spectacular job implementing MOE/MAR. The University Health Network (UHN) has long viewed information management (IM) as important to its mission to provide exemplary patient care and innovative research and teaching. Consequently, for the past five years UHN has asked my company to conduct an annual review of the hospital's IM strategy and related implementations. So again this year, as leader of the Accenture review team, I was privileged to get a first-hand look at UHN's progress. Our review included in-depth interviews with executives and clinicians as well as staff focus groups drawn from across the organization that gave the MOE/MAR (order entry) project high praise. We also applied other measures, including a survey that was responded to by nearly 500 physicians, nursing and allied health professionals. I also know from my own involvement in UHN's first order entry project nearly 20 years ago that implementing MOE/MAR has been no quick-fix, overnight task. When the hospital first embarked on its electronic patient record journey, it was thought it would be accomplished in three years. However, no one imagined then how difficult this project would be in the long run. In response, the organization and the staff in charge of the electronic patient record project (of which MOE/MAR is a significant portion) have consistently shown an unusual amount of organizational tenacity, paired with substantial investment to support its IM implementations - 4% of operating budget annually, compared with 1-2% at most other Canadian hospitals.

What's behind UHN's IM success to date? Rigorous project management expertise and achieving actual senior clinician sponsorship are two success factors that my team has witnessed over the past five years.

SIMS (UHN's shared information management services group) is expert at project management - and not just by adhering closely to good project management principles. Eighty percent of SIMS' project managers are certified by the Project Management Institute (PMI) and the rest are in progress for their certification. SIMS has nurses, physicians and other clinicians on staff who provide clinical expertise and credibility to its implementations. All SIMS project staff must complete rigorous user requirements, clinician-approved test and training plans and evaluations of every project to ensure that projects deliver on plan. When SIMS project staff put a project plan together, the Project Management Office enforces it aggressively.

Because order entry has such significant clinical impact, SIMS very carefully and deliberately engaged senior clinicians alongside senior executive management to own the project. Although our review uncovered multiple occasions where obstinate clinicians could have derailed the entire MOE/MAR initiative, sponsors readily addressed issues head-on before they could undermine the project.

This year the release of our IM review coincided with final implementation of MOE/MAR's phase-one rollout. And how did people feel about it by then? It was very encouraging to find from our survey and focus groups that 73% of UHN clinicians understand the goals of UHN relating to information management and the electronic patient record, and that MOE/MAR was rated as the Number One information technology tool that has had the most positive impact on clinicians' work environment.

About the Author

Denise Zarn is a partner in the Health and Life Sciences Practice at Accenture, Inc. She has been involved in physician order- entry projects for over 20 years and has worked on advancing electronic patient records at the enterprise and regional levels both in Canada and the United States.