# data[].attributes.body
HIMSS Middle East, eHealth Innovations Summit 2016, Four Seasons Hotel, Riyadh, Saudi Arabia

Workshop Report:

The HIS workshop was conducted by Mr Mansour Al Swaidan on May 2, 2016. Eng. AlSwaidan is currently the Director of Patient Care Systems, eHealth & ICT Project at Saudi Ministry of Health and is a member in the KLAS International Advisory Board.

The topic of the workshop was “Implementation Plans, Challenges and Obstacles”.

The workshop gave an overview of hospital information system, HIS, and an insight into milestones of electronic health record, EHR, project.

Before going into the journey of HIS implementation, the presenter gave a brief overview of hospital information system including differences between HIS, EHR and electronic medical record, EMR, and different modules of HIS. According to the workshop, the benefits of HIS include enhancing access to care, enhancing patient safety, improving continuity of care, increasing efficiency, enhancing security, confidentiality, privacy, quality of care and productivity through KPIs.

The project milestone of HIS are: the (1) kick off, (2) gap analysis, (3) data gathering, (4) hardware configuration, (5) system build/configuration, (6) super user training, (7) testing (unit, integrated, regression, and stress testing), (8) resolve issues, (9) train the trainer, (10) end-user training, (11) user acceptance and (12) go live.

The presenter compared implementation of a greenfield project where a system is developed for a totally new environment and brownfield where the system is developed in presence of an existing system. The main issues with greenfield projects are shortage of expert staff, undefined policy and procedure, unclear operation plan and staff turnover and Prince Mohammed Bin Abdul-Aziz Hospital was given as a case study for staff turnover and the effect resulting from that on HIS implementation. On the other hand, the brownfield projects might have obstacles of data migration integrations, staff training and difficulty in adopting change.

Central implementation of HIS is better than decentralized implementation in terms of cost, time and complexity while centralized implementation is better in terms of reliability, security and performance.

The main HIS project success factors according to Eng. AlSwaidan are: organization readiness, change management, organization resources, policies and procedures in place, operation plans, leadership support, accreditation and dedicated resources on the project. And the main selection criteria are budget, properties and functionalities, in region experience, fully integrated modules, scope of work and number of locations. Implementation of HIS at king Saud University hospitals where the selection process went through many steps was given as a case study.

Eng. AlSwaidan mentioned that high cost of HIS solutions, data center readiness, user training, data migration, project management, proper change management plans, resource turnover, communication, testing and issue tracking are the main obstacles for implementing HIS.

Super users and build team have many roles and responsibilities as explained by the presenter including design review, workflow review, policies and procedures review, system administration, issue log and tracking, coordination with department for decisions,training the trainer, training end users, developing training manuals, providing support during and after go live.

The presenter ends his workshop by stating that the mission of HIS implementation team does not end after the “go live” phase. The team has vital roles after this phase especially in responding to the problems faced the end users in the first few months.

5

# data[].attributes.body
I am pleased to participate in this workshop as Mr Mansour showed the his real-life experience managing HIS in Kingdom Saudi Arabia.

He shared his rich experience in HIS implementation through case studies in different hospitals in the Kingdom.

Overall I am pleased to see all my MPH students engaged in the interactive sessions with Mr Mansour.

I will share the snapshot of my notes (on paper) from this valuable workshop.

A few important issues that should be considered:

a. What are the expertise needed to build HIS in house ?
b. How can Saudi Arabia depends less on vendor-based system?
c. What's the main role of Health Informatics personnel in HIS implementation?

# data[].attributes.body
Name:Hamad Al-anazi

Student #: 436106733

HIS Implementation Journey Workshop Report

This is the report about the" HIS Implementation Journey " Workshop by Eng. Mansour Al-Swaidan in the Four seasons hotel Monday May 2 from 9:00 am to 3:00 pm.

Eng. Mansour he took about several point related to HIS, in the beginning he give us introduction about HIS like the definition of HIS (Hospital Information System ) also the definition of EMR ( Electronic Medical Record ) and the HER ( Electronic Health Record) and the different between them

He took about the benefit and modules of HIS. Benefit like: Enhance access to care, Enforce policy and procedure Improve continuity of care Increase efficiency, Enhance quality of care, Enhance patient safety Minimize medication errors and enhance Security ,Confidentiality, and Privacy. Also he discuss the modules of HIS 4 modules it's patient administration system (PAS), Basic Clinic Modules (BCM), Advance Clinic Modules (ACM), and other auxiliary modules like patient accounting (PAC) .

