Published: 2014-06-30

IT manager shares their experiences of Sweden’s first ”Big Bang”

– We see the changeover to a new healthcare information system as an important investment for the future and a way to help meet the requirements for effective and safe healthcare. However, one must not underestimate the administrative burden that the transition to a new system entails.
These are the views of Marit Nilsson, IT manager at Region Jämtland Härjedalen, following the introduction of healthcare information system, Cambio COSMIC R8.0, which was implemented throughout the region’s healthcare network just over three months ago.

The reason for the change was that the previous IT system was becoming obsolete, having been introduced back in 2005. The region wanted access to a modern, technological IT solution in order to better support healthcare processes. The change will affect approximately 2,500 users at Östersund Hospital, around 30 health centres and some district nursing services.

Loyal employees
– Employees, who are out there working in healthcare, have been very loyal throughout this process, despite it being exhausting at times. And there is still a lot of work to be done. But it’s nice that we have got this far, says Marit Nilsson.
Region Jämtland Härjedalen chose to implement COSMIC in one single transition, instead of gradually introducing the IT support service into the organisation. One reason for this was that employees would avoid having to document information in two parallel systems, explains Marit Nilsson. The implementation phase has been named the “Big Bang”, and it is the first time in Swedish healthcare that a county or region has replaced its entire healthcare information system in this way.

The technology is the simple part
To implement a new IT system in this way is a huge business project, where the technology itself is actually the easy part, says Marit Nilsson.
Marit Nilsson says that they have not encountered any unexpected problems with COSMIC during the period that the region has been using the IT system. Everything has worked as planned – even during the very hectic first day. She believes that the region’s decision to not migrate any information from the old system was the reason for the administrative burden being greater than expected.
– It would obviously have been possible to transfer information, but we wanted to start with a clean database. By starting from scratch, we ensure a high quality of information. This is a great advantage in the long term, but it also means that staff need to manually enter some basic information during the patient’s first contact with healthcare services after the transition to COSMIC. And this has taken more time than we anticipated, she explains.

Crosses the finish line next spring
According to Marit Nilsson, there has been an extra burden in primary healthcare due to the high number of patients there.
– There is a large amount of information that needs to be entered during a working day. And some tasks can only be handled by a doctor, for example, prescribing drugs and creating new medical certificates, she explains.
However, the administrative burden has not had a negative impact on patient safety, highlights Marit Nilsson. The patients may have noticed that there has been reduced availability during certain periods. For example, they may have experienced longer telephone hold times and more difficulty in making appointments.
Marit Nilsson believes that the large business project will cross the finish line in March next year. It takes roughly a year before all the functions are fine-tuned and all chronically ill patients are registered in the system, she says.

Support from Cambio
During the process, Region Jämtland Härjedalen has received support from project managers and support staff from Cambio Healthcare Systems. One of those involved in the work was product manager, Johan Thorwid. He is pleased that Cambio had the opportunity to participate in and influence the implementation of COSMIC.
– We supplied a basic configuration of the system in order that the region could save time during the preparatory work. This configuration is based on the experiences we had from implementing COSMIC at eight other Swedish healthcare facilities, explains Johan Thorwid.
Right now, work is underway to adapt this basic configuration for the region’s specific needs. Step two is to start preparing for the implementation of R8.1, which is the next version of COSMIC.
– This work will start after the summer and will run in parallel with finalising the implementation of R8.0, says Johan Thorwid.

Marit’s top tips
Marit Nilsson emphasises that the introduction of R8.1 will be a new challenge and a project in itself.
– However, we have learnt a number of things that we will benefit from knowing when implementing R8.1. The most important factor is to have committed managers who take responsibility for the implementation in their healthcare unit. Also important, is that the work is seen as a business project and not just an IT project. In order to get the maximum benefit out of the IT system, you must focus on healthcare processes and procedures, and work to develop them, says Marit Nilsson.

Workshop in Almedalen
Take advantage of the experiences gained from Sweden’s first Big Bang. Anyone wishing to know more about the experiences gained from the COSMIC-implementation in Region Jämtland Härjedalen, are invited to a Cambio workshop with IT manager Marit Nilsson, in Visby during Almedalen Week.

Location: Mellangatan 18, Payexhuset, Visby.
Date: July 1, 13:00-13:45, “Sweden’s first Big Bang – the implementation of a comprehensive regional IT support service which keeps the patient in the very centre.”

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