Chronology of a Successful KISIM Implementation - CISTEC

About the job

Chronology of a Successful KISIM Implementation

Since 2005, Spital Uster had been working with the clinical information system Phoenix and had invested heavily in individual developments and customised solutions. In 2016, the hospital management decided on a new KIS orientation for Spital Uster.

The reasons were as follows:

• the existing KIS solution had to be comprehensively renewed for various reasons (functional expansion needs, solution age with foreseeable end of support, change from paper curve documentation to digital documentation)
• additionally, a patient data management system (PDMS) was to be procured

The evaluation for the KISSUP project began in the second quarter of 2017 with a total of 8 providers, and the contract was awarded to KISIM/CISTEC in the first quarter of 2018.

The target architecture of the new KIS at Spital Uster included:

• integration into the existing administrative system (Navision), which was upgraded to a new release in parallel with the introduction of KISIM
• integration into the existing internal laboratory system (Opus-L)
• integration into the new radiology system, which was also introduced in parallel with KISIM
• integration into the existing universal archive

Implementation plan and preparation for Go Live

In July 2018, the KISIM implementation project started with the kickoff and installation of the KISIM standard hospital. The entire project was jointly managed by CISTEC, the external project management (CSP), and the internal project management.

The project envisaged two different Go Lives:

• complete replacement of the previous KIS in all clinics, outpatient departments, and wards in September 2019
• Go Live in the intensive care unit and anaesthesia in December 2019

During the concept phase, workshops were held for all clinical processes and their representations in the KISIM modules. Interdisciplinary working groups were introduced into KISIM under the leadership of CISTEC and the project management of Spital Uster and supported in developing the detailed concept with the necessary adjustments for Spital Uster.

In the realisation phase, the developed detailed concepts and specifications were implemented in close exchange between the core team, project management, and CISTEC and made available for ongoing functional tests on the customer test system. Due to the specific patient pathways developed by Spital Uster, the crucial integration tests took place towards the end of the realisation phase, simulating typical treatment processes in inpatient, partial inpatient, and outpatient settings on the KISIM now parameterised for Spital Uster.

According to the "teach the teacher" concept, certain "super-users" of the hospital were trained by CISTEC during the implementation phase for each professional group. The subsequent frontal training by the super-users gave end users the opportunity to familiarise themselves with KISIM in a role- and specialist-specific manner. The training planning was very challenging. Thanks to great flexibility on all sides and the parallel use of frontal training and training videos, all users could still be trained by Go Live.

KISIM – Go Live as a Big Bang

With a delay of just under two months from the original project plan, Spital Uster switched from the previous KIS to the new KIS KISIM on 19 November 2019. From this date, all newly admitted patients had their medical records (curve documentation, reports, services, surgery and consultation planning, registrations, etc.) managed in KISIM. "KISIM – Go Live as a Big Bang" means that KISIM is used for all patients and all processes, and the central additional systems are also connected to KISIM. For example, data was delivered via order and result interfaces to the laboratory system and the radiology system, which also went live on the same day. The archive was also connected to KISIM and integrated into the medical records from the productive start.

The intensive care unit started already with KISIM. The Go Live was brought forward here to prevent a media break. The staff in the intensive care unit could rely on the connection of the monitoring devices. The change from the previously mostly paper-documented curve to digital data collection in KISIM nevertheless posed a major challenge, which was mastered through the high commitment of the staff at Spital Uster and the active support of CISTEC on site.

In the first days, CISTEC, the core team, the KIS team of Spital Uster, and the external project management (CSP) provided active support on site and assisted all users in the transition to the new system. Minor errors were quickly fixed, and initial small functional adjustments were continuously applied to the productive environment.

Project completion

Five months after Go Live, the KISIM implementation project was successfully completed. Certain optimisations regarding documentation or processes are still desired and are now being reviewed and prioritised by the hospital's internal expert committee ("KIS Board"). Overall, users were able to fully record their documentation in KISIM from Go Live. They quickly became capable of operating the system according to their roles and functions and thus managing hospital processes. Demand-oriented follow-up training on individual processes was partly carried out. According to surveys and feedback from the core team, which is in exchange with the super-users, KISIM achieves high user acceptance.

Challenges in the project

Focus on functionality instead of processes

Due to limited resources, the project focus was strongly placed on mapping existing functionalities. Process changes therefore only occurred at a late stage, leading to additional effort regarding (follow-up) training and sometimes longer discussions concerning (follow-up) specifications.

Conclusion: In future projects, sufficient time should be planned especially for analysing existing processes as well as defining and subsequently communicating new processes.

From a highly individualised solution to a standard product

The introduction of KISIM brought a change from a KIS with highly individual solutions for individual users and processes to a KIS focusing on standardisation in all areas. This change to transparent and clear process management sometimes caused uncertainty among users, as cherished individual solutions were no longer available.

Conclusion: It is important, when introducing KISIM and the associated standardisation, to raise awareness among users, process owners, and stakeholders about the related benefits.

Parallel projects Navision upgrade and RIS introduction

In parallel with the KISIM introduction, the ERP system (Navision) at Spital Uster was also upgraded to the latest release. This overlap led to delays in project progress and multiple burdens on central internal hospital resources. Fortunately, the technical possibilities existed for necessary data transformations to be realised in the middleware Orchestra by Integic. Thus, part of the delays could be compensated. Nevertheless, only at Go Live did the last difficulties regarding patient and case data mapping become apparent, leading to considerable effort in processing.

Conclusion: In future projects, it is important to ensure that all ongoing projects and involved stakeholders in the hospital are considered for project-related resource planning of the KISIM introduction.

Authors: Daniel Haas, Head of Customer Management and Christoph Ledermann, Project Manager

Do you have comments or questions about this blog post? Write us an email at moc.cetsic@ofni, we look forward to hearing from you.