He also discuss with us the Timeline and milestones for the project like: Kickoff, Gap Analysis, Data gathering, Hardware Configuration, System build/configuration, Super User Training, Testing (Unit, Integrated, Regression, and Stress testing), Resolve issues, Train the trainer, End-User Training, User Acceptance, and finally Go Live.

Eng. Mansour also discuss the Success and Failure Factors in implementation of HIS in 2 area (Green Field and Brown Field). In green field there is some issues like: Staff Turnover, Shortage of expert staff, Undefined Policy and Procedure, and not clear Operation Plan. And the good thing in green area is Fast Implementation, Less training, and easy adoption. In Brown field also there is some issues like: Data Migration, Integrations, Complex Training, Harder to Adopt change. And the good thing in implementation HIS in Brown field is Robust Policy and Procedure, Less staff turnover, Expert staff. And he mentions some factors for Success and Failure like Adoption/Change management, Organization IT readiness, Organization Resources, Policies and Procedures in place, Operation plans, Leadership, Accreditation (JCI/Canadian accreditation). He also present some case study in (real case) in Saudi Arabia about implementation of HIS.

He also took about the HIS selection criteria like: Budget National Implementations Properties and functionalities, In region experience, Fully integrated modules, Scope of Work (SOW), Multisite – Single site.

Also Eng.Mansour discuss the challenges and obstacles in the HIS implementation like: High cost of HIS Solutions, Data Center Readiness, User Training [Attendance, readiness and equipment], Data Migration, Project Management, Proper Change Management Plans, Resource Turnover (from hospital, from project), availability and dedication Interface, Communication and Testing and issue tracking. And he present real case for the Children and Maternity hospital in Dammam city as example .

He also discuss the Super Users(SU) & Build Team (BT) Roles and Responsibilities in the HIS implementation like: Design review, Workflow review, Review Policies and Procedures, Perform Tests, System administrator, Issue Log and Tracking, Coordinate with Department for Decisions, Train the Trainer, Train end users, Develop Training Manuales, Provide Support During and After Go Live

And in the final he discuss the final step in the HIS implementation which is the GO LIVE. Before go live make sure to avoid bad time to go live.

# data[].attributes.body
HIS Benefits  Enhance access to care where health care providers can access patient information anytime and anywhere. Minimize medication errors through the alerts and reminders. Enhance quality of care through the clinical decision support. Enhance patient safety through safe medication management. Enhance Security, Confidentiality, and Privacy through access control where only authorized employee can access specific patient information. Enhance business workflow through the electronic patient information workflow.  HIS Modules  Patient Administration System (PAS) such as Health Information Management (HIM), Patient Registration, Chart Tracking, Scheduling and Appointments (SAP) Inpatients AdmissionDischargeTransfer (ADT), and Outpatients Visits (OPD)
Basic Clinical Modules s uch as Laboratory Information System (LIS), Pharmacy Management, Nursing Management, Nutrition Management, Radiology Information System (RIS), and Operation Rooms (OR)  Other Auxiliary Modules  such as Patient Accounting (PAC), Patient Portal, Integration Engine, and Business Intelligence (BI)  Project Milestones Kick off  Gap Analysis
Data gathering
Hardware Configuration
System build/configuration
Super User Training
Testing (Unit, Integration, Regression, and Stress testing)

Resolve issues Train the trainer EndUser Training User Acceptance Go Live  Green Field Hospital  Green field hospital means new hospital and implementing HIS in those hospitals has some negative aspects such as Staff Turnover could by high, shortage of expert staff, Undefined Policy and Procedure, and Not clear Operation Plan. Some of the positive aspects are Fast Implementation, Less training, and Easy adoption.  Brown Field Hospital  Mean it is a hospital which is already in business and have its own database and exciting policy and procedure. Some of the challenges in implementing HIS are Data Migration, Integrations, Complex Training, and Harder to Adopt change. Some of the positive aspects are Robust Policy and  Procedure, Less staff turnover, and Expert staff.  Success/Failure Factors  In any HIS implementation, we should consider success and failure factors such as Adoption/Change management, Organization IT readiness, Organization Resources, Policies and Procedures in place,
Operation plans, Leadership, and Accreditation (JCI/Canadian accreditation).  Request for information (RFI)  The request for information provides a format for gathering information about which vendors able to meet the highlevel requirements. It is simply looking for information.

