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Maurer, C. (20121. Project HUGO at LHSC:Leading Urgent Change In Healthcare.


Recuperado de la base de datos de Richard lvey Schoolof Business (041471)

FIrnEy lruuistring
w1379
PROJEGT HUGO AT LHSC: LEADING URGENT CHANGE IN
HEALTHCARE

FdrsBle hufwwo6 lrsiorslofetr, altitidrtnaffi brchss4{roatelrt,meautfuttsrerlrc&afand|o*nhzbiflw


q lrp,lffi hfi&rg d a naf&'orfe sft,lmn. Tha allpr nW hatg 6WM c6'fih tutas &w mW

6tlbcf'

'|d

laffionfoptffi.conlUoa,datry.

p,0ffi

Ihe
pernbslor

d@ oror[|'ltirs rry?dmd hr W tun * b! 8'ty tF.ns uilrptt hc


t*t nffi.l b td @r'td utder atffin by ny p?{cddiln dfits
fo o/dtrobps or,!$,c$p{ntsrb'' b @a
nip/b{Flrs, oorrlpcf ,ry-Pdt$flg' ,l,ry Su*?ast Sc[o4

org,8Eatlxt.

qy&ht

hotdlf-.

ll'dy,trsy.!3f,,don, Ontutq Crde,

cffilyBntg

2Ol

W
Wffit

Ey nd b? taarnih4

Op

ot

i6Omt;tt)619.661.9*8;B)@@W.6;

nr,l,w.irDro?ss.Gorrr.

Veaion:2gB4lAO

2 FlhfrrdAav Sdrootof &r$ress Ferr|d.fion

On lhe moming of Se'ptanba 6, 201

l,

Susaa

lohsoa tmk

a deep

bred

as she entercd

&c

@iqg

lot

of

the l,ondon Hcalth Scieace Cffio (LHSC]. StF bad just lsrrtrftod her children into a new school ycar.
Johnson smiled as she rocalled the excitemcnt and tuticipnticr on dreir faces at their fiestr stryt bsck to
school. I{er smile lessend
her thougtts hrnd to the monumenal obange laadership task
lay

th

ahead.

Todry would hiag a public announcanent by the senior mranagcmd tqm &at'het''Pr,oject

HUGO would be live in all LHSC hospitab by Apr{I2013.

fre direcCIr of Pharriaoy Scrviccs at IJISC. Over tbc past yar, sbo hed bean planning for
thp launch and implcmentation of Projec't IIUGO, an acrqnym for Healttnse Un&rgoing Optinization
HUCO would bc one of the nrost Gomplx, ercpemive aod cballenging projccs wer undcrtakel by thc
Jo'hrson was

hospihto in London and region. HUCO wsuld

tusform the nay Garc was deliverc4 from parnt

registratioa to pdient dischalge. Whcn fully implemcgbd, the physicians, nur!6 md otha healthcar
provid'ls rvould be using a fiilly eleefronic pstimt reoord (EPR) in place of tlie current pryer-based
eystEm d all Inndon horyihls and thp nine smallor regirmal bepials that paftered with LHSC.

ffig

Johnson knew that HUGO would


some opemtional sffioiemcy, but fts main ratisralc fm the project
was to ensure patient saftty and grnliry of care. 'HUCiO was ultini&ly about prcveltring ntedical errors
and savrng lives. She also kncw tbat the implmetrtation of HUGO would bc very challcngrn& including
the risks ofnmning over budg4 rnissingdeadlines and not getting,evryone on lxxrd.

in6e Hluray, slr had nm ino a plXnician whom *re had though wauld have
suppor&r of HUGO. Yet, surpisingly, lhc Sysician had scated, "Susart" I believe that ws will have
electronic order entry very soo& hrt you know, I will never entet my own ordrs, My secretry will do
Jtst fte prcvious wk,
been a

this for me. lon not a

d& atry oledc"

Johnson knewtlrat divrrtirg thls process to clerical strfrwould dilqtr the geins in safgty. She also recalled
a conversation witrr &e den of the medical school who hld stded unequivocdly thd by introducing
elcctrsnic otdcr Grfiry, lndical sfudob uould not lann bow to p'r.cscribe ordqs and proprly care for

Fagq 2

9HIGO3E

patiens. *Thit

is

'coo&book' medioiae,'the

Standadimtion will not work!"

dea had sai4 "I trcat my

pfu

ar

individuals.

THE GLOBAL HEALT}ICARE D{DU8TY AilD THE ]IEED FORC}IA}IGE


Tho glohal

hoattkre idustry provkted

heafthcare senices and producc, inchding mcdicel quipncent,


snd bioteobnslory. Scrviceg could be brosdly &viOeO into noapiU astivitiss, moCical
dental practice; and other mcdical swice, such
those dcliverGd bV registerd diaicius and
optometisb' In mury cu.rntbs, hcalthca,e was ons of the largect industies and ofun one of lte most
ineffisiqrL In mgsry cournrtes, bealthoare consurned.about l0 p* cent of grss domcstio prodtrct (GDp]

Although hml&carc spending abaoftcd nsre thn US$I.? biltioo pff ycat in the Unitsd Strbs aild morc
thm C&S175 blllion in Cansda' prcnatrre rnortatiry in Nqth Anerica remained higher tan in mny
other &vcloped munties. Msst medical recsds were still stored on papor, whhh preeluded lte
coordination of care or routin measurencfi .of qrntity, ad oflea ted to crttical, ofteo fant, nedical
erron. Recsrt media reporb had highligbfcd the tragic corucqunoes of,mdical erron:

,
.
.
.
.
.

