HITC Workflow Webinar 4.24.12
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HITC Workflow Webinar 4.24.12

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Learn how to effectively implement EHR workflow with tips from our experts.

Learn how to effectively implement EHR workflow with tips from our experts.

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    HITC Workflow Webinar 4.24.12 HITC Workflow Webinar 4.24.12 Presentation Transcript

    • The Health Information Technology Community EHR Workflow: Easy, high-impact changes for accelerating implementation success©2012 The HIT Community, LLC. All Rights Reserved. 1
    • 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©2012 The HIT Community, LLC. All Rights Reserved. 2
    • Welcome!©2012 The HIT Community, LLC. All Rights Reserved. 3
    • 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©2012 The HIT Community, LLC. All Rights Reserved. 4
    • Agenda • Overview of workflow Re-engineering • Healthcare processes impacted by EHR deployment • Workflow re-engineering of healthcare processes • Critical Success Factors • Questions & Answers©2012 The HIT Community, LLC. All Rights Reserved. 5
    • Polling Question • Put in polling question from last time on where attendees are in the EHR deployment process©2012 The HIT Community, LLC. All Rights Reserved. 6
    • Healthcare Clinical Processes workflow: 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©2012 The HIT Community, LLC. All Rights Reserved. 7
    • Laundry Process = Success!©2012 The HIT Community, LLC. All Rights Reserved. 8
    • 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)©2012 The HIT Community, LLC. All Rights Reserved. 9
    • 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©2012 The HIT Community, LLC. All Rights Reserved. 10
    • Polling Question • Have you ever done a structured business process redesign? – Yes – Now©2012 The HIT Community, LLC. All Rights Reserved. 11
    • EHR & Healthcare Processes People & Commitment Goals Business & Process Metrics Technology©2012 The HIT Community, LLC. All Rights Reserved. 12
    • Major Healthcare Processes Clinical Business©2012 The HIT Community, LLC. All Rights Reserved. 13
    • Major Healthcare Processes Clinical Business Time 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©2012 The HIT Community, LLC. All Rights Reserved. 14
    • Major Healthcare Processes Clinical Business Time management and scheduling Registration/Check-in Reviewing diagnostic test results and Schedule clinical documents Clinical encounter Diagnostic test ordering Patient education Patient encounter documentation Billing Electronic prescribing Patient Check-out Electronic signature Clinical decision support Disease management Data analysis and report generation Patient education©2012 The HIT Community, LLC. All Rights Reserved. 15
    • Conducting a workflow evaluation Agency 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©2012 The HIT Community, LLC. All Rights Reserved. 16
    • 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©2012 The HIT Community, LLC. All Rights Reserved. 17
    • 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?©2012 The HIT Community, LLC. All Rights Reserved. 18
    • 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©2012 The HIT Community, LLC. All Rights Reserved. 19
    • Diagnostic Test Ordering – Example BPR Workflow Yes NoCreate and Submit Get Yes Electronic Need More No Order OK? Receive Results Enter Into EHR Inform Patient Lab Order Acknowledgement Signature Labs? Data Needed •Diagnosis •Lab •Original Lab •Physician ID •Original Lab •Original Lab •Lab Results •Patient Info •Possible labs acknowledge Order Order Order •Diagnosis •Lab Results ment •Lab Ack. •Lab Results •Lab Results •Diagnosis •Diagnosis •Diagnosis •Diagnosis Who is involved? •Physician •Physician •Physician •Physician •Physician •Physician •Physician •Physician •Nurse •Nurse •Nurse •Nurse •Nurse •Nurse •Lab •Lab •Lab •Admin Staff •Patient EHR Functionality •Order Sets •Lab System •Clinical Decision •Electronic •Lab System •Clinical •Lab System •Patient •Order (LIMS) Support Signature (LIMS) Interface Decision (LIMS) Interface Communication Protocols Interface •Order Protocols Support •Lab System •Order (LIMS) Protocols Interface Benefit •Faster •Faster •Faster •Safer •Faster •Faster •Faster •Faster •Less Error •More •Less Error Prone •Faster •Greater •Less Error •Greater •Greater Prone available availability Prone availability availability •Improved Communication ©2012 The HIT Community, LLC. All Rights Reserved. 20
    • Diagnostic Test Ordering – Example BPR Workflow Yes NoCreate and Submit Get Yes Electronic Need More No Order OK? Receive Results Enter Into EHR Inform Patient Lab Order Acknowledgement Signature Labs? Data Needed •Diagnosis •Lab •Original Lab •Physician ID •Original Lab •Original Lab •Lab Results •Patient Info •Possible labs acknowledge Order Order Order •Diagnosis •Lab Results ment •Lab Ack. •Lab Results •Lab Results •Diagnosis •Diagnosis •Diagnosis •Diagnosis Who is involved? •Physician •Physician •Physician •Physician •Physician •Physician •Physician •Physician •Nurse •Nurse •Nurse •Nurse •Nurse •Nurse •Lab •Lab •Lab •Admin Staff •Patient EHR Functionality •Order Sets •Lab System •Clinical Decision •Electronic •Lab System •Clinical •Lab System •Patient •Order (LIMS) Support Signature (LIMS) Interface Decision (LIMS) Interface Communication Protocols Interface •Order Protocols Support •Lab System •Order (LIMS) Protocols Interface Benefit •Faster •Faster •Faster •Safer •Faster •Faster •Faster •Faster •Less Error •More •Less Error Prone •Faster •Greater •Less Error •Greater •Greater Prone available availability Prone availability availability •Improved Communication ©2012 The HIT Community, LLC. All Rights Reserved. 21