Request for proposal (RFP)  The request for proposal provides the official request for vendors to submit how they will meet the requirements, which are more defined and include timelines and budget details. RFP is more official than the RFI.  Selection Criteria  Selection criteria is based on your Budget, your National Implementations, Properties and functionalities, your Scope of Work (SOW), and if your implementation is going to be multisite or single site.  Obstacles/Challenges  Some of the obstacles and challenges in implementing HIS are High cost of HIS Solutions,
Data Center Readiness, User Training [Attendance, readiness and equipment], Data Migration, Project Management, Proper Change Management Plans, Communication, and Testing and issue tracking.  Roles and Responsibilities of Super Users  Some of the roles and responsibilities of Super Users are Workflow review, Review Policies and Procedures, Perform Tests, Issue Log and Tracking, Coordinate with Department for Decisions, Train the Trainer, Train end users, and Provide Support During and After Go Live.  GoLive  Golive is not the end of the story. It is actually the start of a new chapter of the story where you need to retest your system, modify your policy and procedure, do process reengineering, change your workflow, and do the maintenance to your system.

# data[].attributes.body
On 2\5\2016 we attended HIMSS workshop with Eng. Mansour Swaidan in Four Seasons Hotel, Riyadh about HIS Implementation plans, challenges and obstacles. In general, it was very beneficial and we had very great time at workshop.

the objectives of this workshop are:

•   Introduction to HIS Benefits and Modules

•    Timelines & Milestones

•   Success and Failure Factors

•    HIS Selection Criteria

•    Challenges & Obstacles

•    Super Users & Build Team Roles and Responsibilities

•    Go Live

Firstly, Eng. Mansour Swaidan introduce himself as assistant to the general director of information and communication technology in eHealth Program and

member in the KLAS international advisory board. Then he briefly explain KLAS as organization that evaluate EHR.

Secondly, he started workshop by introduction. during introduction he defined hospital information system HIS as comprehensive, integrated information system designed to manage all the aspects of a hospital's operation. while Electronic Medical Record EMR is a digital version of the traditional paper-based medical record for an individual and represents a medical record within a single facility. However, he defined Electronic Health Record EHR as official health record for an individual that is shared among multiple facilities and agencies. moreover, he discussed benefits of HIS such as, it is Enhancing access to care, enforcing policy and procedure, improving continuity of care, increasing efficiency, enhancing quality of care, enhancing patient safety, minimizing medication errors and enhancing security and Privacy. After that, he showed us a videos about HIS benefits and experience of some health care worker after implement HIS in their facilities( video URL https://youtu.be/EXxJOwXwPKw). In addition, he talked about HIS modules which is divided into 4 modules, Patient Administration System (PAS) for example, Patient Registration, Basic Clinical Modules for example, Pharmacy Management, Advanced Clinical Modules for example, ICU, Other Auxiliary Modules for example, Patient Portal.

Next, he discussed the main project milestones that is,

•       Gap analysis

•       Data gathering

•       Hardware configuration

•       System build

•       Super user training

•       Testing

•       Resolve issues

•       Train the trainer

•       End-User training

•       User acceptance

•       Go Live

Furthermore, he compared between green field hospital and brown field hospital which is to say that:

We concluded that the implementation of new HIS is not that easy.

Then, he showed us some of case studies in Saudi Arabia that have had failed or face some obstacles with their HIS for many reasons for instant, Mohammed Bin Abdulaziz hospital they failed due to stuff turned over other example, Sultan Humitarian City,HIS implemented by their IT and the cost to replace the HIS was above their budget. Other example, King Faisal hospital in Taif, they build their system from scratch which have a bad quality comparing to systems that bought from HIS vendor like CERNER or EPIC.

Then, he discussed HIS cost and best practice that are depend at research and development, quality, continuity, stability, multi-Site, technology, upgrades and standards.

In addition, he talked about success and failure factors which are:

•       Adoption or Change management

•       Organization IT readiness

•       Organization Resources

•       Policies and Procedures in place

•       Operation plans

•       Leadership

•       Champions

•       Accreditation

•       Dedicated Resources on the Project (Super Users & Build Team)

After that, we discussed main Selection criteria that are budget, national implementations, functionalities In region experience, fully integrated modules and multisite or single site. Then we discussed the obstacles and challenges of HIS which are high cost of HIS solutions, data center readiness, user training, interface, communication, project management and data migration.

Finally, we discussed super users and build team roles and responsibilities which including design and workflow review, perform test, review of policies and procedures, train the trainer and end users and provide support during and after go live. Moreover, we discussed Go Live.

Overall, it was very interactive discussion, answering all questions that rose from the audience and sharing experiences with others.

# data[].attributes.body
Mr. Mansour beginning his talk about HIS Benefits such as Enhance access to care ,Enforce policy and procedure, Improve continuity of care, Increase efficiency, Enhance quality of care, Enhance patient safety, Minimize medication errors, Enhance productivity through ,KPIs dashboard, reporting, Enhance Security, Confidentiality, and importance of Privacy part. After that, he present a short video talking about the HIS benefits.

In addition, he talk about HIS Modules like the first: Patient Administration System (PAS), which includes Health Information Management (HIM), Patient Registration, Chart Tracking, Scheduling and Appointments (SAP), Inpatients Admission-Discharge-Transfer (ADT), Outpatients Visits (OPD), Emergency Room Visits (ER).The second model are Basic Clinical Modules and it includes Laboratory Information System (LIS), Pharmacy Management, Nursing Management, Nutrition Management, Computerized Physician Order Entry (CPOE), Radiology Information System (RIS), and Operation Rooms (OR) Management. The third model are Advanced Clinical Modules and includes ICU/CCU, CCSD, Anesthesia, Dental Information System, Cardiology Information System, Endoscopy Information System, and Dental. The last are Auxiliary Modules such as Patient Accounting (PAC), Patient Portal, Integration Engine, and Business Intelligence (BI).

In the second part of his workshop he talk about Timelines and Milestones  Many have been mentioned like ; Kick off, Gap Analysis, Data gathering, Hardware Configuration ,System build configuration, Super User Training, Testing (Unit, Integrated, Regression, and Stress testing),Resolve issues, Train the trainer, End-User Training, User Acceptance and finally Go Live. Moreover, the journey does not end so there are issues arriving soon.

He talk also about the differences between Green Field  and Brown Field and what the issues that facing the green field like Staff Turnover, Shortage of expert staff, Undefined Policy and Procedure, Not clear Operation Plan, and the Features like Fast Implementation, Less training

Easy adoption. In other side the brown field and the Disadvantages of it; Data Migration, Integrations, Complex Training, Harder to Adopt change and the advantages are Robust Policy and Procedure, Less staff turnover, Expert staff.

Then he speak about National implementations, Centralized or Decentralized Approach and which are better than other  ,Among these topics Cost, Time, Operation and Maintenance Cost, Reliability, Performance, Security, Availability, Complexity, hardware cost

The third panel discussion at the workshop it was about the Success and Failure Factors, including the following; Adoption and Change management, Organization IT readiness, Organization Resources, Policies and Procedures in place, Operation plans, Leadership, Champions, Accreditation (JCI, Canadian accreditation) Dedicated Resources on the Project (SU & BT) And he mentioned an example was reported on bad decision-making administrations of hospitals in Qunfutha Hospital and Sultan Human City.

The fourth part of his discussion was about the HIS Selection Criteria and he mentioned the following criteria ;Budget, National Implementations, Properties and functionalities, In region experience, Fully integrated modules, Scope of Work (SOW), Multisite – Single site. Moreover, he talk about a case study for King Saud University.

The fifth part of MR.Mansor talk were about the Challenges and Obstacles that facing HIS and he mentioned the following; High cost of HIS Solutions, Data Center Readiness, User Training [Attendance, readiness and equipment],Data Migration, Project Management, Proper Change Management Plans, Resource Turnover (from hospital, from project), availability and dedication , Interfaces, Communication, Testing and issue tracking. In addition, he bring a case study of Children and Maternity hospital in Dammam.

In the sixth part of the workshop he talk about Roles and Responsibilities and the pints he focus on it are; Design review, Workflow review, Review Policies and Procedures, Perform Tests System administrator, Issue Log and Tracking, Coordinate with Department for Decisions ,Train the Trainer, Train end users, Develop Training Manuals, Provide Support During and After Go Live. Moreover, Extreme data confidentiality, Knowledge transfer, Narrowed Vision - No process improvement, Team Work, Staff Overload, and finally Communication Issue.

The last part was about the final stage of HIS implementation (Go Live... What's Next ...) He mentioned that the final stage does not mean the end of problems. It is the beginning of a new stage and a journey may be it will be full of surprises; we must be careful about Bad timing As well as bad planning which may be dangerous to the success of the entire HIS project.

# data[].attributes.body
HIS Report: At the beginning Mr.Manssor mentioned the difference between EHR & EMR. He described the EHR as the canal between hospitals when the exchange of information happens, while the EMR is the system of one hospital.   HIS Benefits

•       Enhance access to care •       Enforce policy and procedure •       Improve continuity of care •       Enhance quality of care •       Enhance patient safety •       Minimize medication errors •       Enhance productivity through KPIs/dashboard/reporting  •       Enhance Security, Confidentiality, and Privacy

I learned how important to understand and follow the project milestones step by step to enhance the success of HIS implementation.

•       Kick off •       Gap Analysis & Data gathering •       Hardware Configuration  •       System build/configuration •       Super User Training •       Testing (Unit, Integrated, Regression, and Stress testing) •       Resolve issues •       Train the trainer & EU Training •       User Acceptance •       Go Live “is a term used when implementing new information technology.”

Mohammed Bin Abdul-Aziz is example of the green field hospitals, which means implementation HIS in new hospital. Some people think that easy to do, but actually they faced too many issues such as staff turn over, lack of operational policy and standard workflow.

Best HIS should have research & development center to improve the quality, continuity and follow the advanced technology. Also, standardized HIS is very important to have upgrades in the right way and integrated health exchange.

The human resources required for successful implementation and both technical support and change management support are needed ‘IT readiness’. We need to train and engage our resources to the project from early stage such as stakeholder, super user leadership or doctors to prevent resistance. Commit to make the implementation on time because we don’t want to lose our resources trust and to keep them optimist. Hospitals with JCI/Canadian accreditation has high rate of successful implementation in less period of time.

The difference between RFI & RFP

|   Request for information (RFI)     |   Request for proposal (RFP)
|   The request for information provides a format for  gathering information about which vendors able to meet the high-level  requirements.      |   The request for proposal provides the official request for  vendors to submit how they will meet the requirements, include timelines and  budget details.

# data[].attributes.body
HIS WORKSHOP BY YASSER ALOTAIBI

Today I attended  workshop with  Eng. Mansor  Alswaidan about hospital information system and it was really excellent workshop .

During interactive discussion we discussed definition of HIS, EMR and EHR  and we discussed the difference between them and we see that HIS is the umbrella of all information systems in a hospital including electronic medical record "EMR" while EHR  is the EMR in multiple health care facilities .

And we discussed some issues about the time needed to implement HIS and the misunderstandings about the HIS implementation duration and milestones of HIS implementation process and we see that the time of implementation will be different according to the requirements and the size of the hospital and to which extent the vision is clear about the      work flow .

Then we talk about the success and failure factors ,including the good design of HIS and its covering for the organization requirements , attitude of end users , support of CEO , stability of the employee , efficacy of training , infrastructures "including even the electricity " and other factors .

Then we discuss the selection criteria of HIS "EMR" including the choice of developing the system from scratch to choosing one of the best practice EMR like EPIC and CERNER and we talk about the deference in price and the causes of high cost of such systems including the grate budget of research and development and the rapid turnover of the technology and the barriers of updating the old versions of these systems.

Then we talk about the role of superusers in implementation and training of the other users and the impact of turnover the employee on this process .

The discussion involve the challenges during the implementation including the language , communication , training , shifts and night duties and other factors ,

Finally we discuss the Go Live and its success which related to the testing the system during the implementation and the critical time during the first days of  Go Live.