*Da6s of 3 Babies in
Indiana Spodight Mcdication Mix-ups"
Sasran Glabe, SWembq 23, 2006
lQuaids Sue Blood-thinncr Manufrctrer',
Lw Angeles ?ilnel, Dec S,?AO7
'Heparia ovsdoses Hit Babis in To<as Hospital'
vau street Jaur.nal,July 9, 200g
"3 PhihdelphiaInfaGDicAftrMix-upatHospitalPhnmqy''- Phtlefuhia lryuir*,Jurw l9.ql0
*Iwo Die in Hospicl Dialpis Mu.-Up"
March 19, A004

*Hospibl Enor,
Wonnaa

Did'*rBC, -Natiorutlpast,
Wedaesday, April 4,?ffi1

In addition to these alffsdng media reports, the asadomlo litratue abo painbd a bleak picure. Tbe
Instinrte of Medieine published findings of widesproEd uediaal errors in ib rpo4 To En k Htrllprtt''fte
rWort sugge$ed that ss marry as 98,(n0 Ameeiens died erery yqt as a rcsrtt of mcdicd crnor. A
subsequcut Cansdian snre/ ectocd ttrcse fi'yrirug rcporting Ut"t-Z.S pr
'ctrt of peierrts
-colsidercd
"d-itd to
hmpital had exPeritnscd sn adve,rse evat Of those patients, 37 per cpnt rryr
to haw
otpedenced preventable evnts, and2.l percot had dicd as oresult oftheh adversc evrits. Acroos key
{ees in the medkdsa prooess, ditrrerdt}"es of enors oosrrred with difraent ficqrrncics. Enors were
classifitd into odering erron, tranccription erors, dispelrsing rrers, and administation mon (see

Extribft 1).

BACKGROUND OH T}IE ORGA}IIZANOO{s


Insluded in the rruGO pmjoct werc a total of I I horyitals, all located in and arorurd lfirdon, Onbrio, in
soutbrrestern Orfiariq Canada- firese bospitals included l"ondon Heatth Sciences Centre, SL Joseph's
Halfh Cane London and nins smallr regional hospitats (sce Exhibit 2). In btal, HU@ u,ould atrect
more than 10,000 shffraembers acrms the diffrcnt b$pitals and sies.

LHSC, one of Canada's largest aoute-care teaching hoqpitals, cared for the moat critically itl pationts and
the most medically cor4plex casoe in the region. In 2010, 150,000 patients visited the-emergcucy
doparhcnts,700,000 patienb visited oubstint derprhr*rnb aad 40,900 patients wele adniilsd. [HSC
t

&rs&rda

ts9t.

G.

hbtHtp',

To

En tstlwran: Buitdima

ffir lffi.ella

Sya#n.

N&d AenyFncs,

!'.tdlludorl D.c..

Rer &ab et 4., 'TiF &lnsd&l't ,d/vee tunb thfi4 frp tm:dern of,{da/se Erads azror4l r$gfid
Can&n ltccfrp/ Asffin Jaurnd. m4" wt. lVA, ttc'. l l, g. I 6ltl ffi9.

@nadg.,' Tlp

tu&,rils ilr

Pegc 3

9Blt0038

was the lqest mPloyer in London, wi& rnorc tran 2,200 dostors and medical studonb, alnost 3J00
rursq 500 olinical str(such as pliararcists, ntfitionist and pnvsioucrrylsel ard
4p,roxim*oly 7,000

other staff and voltmbers.

It

eacompssod S Sodh $teet Hospial, Utriversity

ilotpitrl, Vi6rt"

Ilospttal md Ctil&n's llospitaf Byron Fanily Mdical Ccrt md VictoriaFmrily lrtodfu Ceuge, aod
was home to the FowlsKenncdy SportMedieine Cfnic, Canadian Surycsl fecUrotogies aqd Advamcd
Robotics (CSTAR), Lowssn tlealtt Ress&h Institr*. Childrcn's Health Foun&tion iad Lonfon lleatrh
Seienca Foundatiur-

St Joeepb'r l{lth C,are London (st Jospht) r+rs a m4ior pciem catr, eaceiry and rtsca13h cEbe. It
ryU{ 8L JosePh:s HolPilalr Parkwood Hospital, Mount Hope Centre for Lofu-rerm &re, Regionsl

Mental Health Carc Londod ad RegionalMental Heslth Car-eSt Thomc. Annually, morc than 50O,OOO
PdiEilB vbitodthc cr@Lart clinics et SG Josephrs, fi,fl)0 surgerics ..rar petfotneO aod 41,000 111g*
cslE csss nr{minictspd. St Joeeph's uore e8a 5,000 ;aff ne;bers imtrUea almost l,SO0
ihysiciinq
residcrtr aqd medical studocilE aad 1,100 nursing,srd allicd health profcssionals.

Bo{h LHSC md St. Joseph's h8d

rynly spFoiftpd chicf

vision for thcir oqguizdiom (eec E!&ibit

estecutive officers, wbo wcrs rcdcfiaiqg thc

$. wUte tho organidions

nsnp slgtUy difforcnt in

ways, borth orgeizdions werp sobscssod? with quality ofcarc-d,paticut saery.

sms

Johcrson knew that. statr diftred md csutd be categorircd into physicienq muss and alliod
healtl
professionals. Becauso physicians were in@ndcnt md not reguhr drployo of thc bospial,
h$pital
adnin5qcion rves permittcd only lirrired dircct influence over physiciansi wor*flow. phlrsicians rrere
more likely lirn nums or allied hedth professionals CI switc,h iroipiats seveml times in'their Gj1.ce6.
Thgr_ofiel compared tho pcrftrrrance oftheir hoepitat wittr the perforrrurce of ofter hospitals in g116rio
-nna
and Canada. Many pbysicias rsisted chmge in &eir mfins
resntsd purcly adniniemtive trsks.

rndenA$e

'TE, mny and professionat prestigc. ilri"iaor


urcre ultim*ely
thd wm ordcfed. Nursx rvete etnptJyws oftne Uospiat wlrerc they
,t9** and_gpiaally rmaincd d ttre sarrre placc of work for a longer dr.rtion Oan pirysiAars. Thei
valusd otellence in P$*t caq time efficiency asd oonsisHrt md ongotng emptoymini. Ttre agc ani
tenure'of runes ranged 'widely, with some senior nurses having Ueen employed Or sevoral decades. Tlrc
Thls group valued

respoasible_for the patienr hcalthcarc

atlied^h{tr proessionals tms the most diverse group-ofhospitai rtifi, i"cfudiqg sweral smaller
Soups of professionals, .such as phannacists, physiortrerapists, egcupsionl nrrryirq dieficios, 1ab
technisianq radio teclmioians and mmsage thr.rpfu" tesi pnofesionrls rrcre Aivin Ui fbeir afifiy
rc
Providc sfe sd sffoctivc care frr pdeffi in m effisieni msnnei. T.hey wcre elso concerd with
communic*ioos wi& bo& physicb and patieira. For all throe groups, tlrc abilry to rccpss pdient
remrds from uywhcre in thc hcpitat aod bcfore sseing a pdient woutU signinearrly irrprovc *eir
Sility to provide higbauatity, e&ctivecare in aoefficient mannr.
gmup of

$u9A1t

JoHilsot{

Susan Johnson hsd ta*ur orrfte role as dirEctor of Pbarmacy at LHSC six mordlrs eadier. She
had been
as a clinical phamacist and had gained rclatcd experience in muttiple artas over alnost ZO

I-"ttd

bd

y"ro

practiced clinicd pbermacy in pediairic spcialty aras, general sr4ery, gai6oifficstigal


nedicine, infectious disas aod adult intensivr plograms. Additioiully, sle naA spenitrro years as a
pharmacist inatoaching&mily medicire clinic, pmviding phirmaoantic"t ca* to an amtulatory ptiurt
populatio& In 21F0, Johroa becamelhe cosrdinatsr ofPhrrracy Operations d St. Josph's Heatn
Care
in Londo'ni Ontado. [q lhis dminietrdive role, she had played a keyrote in the implementation of smart
infirsion systerm' apurcbring systmr ard a phannspy information system.
Shs

sttc038

Pegn 4

In 200t, Jo&ns& hsd esfiSlisM lhc new trledic*ion Srfety Oep6@nt d St J6c?tr's ltrcaltb C.r! aad
bccn i6 ooordinalor frr 19 )8ls. In tbis mlc' sh had furylac d wveral mcdicci'm safrty

initietivsq induding lvlsdic*kn Recmailicion,

a higb-alut nedicatim saety pcogre and had

furoducod en ind4cmdctr &rl&'c.bck sysM" In 20@, $e hd gsrbli$ed {he nc\r Deparffi of


Clinicat Infunatics d London Horhh Scitrccs C6tre md St Joacpb'r Hcdlh C,ae. Ovr tb two ycm
Jobnson was dirpcbr, this dFrtrw f had grmm to a s'bffofz0 ftll-titrc equivaloc.

th

Prcviously, slrc hrd reecivcd hcr bacMor of ssisrcc dcgrae in pharmacy from ths Univcrsity of
xrd hcr
dogrc in hcalth strdcs $-Gedcr*rip) fom Athahsca Univenig.

ne's

Tmolo

HTSTORYOF EI,BCTR(rI|G PATIEITT RECORS AT LHAC

HUGO uas LHSC's seoond smptto imptrcnrcnf raelec*ronis pcient rcoord (EPR) systcin. Fmm 2003
to ?I)05, a maumatal etrlrt trad becn undcrbkcn to irnplaffirt ooryrmitd ptrovidcr ore s$y
(CFOE) ad cllnical doqrucrmtion" Inforrnation er,hnology sffi, not clinicst gtafi, had &ivea this
Frojecl Sevsmlconsutaab S,omfrs UrdtdStEFs bdbeeq{pars,h$od in*btltcorgetz*mbbuild
&ilod b tDcd
dlincs"
tlc systEm- In ttc spriry of 2@5, t$c FNCiect was ovrr{ndgrt and
Clinicims had coqsidersd fu sysEm eumbcrsmre ud rruupprtive of patient mte. Hspe, they werc
frustnfd by tre eystm bofore it had wen been larnclrs4 and drcy had clarly itrdicelGd tbey would
re.yerusc ir ?lE projec-t nas put on idcfinie tnld ad bd nmaired dornad umil2009; horrcter, ttc
organidional mclnory of the frilod dqnpt b isboduae EPR hod stayod alivo in the minds ofthc nnry
shffudto bad rcmained at tba hospitat

bf

tco

rder Johnson'r ladership, a naw trm was forn4 fr. Clinical Infmaics Team. This
was staftd with olinicians, includiilg nuscq phnrnmlsh and nufritimisfs, and v*as taskd with lhe
dcsig& imptemerilation, educdion urd Saining of the clinical systcrns. Thb tem a#d u advocales for
thc clinigat stafflnd fq the r:sc of tcobnologl to cnhanc qrnlity of oare and petient saftSy. Thy ako
played kcy roles a; ffi$latorc bctwecn thc infurm*iqn e$enobgr staff and clinical stafr, t$o grorye
o*enused very di&rent lffuage.
In 2009,

