HITC Workflow Webinar 4.24.12

The Health Information Technology Community

EHR Workflow: Easy, high-impact changes for accelerating implementation success

Michael Levinger• President, CEO and Co-founder of The HIT

Community • 30+ years of experience in the successful

use of mission-critical software including EHRs and Health Information Technology

• On the faculty of Boston University teaching a masters degree course on Electronic Health Records

• Serves as the Health IT “Ask the Expert” for Pri-Med

• Member of Massachusetts REC workgroup on Health IT Workforce Development

Welcome!

The HIT Community Services

Create and manage online collaboration solutions

Manage public, sponsored nation-wide online communities

Consulting services on communications & collaboration strategies and online social communities & media

Supported by data analytics

Agenda

• Overview of workflow Re-engineering• Healthcare processes impacted by EHR

deployment• Workflow re-engineering of healthcare

processes• Critical Success Factors• Questions & Answers

Polling Question

• Put in polling question from last time on where attendees are in the EHR deployment process

Healthcare Clinical Processesworkflow: n., in an office or industrial organization, the sequence of processes through which a piece of work passes from initiation to completion - Oxford English Dictionary

Laundry Process

= Success!

Example:Laundry Process

What is what we’re told we should do? (Perceived As-Is)

What do we really do? (Real As-Is)

What should we do? (Should-Be)

Common Workflow Improvement Methodologies

• Total Quality Management (TQM)

• Business Process Re‐engineering (BPR)

• Plan‐Do‐Check‐Act (PDCA)

• Six Sigma

• LEAN Systems

• LEAN Six Sigma

Polling Question

• Have you ever done a structured business process redesign?– Yes– Now

EHR & Healthcare ProcessesPeople &

CommitmentPeople &

Commitment

ProcessProcess

TechnologyTechnology

BusinessBusinessGoals

&Metrics

Major Healthcare Processes

Clinical Business

Clinical BusinessTime management and scheduling

Reviewing diagnostic test results and clinical documents

Diagnostic test ordering

Patient encounter documentation

Electronic prescribing

Electronic signature

Clinical decision support

Disease management

Data analysis and report generation

Patient education

Clinical BusinessTime management and scheduling

Reviewing diagnostic test results and clinical documents

Diagnostic test ordering

Patient encounter documentation

Electronic prescribing

Electronic signature

Clinical decision support

Disease management

Data analysis and report generation

Patient education

Registration/Check-in

Schedule

Clinical encounter

Patient education

Billing

Patient Check-out

Conducting a workflow evaluationAgency for Healthcare Research and Quality identified 6 major categories of impact on workflow

1. Reminders, alerts, and reports that, when provided, increased efficiency and improved workflow.

2. Administrative and clinical workflow, and work/job design that have positive and negative impacts on workflow and job content

3. Patient-provider consequences of the health IT system that affected workflow

4. Interface design that affected job content and workflow

5. System integration that, in all cases, positively affected workflow

6. Planning activities and their impact on workflow

Carayon P, Karsh B‐T, Cartmill RS, et al. Incorporating Health Information Technology Into Workflow Redesign‐‐Summary Report. (Prepared by the Center for Quality and Productivity Improvement, University of Wisconsin–Madison, under Contract No. HHSA 290‐2008‐10036C). AHRQ Publication No. 10‐0098‐EF. Rockville, MD: Agency for Healthcare Research and Quality. October 2010

Question

What are key processes you feel you need to redesign as part of your EHR Implementation?- Patient Check-in- Intake- Exam- Diagnosis- Order Entry – Diagnostic or Treatment- Prescribing- Patient Check-out- Insurance Claim- Other

Easy Workflow Re-design Steps

1. Identify what is the workflow and its key process steps?

2. What is key information needed at each process step?

3. What people are involved for each process step?

4. What EHR functionality is used for each key process step?

5. What are the benefits from changing/improving the workflow?

Easy Workflow Re-design Steps

1. Identify what is the workflow and its key process steps?

2. What is key information needed at each process step?

3. What people are involved for each process step?

4. What EHR functionality is used for each key process step?

5. What are the benefits from changing/improving the workflow?

Diagnostic Test Ordering – Example BPR

Create and Submit Lab Order

Get Acknowledgement

Order OK?Electronic Signature

Receive ResultsNeed More

Labs?Enter Into EHR Inform Patient

•Order Sets•Order Protocols•Lab System (LIMS) Interface

•Lab System (LIMS) Interface

•Clinical Decision Support•Order Protocols

•Electronic Signature

•Patient Communication

•Physician•Nurse•Lab

•Physician•Nurse

•Physician •Physician•Nurse•Lab

•Physician •Physician•Nurse•Admin Staff

•Physician•Nurse•Patient

•Diagnosis•Possible labs

•Lab acknowledgement

•Original Lab Order•Lab Ack.•Diagnosis

•Physician ID •Original Lab Order•Lab Results•Diagnosis

•Original Lab Order•Lab Results•Diagnosis

•Lab Results•Diagnosis

•Patient Info•Lab Results•Diagnosis

•Faster•Less Error Prone

•Faster•More available

•Safer•Faster

•Faster•Greater availability

•Faster•Greater availability•Improved Communication

Data Needed

Who is involved?

EHR Functionality

Benefit

Workflow

Get Acknowledgement

•Safer•Faster

Data Needed

Who is involved?

EHR Functionality

Benefit

Workflow

Get Acknowledgement

•Safer•Faster

Data Needed

Who is involved?

EHR Functionality

Benefit

Workflow

Get Acknowledgement

•Safer•Faster

Data Needed

Who is involved?