    • Diagnostic Test Ordering – Example BPR Workflow Yes NoCreate and Submit Get Yes Electronic Need More No Order OK? Receive Results Enter Into EHR Inform Patient Lab Order Acknowledgement Signature Labs? Data Needed •Diagnosis •Lab •Original Lab •Physician ID •Original Lab •Original Lab •Lab Results •Patient Info •Possible labs acknowledge Order Order Order •Diagnosis •Lab Results ment •Lab Ack. •Lab Results •Lab Results •Diagnosis •Diagnosis •Diagnosis •Diagnosis Who is involved? •Physician •Physician •Physician •Physician •Physician •Physician •Physician •Physician •Nurse •Nurse •Nurse •Nurse •Nurse •Nurse •Lab •Lab •Lab •Admin Staff •Patient EHR Functionality •Order Sets •Lab System •Clinical Decision •Electronic •Lab System •Clinical •Lab System •Patient •Order (LIMS) Support Signature (LIMS) Interface Decision (LIMS) Interface Communication Protocols Interface •Order Protocols Support •Lab System •Order (LIMS) Protocols Interface Benefit •Faster •Faster •Faster •Safer •Faster •Faster •Faster •Faster •Less Error •More •Less Error Prone •Faster •Greater •Less Error •Greater •Greater Prone available availability Prone availability availability •Improved Communication ©2012 The HIT Community, LLC. All Rights Reserved. 22
    • Diagnostic Test Ordering – Example BPR Workflow Yes NoCreate and Submit Get Yes Electronic Need More No Order OK? Receive Results Enter Into EHR Inform Patient Lab Order Acknowledgement Signature Labs? Data Needed •Diagnosis •Lab •Original Lab •Physician ID •Original Lab •Original Lab •Lab Results •Patient Info •Possible labs acknowledge Order Order Order •Diagnosis •Lab Results ment •Lab Ack. •Lab Results •Lab Results •Diagnosis •Diagnosis •Diagnosis •Diagnosis Who is involved? •Physician •Physician •Physician •Physician •Physician •Physician •Physician •Physician •Nurse •Nurse •Nurse •Nurse •Nurse •Nurse •Lab •Lab •Lab •Admin Staff •Patient EHR Functionality •Order Sets •Lab System •Clinical Decision •Electronic •Lab System •Clinical •Lab System •Patient •Order (LIMS) Support Signature (LIMS) Interface Decision (LIMS) Interface Communication Protocols Interface •Order Protocols Support •Lab System •Order (LIMS) Protocols Interface Benefit •Faster •Faster •Faster •Safer •Faster •Faster •Faster •Faster •Less Error •More •Less Error Prone •Faster •Greater •Less Error •Greater •Greater Prone available availability Prone availability availability •Improved Communication ©2012 The HIT Community, LLC. All Rights Reserved. 23
    • Diagnostic Test Ordering – Example BPR Workflow Yes NoCreate and Submit Get Yes Electronic Need More No Order OK? Receive Results Enter Into EHR Inform Patient Lab Order Acknowledgement Signature Labs? Data Needed •Diagnosis •Lab •Original Lab •Physician ID •Original Lab •Original Lab •Lab Results •Patient Info •Possible labs acknowledge Order Order Order •Diagnosis •Lab Results ment •Lab Ack. •Lab Results •Lab Results •Diagnosis •Diagnosis •Diagnosis •Diagnosis Who is involved? •Physician •Physician •Physician •Physician •Physician •Physician •Physician •Physician •Nurse •Nurse •Nurse •Nurse •Nurse •Nurse •Lab •Lab •Lab •Admin Staff •Patient EHR Functionality •Order Sets •Lab System •Clinical Decision •Electronic •Lab System •Clinical •Lab System •Patient •Order (LIMS) Support Signature (LIMS) Interface Decision (LIMS) Interface Communication Protocols Interface •Order Protocols Support •Lab System •Order (LIMS) Protocols Interface Benefit •Faster •Faster •Faster •Safer •Faster •Faster •Faster •Faster •Less Error •More •Less Error Prone •Faster •Greater •Less Error •Greater •Greater Prone available availability Prone availability availability •Improved Communication ©2012 The HIT Community, LLC. All Rights Reserved. 24
    • Doctor Office Visit Process Steps Area Task Check in Make appointment Check in Check in with receptionist Check in Look up patient information Check in Update form Check in Verify insurance Check in Co-Pay Intake You wait Intake Nurse comes and gets you Intake Takes you to exam room Intake Takes Vitals Intake Enters into health record - electronic or paper chart Intake Gets symptoms Intake Exam process Intake Nurse Leaves Intake Wait again Exam Doctor looks at record Exam Review symptoms, vitals, etc. (SOAP) Exam Do tests and/or do orders (lab, radiology, etc.) Exam Get results via fax, electronically, phone or other Exam & Checkout Review results Exam & Checkout Diagnostics Exam & Checkout Treatment plan Checkout Inform Patient Checkout Follow up actions (schedule follow-up visit, referral, prescription, etc.) Checkout Billing©2012 The HIT Community, LLC. All Rights Reserved. 25
    • 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©2012 The HIT Community, LLC. All Rights Reserved. 26
    • Medication Refill 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©2012 The HIT Community, LLC. All Rights Reserved. 27
    • 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©2012 The HIT Community, LLC. All Rights Reserved. 28
    • 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©2012 The HIT Community, LLC. All Rights Reserved. 29
    • THE HIT COMMUNITY©2012 The HIT Community, LLC. All Rights Reserved. 30
    • HITC Communities Standard Community Public HITC •Public & Private Groups Other Services Communities •Content Management Tools •Community Framework • White Papers • Shared Knowledge •Community Site Operations • Webinars used in Multiple Communities •Training Tools to Manage Community • Learning Programs •Integrated with HITC Public Communities • