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The Toolkit resources/workflow-assessment-health-it-toolkithttp://healthit.ahrq.gov/health-it-tools-and- resources/workflow-assessment-health-it-toolkit
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. . . for our health
The Value of ResearchParticipation for Practices:
A Case StudyErin Leege, MPH
Amy Irwin, MS Paul Smith, MD
Wisconsin Research and Education Network (WREN),
UW School of Medicine Department of Family Medicine
The Study: “The Toolkit”
• Agency for Healthcare Research and Quality (AHRQ) developed “The Toolkit”▪ Workflow Assessment for Health IT Toolkit
• Purpose▪ Provide tools and resources to better integrate
technology into clinical care through workflow assessment
• Audience▪ Small- and medium-sized primary care clinics
The Toolkit
• http://healthit.ahrq.gov/health-it-tools-and-resources/workflow-assessment-health-it-toolkit
Project Objective
• Evaluate the usability and suitability of AHRQ’s Toolkit
Partners
• Oregon Rural Practice-Based Research Network (ORPRN)
• Wisconsin Health Information Technology Extension Center (WHITEC)
Methods
• Eight Wisconsin clinics met regularly for about 10 weeks to discuss the Toolkit▪ Usually every other week▪ Research coordinators had
observational role
• Clinics self-identified workflow process needing improvement
Results: Clinic Demographics
Number (n=8) Percent
SettingRural 5 62.5Urban 2 25Suburban 1 12.5
OwnershipPrivate 6 75Hospital 2 25
Range Median
StaffMD/DO 1-7 1PA/NP 0-3 1.5RN/LPN 0-9 1.5MA 1-5 3.5Other staff 1-13 9
Total employees 4-33 18.5
Number (n=8)
EHR StatusImplemented, and in use 8Determining system requirements for new vendor 1
EHR VendorsCernereMDEpicGreenway Prime SuiteMac PracticePractice Choice
Results: Electronic Health Records
Results: Self-Identified Projects
• Most (n=6) focused on lab workflows▪ Ordering (future), processing, billing, notifying▪ Wide range of lab-related processes
• 2 clinics worked on prescription refill processes
• 1 clinic began EHR vendor switch process
Results: Clinic 1 Changes
• Initial focus: Future labs (ensure follow up)• Before:
▪ Complex▪ Inefficient▪ Missed opportunities
Results: Clinic 1 Workflow – PRECurrent Process for Scheduling Future Orders – Urgent Visits(continued on next slide)
Results: Clinic 1 PRE, continuedCurrent Process for Scheduling Future Orders – Planned Visits
Results: Clinic 1 Workflow – POST
Results: Clinic 1 Changes
• After:▪ Streamlined▪ Standardized▪ Solving larger problem than initially planned
۰ Final product: all labs and visits
Results: Clinic 2 Changes
• Planned implementation of a new process (see next slide)
• Identified other areas needing improvement▪ Vaccine inventory and administration
• Created manual for new employees describing workflow processes▪ Incoming phone calls (how to funnel)▪ Patient check-in▪ Other administrative processes
Results: Clinic 2 Workflow – NEW
Results: Clinic 2 Changes
• Planned implementation of a new process (see next slide)
• Identified other areas needing improvement▪ Vaccine inventory and administration
• Created manual for new employees describing workflow processes▪ Incoming phone calls (how to funnel)▪ Patient check-in▪ Other administrative processes
Before After
Poor tracking of preventive care (focus: women’s physical exams)
Regular meetings with Planned Parenthood
Limited staff exposure to workflow assessment
Purchased Visio software to plan workflows throughout clinic
Results: Clinic 3 Changes
Results: Clinic 3 Changes
• Discussed future model of care:▪ Clinic – preventive care▪ Planned Parenthood – contraception▪ Telemedicine
Lessons Learned
• Drivers of successful change▪ Dedicated (paid) time▪ Someone serving as a reminder
۰ Research Coordinator
▪ Small, diverse team▪ Project champion
Conclusion
• In addition to completing the primary aim of this project, most clinics developed new workflow processes in their clinical practice.
• These results suggest that participation in practice-based research network (PBRN) projects may benefit clinical care in unanticipated ways.
Partner with WREN!
• Upcoming studies (clinics)▪ Influenza Surveillance
• Join WREN (individuals)▪ Listserv – participate in surveys impacting primary
care, discuss “Hot Topics”▪ Check out our website: wren.wisc.edu
. . . for our health
Questions?
. . . for our health
Thank you!Erin Leege, MPH, [email protected]
Milwaukee Research Coordinator
Amy Irwin, MS, [email protected] Northern and Western Research Coordinator
Paul Smith, MD, [email protected] WREN Director