&*

In 2010, witl6s Clinical Infsnnstics Term oo 6s Sound dd trc Tocmto horyitals rcpctiag swcescftl
CPTOE implerrenatioqs, the Lonilos hospitsls e:cpcrieircod rcneupd intgrst in a scod uy

implmcfing CPOE. A rcport was rplcread that oorrpcod Cangdian hospitals' dopd@ of ncw
tocbmhgr. I,ondoq typically s nstimal lsdor, uns sbrtirg to ftll behfud mrrci smslla Canadiao

hospitats. In addltion, mporB wem emerghg from wory rnqior organization regerdfutg tb trernsdotts
gaim in pdiqrt saftry bing reatized as a r$rtr of the irnplonrntatim of aa ohcursric psticctt r6d.

bcpials for
rpordc. Ercpoce-d to follow suit was Ceade Hsalth lnfoway, a Sdcrally fundd
gowrnmont orpnizstcn creed to foeilcr ud accelerstc adoption and implemcrrrion of ekctronic
hsd& rccffds.
Utrdcr President Obarm, &e U.S. adninistruion had &rvestsd billiqrs of dolhrs in U.S.
clec,tronlc pdint

PRN'E

HU@

Senior leadership st tbs hocpihl bd sskd fohnson to deermire u&at it would uke O larmch a full
had caarpleed an ercEnsiye rmlysis of the
SC. In resporoc,
elecbonic petient record project d
phCIrsical
re
r)rrcs
atd tto ptoposed roll-ors plaa. Tls
rquircd,
tho
ad
trdsd
human
clrangp sftrt
estimatod ccst of HUGO was mor &an $25 million. Part of this cost uns tbc tochology thd wag new,

33tte$0

Prg! 5

soenis*ara aad arposiva tha soo'pe of hjoct HUGO was mrsivg considsriag tto nmbcr of
hspiials ed shtr involvod. The anont of d& rbd wqrld be poeesod loctrodcslly insd of
rnarudly was dso shggsingly higb Information on approrirnealy ssvon millior pdieot vbib was
alrGody ol4 dcwisfurrdimsd{dbaddod quic*ln &ctorryidlyiscaaingbea![ca,eneedr.

ph includd an rgglwsive tlme sahdule tut would sc &c prciest rollou occtr over o 24moue paiod bqinring in fubr ml2. At lcast 100 additioosl staffMrbcrs rrurH nced b bc bircq
ard the curcnt clinicim wstflow EouH d !o dange dranfcatly.
Johnsoa's

lYorkflons in hospiul healthcnrc system were highly wnplex, rwulting in inefficimcics ad rom for
error. A process andyds, frm a Stsiclm orfuing a msdicstion io 6e administration of6c drt4 to thc
prticnt sluwcd &e involverrcnt of at lea$ five pcoplo and 24 kcy stps (rco Exhibit 4). HUGO would
shortrn this pocess aonriderebly (see E:cttibit 5). Handruitien ordas thd uEG oftea illcgible addd to
cdcrs
dsk of seriour crus (sce E &ibit 6l HUGO would climin# th ncsd b tuiphcr poorly
and w.ordd po&rce easily redlblc ad hanedbls rmdicuion ordens {se Exhibit 7).

*rikr

fu
tb

LI{SC" St" Jos'ph's and tbe regiooal hpihts ahsady had in phoe the fouoddioml aonponmb of
horrryver, to aohiw *rc promise of a fully fimctiotrrd and i@nted EPR, firther dwehpnent uas
ncossary. All of thc pmgrams would rcquire sipificant process rcdesigtr drd chtngps in clinicigtrs'
b*aviorn md ein&iry; Sysnm, scrstlncs ud proccsc would ncd to be aligned ad imuiomatly
designod to achievc the dssird ot$cqrc&

EPft

The prqiocr included trvo main

rym.

The first rvas oompunrizcd providcr orde cdtry (CFOE) (by

or pretilionm), the tcsord u/as a elosed-loop medic*ion admlnistration ptoaeos


(CLlvf), which inchrdcd elechmio medicuion adminisation raotds (eMAR) and oloeod-loo,p
phygician, nruse,

medieion a&ninistrgtion (CLfv{A).


CPOE refrred to the procera b1' which a physician or o&er halthcare providor crtercd ordcrs (e.g., lab
ordors on a pryer chnrt
bst, X-{ry8, modioatims) direcdy in$ tb aoaoprbr rafur ttun hmdwridqg
CPOE decr$d dslsys in ordcr caryletioq roduaed mcs rclf,lod 6 hanA*riting allowcd ordtrffiy at
eitho point-of-care or oFsitc ad prwidod bo& artomsted erxrr-checking and alerts. Aler6 would occur
uften a physicizr ordred a drug that a pcia* rvas know! to bs allergie to or ordcrod 1161drlts had
alreedy bcon oonplcbd (cee Exhibit 8).

ft

d tk pdicnt's bedsida Pstien8 receivcd s bqrcdsd


&c h6pibt, Whm a nurss or a &erapist rdminisM a
medicdion, they ud tte list of medicdiors on 6e cMAR and vcrifed thf the paliril uns givtn drc
oorrat nedicadon by soanning caph doso at tro bsdsidc. Nerq the nurse or therapist ecutcd ttrc patient's
rmhnd o verify fut trh parient rooeivsd the curoct rdiodion In tbc cssc of sr insrcct lurh
bet$Eer pdir* and mdicatio& the safsty softruE iseircd a wsniry; Le*ly, dre nurse soamed her om
idedificarioo badgs. The adndnistrqtion of tbe modicatirn uas tlrcn auomaically doeumeded on the
CLMP and eldAR pr* drc power of tochology

pati,cilt idotificatkrn bard whsn admifcd to

patietr's olcctnonic

lwrd"

believed to lad to rnqjot heslflcatt


Tlre broad adopion of elcetronie padcnt record stratems rms
^wrdely

savinp, a rrduction in nedical eros ad inprsvcd hcalttt' A p{ient's blood tSDe' pressibed dru$r
mcdiaal cmditioss and odrcr tspects of srcdisrl hictdry cotrH bc moounied frr much rnae Af*ty. At
thc very lcast, an EFR could raw tlrre attbs doctor's ome. At most, guick access to reeor& could savc

Rbfisd

!ffidrd rf rr., .Gs, Effic W

Swtngs ryrd Cos0s,'

rffit

A{lelr8.

&e{' l|tI. 21, rp.

tucod qnhnt
5, Fp,

&l

17'

Trans|om

,W,

Cnr?

ffefi

8ett.fr*

Prg.8

0a1{o03t

lives ia

Dsspitu

fu

fu

tb

qucciom ncd to bc arutercd quickly durhg


mergr&? si$dim
cmergcncy
doci;rion-mokitg proc6ss. F'or rxmrplg duriag su& eqic ovents a$ 9/ll and Hunicano K$ina, th
beocfit of *clronic rcood kccplry wtar bighlt&d The injud wGr rurc @ily trcdod *nd may
baveH bffiqgcomlf lhgn thoco wbm pepareoords had bscndostroycd-

st$grriry cofb sod thc manitrdc of 6is ugurizdionsl

ledcrship Eiln bad dccidod thrt tbe potcotid ggins io quality of pdicdt

grdto delay any fi$thcr,

aod henao, had

c;harge

chlloogc, &c senior

sc ud estic'trt safcfy wero too

rccnily apprcvedProjcstHuc0.

A SOSII CHAilCE

While ,IohnsEn knew tftat gEtiing HUCO offtbe grorrtd was a ms'nrnnantrl dntloge sle also lnctil that
rEsrdB srqff bG *ell wordr thc eftre Sfts hsdspent rnuch of the last for yeers rccearching
HUCO wagn't
causes of msdi$tion ensE ad advocating for chargx to ths sys&m. Sls lcn{r
efficiac,y or saving monoy; it was about savirg live She tlnught about thc modia bcsdlhes thet ulut
burnod into her mamory f6wrr. Shs hDelrl thirt dl of tlmcs tagdies could have beeo pwatd !y

fu

systcms

fu
fuit

fu

likeHUCO.

Yt Johm *as dso mnly arwu oftts mrry &aors &d could tuve a sdow nqilivo impart ou tho
adoptio of fiis pmjcct $hs "lso tnew thst ltlc od& of $rwss were st in her ftvour, with t4 to 50 por
fiwt clinicians" Shc rcmcmborcd Eading
ccart of CPOE p,roject tlryicatly &iline kuse of ruitu
sbort Ctus Sinai Horylat in Celiforni& ln 2W2" tts orgrniztisn had bm forad to sanp a $il
million s),stem when pbysiqisnc bad *wslked orf of tte hopital and rcfirseil to work lmtil the c)rstfit
was rcmovcd-{ Many rcasms had booa noted for wbf EPR systams hd fiild (sec Extrtbit 9).
Tbinking bqck o hcr prior convecsdims with physicians, Johnson knevy tht ttp clinicirns Se had
lno*Ed with on a daily basis hsd fuir or'n peisoml ncasffi for Fsisting HUGO. Atd it was ad just
ptr;rsiciae tb.qJotrcmhad bad &omwlilc wo'rkingon&e HUCO propos,el. Nutos *sr6 slso vocal in
their oppositim. Tby hd carcd for pdc6 f.u many years using pen and pryer (ofun weu just a per
torvcl), r*ic'h tley fclt bd wo*sd jnet fire. Thesc nurses chirncd tr* mistrlses did lot htppen to lhNrl
beerse thoy had pcrfeced tbe nanual pmcesscs. Johnson was rsmindd of r repsfit from a hospinl tbet
noted ir tbe firsf sk mootLs a$er the irnplenrentatftn of barcodd msdioation afuioiete$oo' a total of
746 medicatim errolB had b@6n evoidsd- Most of ttese ffion r,rould bave gonc unrmticed by nursing
suJf, Bvcn Johrgon's orm pharnacy strff md othcr allicd health providen bad lcse,rmtims sborf
HUGO. Moot sdbelievcd+ltet tlp ph5rsicimr r*ould find a cfiy to defloct order entry rusponsibility
phannacir$ or nrnse ard thus rqs,ttd the W@d inspse in ftoir workload.