EHR Functionality

Benefit

Workflow

Get Acknowledgement

•Safer•Faster

Data Needed

Who is involved?

EHR Functionality

Benefit

Workflow

Doctor Office Visit Process StepsArea Task

Check in Make appointmentCheck in Check in with receptionistCheck in Look up patient informationCheck in Update formCheck in Verify insuranceCheck in Co-Pay Intake You waitIntake Nurse comes and gets youIntake Takes you to exam roomIntake Takes VitalsIntake Enters into health record - electronic or paper chartIntake Gets symptomsIntake Exam processIntake Nurse LeavesIntake Wait againExam Doctor looks at recordExam Review symptoms, vitals, etc. (SOAP)Exam Do tests and/or do orders (lab, radiology, etc.)Exam Get results via fax, electronically, phone or otherExam & Checkout Review resultsExam & Checkout DiagnosticsExam & Checkout Treatment planCheckout Inform PatientCheckout Follow up actions (schedule follow-up visit, referral, prescription, etc.)Checkout Billing

Medication Refill Process

• Original Workflow• 16 Process Steps• Substantial staff

involvement• Multiple Decision

Points

Source: California Healthcare Foundation Workflow Analysis: EHR Deployment Techniques by S.A. Kushinka, M.B.A. , Full Circle Projects. January 2011

MedicationRefill Process

• Post workflow redesign

• Now 7 steps• Substantially less

staff involvement

Source: California Healthcare Foundation Workflow Analysis: EHR Deployment Techniques by S.A. Kushinka, M.B.A. , Full Circle Projects. January 2011

Polling Question

What are some of the benefits that might come from workflow re-design in healthcare?• Reduced staff time• Reduced out-of-pocket costs• Faster• Better clinical care• Safer clinical care• Better patient satisfaction• Other

Workflow Redesign – Success Factors• You need a team:

– Of staff doing the work– Multidisciplinary– Include everyone involved in the process– Unemotional– Unbiased– Not “blaming”

• Focus on the “real” work flow – not the expected or prescribed workflow

• Workflow redesign should be an integral part of EHR implementation

• Get to the root cause of inefficiencies• KISS

THE HIT COMMUNITY

HITC Communities

Public HITC Communities

• Shared Knowledge used in Multiple

Communities

• Information to Engage Members

• Member Connections & Engagement

Managed Community• Standard Community Above

• Community Access Control

• Community Activity Reporting

• Plus Part-time HITC Community Manager

Standard Community• Public & Private Groups

• Content Management Tools

• Community Framework

• Community Site Operations

• Training Tools to Manage Community

• Integrated with HITC Public Communities

Other Services

• White Papers

• Webinars

• Learning Programs

• Email Programs

• Content Marketing Programs

• Data Analytics

• Consulting

The HIT Community• Partners with providers, RECs, QIOs and other organizations• Provides a ready-to-go knowledge and collaboration solution-

Tools / Data / Expertise• The expertise to succeed:

– Knowledge sharing, collaboration and communication experts -How to create conversation, engage members, and collaborate to achieve results

– Expertise in online knowledge, communication and collaboration tools– Quantify results – healthcare performance measures and data analytics

Voice of the people - Our mission is to help all healthcare providers through critical healthcare industry inflection points.

Questions?

HITC Workflow Webinar 4.24.12

Technology

SAP Workflow - My First Workflow _ SCN

Ponencia HITC ehealth Barcelona 2001

Workflow Management mit Nintex Workflow (Grundlagen)

Workflow Administrator's Guide - download.microsoft.comdownload.microsoft.com/.../WorkflowAdministration.pdf · 2 WORKFLOW ADMINISTRATOR’S GUIDE Introduction Welcome to Workflow,

Kapitel 3: Workflow-Ausführung, Workflow-Architekturen und ... · n Workflow-Server mit jeweils eigener Workflow-Datenbank auf n Rechnern Jede Workflow-Datenbank enthält Replikate

HITC Cost Budgeting Webinar 4.19.12

Workflow and Approvals Guide - Document Logistix … · Workflow Overview Workflow and Approvals Guide 2 Workflow Overview Document Manager Workflow is a feature that assists in the

Standard Workflow Processeslearning.employeeconnect.com/.../Standard-Workflow... · Standard Workflow Processes A reference document designed to help individuals use the Workflow

Introduction to the phenomenology of HiTc superconductors

MAS.S62 FAB 2 4.24.12 Error Correcting Systems n MAJ p p p p p p p p p k

Workflow workflow tools and design of workflow

HITC Attestation Webinar 1.11.12

The Argonaut | 4.24.12

Classifieds 4.24.12

Workflow Experience Simplified - Axisvationaxisvation.com/images/Workflow Experience Simplified.pdf · Workflow engine. SharePoint 2013 Workflows run on the Azure Workflow engine,

Workflow Management Coalition The Workflow Reference Model

By, Nasheet Ahmed Siddiqui. Agenda Workflow overview Workflow development Query for a Workflow Workflow category Workflow type Workflow elements Enable

HITC eLearning Modules Quickstart Guide health/Hamad International... · 2016-11-10 · 1 Revised 26-Jan-16 HITC eLearning Modules – Quickstart Guide This Quickstart Guide has been

workflow mining - ipd.kit.eduipd/institut/workflow/workflow_mining.pdf · Vorlesung Workflow-Management-Systeme Institut für Programmstrukturen und Datenorganisation (IPD) Workflow

Workflow - krutec.de · Workflow Dashboard, alle Funktionen sofort erreichbar Workflow Dashboard und Einstellungen Der Workflow Einstellungen Mit dem Workflow werden interne Genehmigungsabläufe