isnornal,"JohmthghL brssbc cotrld nothelpbutwq&rnrhs$erlhetieing


ffis rishtb srrbar& on HU@. Wiftin thp stinical ar6& staffwss dlalfog with pressing ictus. Infectioo
transnission of antibiatic-rcsistant organisr$ lvas at an all-tims hi8h, esd staff feil $cy wue btfng
'tesistroc hchngc

blamed for poor infegtion pordr,ol practicc. Wait timcs in the anergcnry deparErcffi ntrt much longer
than in any orthsr hospial in Canada; patiorrs werc waiting r4 to trree days br a bed a$cr a phpician's
bsing ou8ottttod to
decigionO gdmil 6Nrlr Ia addition, tbo informatioo tecblogy (IT) scrrricc
Uritcd Statsf and many of &c r(prtlschnical $atredLHSC nepdd to re$ on hd bcst laid ofr, SoIf
&rorrghouttb qgmidian ws cxhnstod, morals at an all timc lory and siek timo qru at rccord lsvels.

tb

lwt

'

Gedap-Sfnd Ooctur o&lg to

tun aN tupq, by Ud

Coruroily,

l$rp1r}n&l-frgl"

2M

,Nch

21.

z06t

Ntl.

gBtlCtXtE

Prgr7

Hdrro IAKE HUcoruORl(

{JA||D

SrFR

Johm wu well arruc of lho mgnindc of ttc oreeizdisrat clwrgc challagc fu sbo ftod- She
knc*' 6s ec implenron ion of an EFR ws lils a hrriostrG wltipping fuoqgh m oqeniuioa
Evcrything thsl staffonse brp wotrld changp.
'Thchappy

orcitmt brthc rcw soblyear thdny childra ftcl could rctbe more diftrtntfronthc

not so joyous

rnticiprim of HUC0

for hoepitrl

ctsff,

Jahnson

fbsttgtl

E$tbttt
EFFEST OF HEALTH NFORTATPII TECI{ilOLOCVAT KEY gTAGE9IiI THE Prc|CESS OF
TEDIGATIoTI USE

dil
ngorandke*nm

Tte1tarril*in rrp+r. 11*

T.rrteiptio!

6hgodAerm4Il*ofd

If,Ihctl,r& l$ldrrdt dod

:rgdanr rnrSn&acrltn

unfr

6*119 b.rddl *rr!!ert

mtcfut'or

ir.dbtliln
rdmlnmnAon

rsd

sedour mrdkrtiolieimrs
\AtHfi

Sqroa' Eic G. tun, at al,

Jn l

tcc*te-NlO,

brr<cdr rlllR,5U6 cduc$on

EM d tu-Oo*ta Tadrn*gy on 8n S!frly d ltffiott

d.8Z

W. t@F|mt.

AdrNtrsldbn,'

tug&lnd

Page

gBttc038
Exhlbtt2
SUNTARYOF HOAFfTALS IIIVOLYED Iil PRE'ECT HUGO

Acnto-crrc

Irondon

Ilcdtl

Sdenccc

Ccntre

t98

Phsvtdcs tbe bmodest mrrge of paliem scrvioes of any lbspttal in

bmH4rnd

(offcri4

rtccrrch
hotpfrrl

Pnsvidpd carc

et&io

carc in 5l ditrera* ryccidfties)

b more thsp I million paticats in thc past ycar, includiog the


mo$ medioally conplem and criticdly ill pdienb io tbc rgion
Home to South $hect ltospital, Unive-rsiS Hospital

Vimia Hospial,

Gildren's Hospiblr Byron Faryily lvlodical Ciltre, Victdis Farnily Mtdical


Ccmc London Rgional koer Progam, FowletKennedy Sport Medicinc
Clinic CSTAR (Canadiar Surgical Tcchnologies & Advanccd Rotodcs)
srd Lswso*r Hslth Rcscarch Institute
SL Joacphtr

Meior prdent

IlcltthCrrc

crrqtcrctiry

Prwides a broad r6ngp of petint cam, inc'ltdkg ou$atieng bng-tcrm'


rionsl mentd heal$r,rclrabiliatbn, pallixiv, vFrns and ryecislized

rnd roorrch

ge&tric servicrs

r27E

ccotre

Home to $r Joseph's llopitat, HmooCHospital Rsgklnel I{cntal Hatlh


Can (tnndon & St Thomas), MountHope Cntrefor Lottg-Term Cart' the
Ivy EVelnstihrbi udLawson Resnarsh In$itft

Uiglglfc pwfu *n@s b tlplsllowirW rvfud


b{ct**lm

maoamrd svRtam
uomruBtty

35

lwpttals, ircbdiag dc operattw of a slwed electrcslc lsolth

Alr asute- md continuingr hosPltal offecing

varicty of rcrviceq

inolufug rdical, day Eulgery aod thcrapy u morc than 20,(F0 padants

hcatfrcarc
provider

snually

(bmmrmity
healtlmse

LIv![-Ir

Scruas Inqersoll end 6esurrcrtdlnc ata


Cornpmed of tistowpl Mwrid HosPita! (tlvffD and Winghmr rnd

{T

DisrictHospital

p'mvidcr

WDH:

furidi:s

34

Commnity

SlvtGII:

healthcare

54
FiCHS:

provider

l6
Community
healttrcaF

t9

nrrvider

Comnmity
health cue

tffi

pwider
Comrudty
healthse

$DH)

ntmetous stti* inoMng Mdidre, Eme4atcy" Oncologt and


.Winehem
Sunaem to the nlas of Li$swel and
(hneral
Hocpital ard Four Courtrics
Cmposed of Srdroy ldiddlesot
Hcclth Str,,icgs; scnes a osmbinod rta of 5E,0fi)rcsidcats
Focuses on providing ougatien! diagnostic and ambulalory caro to the
srrtrrndino rnmmrrnitv
Scrves aprproximately l 9,fl)0 clicnb within the Muicipatity of Sotilh Htmfl
md {ircot communities, ofering bo$ aeute aod chronic caac
Provids mpdiinp, surgpry, ob$erics, pedieics, mc$hsia, emergency
endfunilymedicino scrvices'to St Thomassnd b Elgin County, whi* is a

cddimert

qrB

of E9'0oo residstts

5t

Provides numsous carg strviaes, including medicine, surgery, qncrBrlc'y


and mcnlal hath b the rsidcntsof 6e Tillsonburg area

ll3

Srviry;ffiot

providcr
Gornmunity
hatthcnrc

host of ser.vices,

mider

rrehabiliratiur

arce of more than 54,@0 rcsideots"

wGIr provides a

incMing critical care, nrgery, ambulalory calp and

tB{{c038

PagF {0-

Erhlblt 3
OROAI{trATIOM1 Y|g|gil STATETEHT8
Londqr

HaIh qcbncec hr0t i

Thle

\rndon

rm afirr$r* vker - Enofrard ffi,

ffilif l*tmffir - r* h.hlJCC k*

ffil$rryttodG rd

rfunh:oryrnerilon

Srarr3ft

ulrhhw* ca rxh.ctrhrlt aryvrrt brs"

Sourcs: u18C htbnnl dor;unsilEfiin.

8t Jo.cphl [b.Ah

Garsfs Vblon

From the shortest visit to the longest sry, we eam ccmple& confidence in tho cale we provide, and make
alastingdiffernos infu otmtto live frrllv.
SoryDa: Sl.

Jogptrbfroalfr Cr,n,

l-o,1dq, Wrl{vvtw-ryhclrrdononca/rrischrrvdebmadrrs

hge

gBfio&t8

11

ExhlHi{
GUFRETY

ffi EICATPfl

WORI(FLIOYS

Trair{llil,
rilrs tr'
ft' il
litA*

ErErcil$
rL 7 LoetCh*a
Nlttrntrt}rtr

tt*n*;,r:ls*

lio F.rtl
F til|*6s

l
ry"dt
T \"-il
l

gepyr io tLr
$snd Ca
I

x$ify
lhr Hgrr*

FhgtndumCtrl

ildryWrrd dil.rffffS{

NrtftS

tie*io*s Sharis
Valide{e Sd{tr

Trsmciht b

l*J\R

Serd Sopy tn Fr

P}IARI*C!
PfiABn4cliT

RxrivrOr*r
iacrivrOa*t
ffi

rd*V*rffier
6sd*V*rfficSr
d*V*rfficSsr
?r*r!*ttbo
rarltcrbo
R
Arltrrbo i6
tt RX
ft

S*tgb*a

ttf.lisa{tDr:

Skti*xaa

trerg$ltsrrsrrs

Pre- CFOE

OoecReconcili*tbrti -- 24 Key
l-ranractitffls
Itrn.'al Bi$rnc

Abb;Rfl=ragdrpclrrnse,'tlARcmaM

qty

$rrca'

OjSC lltsnC

fuanlelffioa

afch#onmd f*=W

SOEr 8@uEtbtrNwrdaroftar

Psgs

f2

9B1tCoS
E

filb[5

PrcFOSED HUCOWORKFLOIfl

I'lg/rr QfuE

- qr$y'rt&rd pltdtbr

Source: LHSG rrmund

Dc.&flffi,

otdpr

efty:

elllR'

cboilronb ncdlrd

ffinisdlrqr. B@d

9BfiS3E

Prse 13

E$iHt6
SATPLE HATIilRITTE}I TED|CATIOI{ ORDER

ErhtbltT
SATPLE HUGO NED|CATION OruER

t t# nio&ut 0# il@I'$,P9,0+,Bor|r.ll/lttU$UIOESI
n i# *Mrdenc 0*nd firslS.P0,D4,Rnlh,1U{AmmmE$T
n

!s 8d,

o'*d

*Hffilfr*lfrHn*$nrsE$T

f b# hd$uitt5rffil $fid 0[l[tB,TlB,F0,0tt R0d!],ll/12il[$ftmE9T


odd 5rfi,IAl.Pfl,D*.nilit ll/lAmsmoE$I
r b# hh4d
$sds ftEnplth Hl,0l0 fi lim a4l, 11fl1dn'A:ftOE$T
Sonrco;

Lfl$C lolond Dor,uneffin

rop14

Bltc038
Edllbltl
CHATEES FOR CLITIICIAT{8

Phyrician Ordcs

'r
r
.
r

.
r
r

ftcarc.haadurittenonpap.

Handwritilgisotcerdiffcultto

&iSa!

No urbnratic alsts or wanringr if &sc


isunolrg or paticot b allergiato $e
dr$C,

Physician'mrr*havethechlt
hardsb wibdrc order.

inftcii

Nunrc.mroually rvriics ngw orders to

paperadahiuftqr rccord

lrhrseadrnioistrsmsdicaiiorwithno
double

c,hr* or safety nct

Nursedocumests.adminigation
manually onthc papcr record"

In tbc pryer world, rnany policles and


processGs arc not adrred to,
puticdady if thq re n* pcrmired by
stafrto bc importad" For omplc"

medicatimr mu* be a&niqisrs$d


within onc hour of the ti'netlcy aro dre.
This tlmc roquircd i! not trccked
carcfirlly ia apaper worldand no
rcpertussiogr rpsult wben a dose is

r
r

Plrysiciaacanorderursdicctlons
for arry pcienq anywhere,
auytime bmrsetlrey acccss
clwt thougba conpub.

dre

}lmd*,riting legibiEty is a non-

$se.
DospmngcdleckingnNtesand
evids!e cffir sae, higlrCqllity oara Physioim rGceives
a w$ning if thc &qg orderd is

ldodietionsrycardirecrlym

elscxlonic rnedicrtion
gdfidrishatioo lecord"
ldedicdiorq petientand nurse

st

becodcd to artomstically

oonfiror that they are conect

Nursefma[yhas adreckattlre

Intheefemnic$d!4 6c
urrse will rcceive a nr nrirg
uftea adosc is late or er$.
the dosc fu-notgiven, an

tf

inddnt rport is gEosttcd,


leodiagto m Grglsnation bhg
fesuird by the aurse.

Pegp

tj

98fiGo:n

Eril*t*t

TOF,IO REAgOilS COTPUTERIZED PRO,IDER ORDER EII|IRY TCPOEI trFORT8 FAIL


Pesqipton

Rcrson

t. li[otivgtic

irylltmmn

frr

irnplemcntation is drivcn
by my&ingh*pdicrs

cStt
2" Laok

mUganon Slratssr

Tbc p|rposs of
nust bG
quality cfcare sad safry
(not a
echnobgr tfll or
a&rrinisnafoe poject). Carnot bc pqpcivcd

inffior

bbefrccdl

Tk cgsnizdidr

ofctlrity Ll

ttnst have a ffi

vision

ftromtim of C?0E
martsgrncot and

bdsneoatm

sq1.

as a poccss

of

ndhd

mtmeiely thc cofy of sdrs,

of a alca comtnicdbn gtd


Why is drangp ooc&tr?

CPOEvis,im

rcgardi4g tbeprpoec of CFOE

clunge

3. Ldofvisible
leademhlp support

Smim lcadcnhip is not visibly supportivg

ofthe cbsrye.

Sq&n Brrgcmsrt mrlt hry" an rnuEvring


oommihcrlt to tbc chege aod a[ bdtsviours

mrn nrfloa this corxniucrn

orpnizedmust

thcel

costsof

Ch3mlza$oru brgcf $out be mgoiqg


Thcy m$taccotxtt ftr
ttrrporsy dcncas* in poduc{iviry.

TLe

undsltir6d

codsofumcrclfp

owncrrhip. E!.hr srlsrlgis n$rittderiry thc


go-live pccss to tr&"ne ths impt of dseasd
pnoenivity. Consida a do*asc in pdiaat

5. ll/o'rtflowmd
pmcsscs slend

Orgmietions do nd fully apprecioetbe


onplex$ of emed uoddow ptoocases.

The org8nization musi conddcr &e totd costs of,


ovmer*ip Erctmcgtrng is rcgdrcd drfrtg ttc
go-lfuc proocs b rdroe 6 hrpaEt sf decrEa$d
pmdlcdvity. fusida a dcctcacc in pdcnt

4, CoSr are

oonsider

e&nisims a{dwlure?

oscrrady andoompleef

susis otui tcr4ted b siqly Isctd

nrped rndunder*ood"

eeirpqslmmual

6. Valuc

users

pmcesscs in

cloctmicrrryld.
Cliniciens musi undeisrd

not

tbe value

proposition Cliniciras cannst

appdrnt

tr

thc

CPOEas clericgl r+o*.

drnlaqiorr* atd volufas?


Usc decision*upport and crridencstssed

Dcmqr$rale thd tlrc beoefaofth lystrt

mtscd EFt oc$ss$.


nungls.
Rccruilrred critcrh will includ. qpqiw wi&

carmotbe

Pmjcctnungemnt
mcfho&logr ismt
followod to Edrecc
spcod b knplcrnsrt Tte
7.

Rcquircs very tigbt pmjsct mgdlgctnot atd

acountrbi$ty

inplenenulion

drcy heve nrcccssful$

- projlcts srd lulrc aorc


colvcrted J3 CPOE
tr CFOE onoiecls in sorres$.

om!
Cmsidcr ussbility, qyebm pcrfomuacg
sigrr oo, cficta. Dwicefuloyrn$tand
80eGs;

9. Training and support

seoior projlct

xrewill cnpgsCeocr!o assi* hqtr

their

8. Tcchnologr

rerrided bv tbe

Bnd$f ircltded for

CFOBiuphcaador

misrahbelid6ar
hosp,itals can do it on

or&

s{s,

Rcquirc

qlbcr bdp

at thc clbow.

rsrovedtoosom

tfin

Slgr-on sffiegr will be in placc bc$atgo.live.

Clinical inftrmdcc IT *ltralrd clinieiaos will


deatgo intcrfrces !o ensurc usability. Plauing on
tqn deviccs ocrourge!
Will have 24f support on site br6 rrtcks

{Flrtrned}.
hEvp soeific rhvsicisn tplp line.
IT staff will suppon fu sY$m Un aftr he
g*,live dab. For ongoirg opimialioa issues an

Will
10,

Ncoptiniztlior

pntoc[is

Noed a plan for rrpid action asdchmgc


wift
sfter$e go-live {de b
unocpocred irwcs. Ncod aptnn to o$imize

&l

thesy$EoMonfto&ack

e+uggpsttotr

bo( wilt be inplam. Clinisl

Inftilmstics team uvl[ be dcployd


with tdns.

in&rsEt

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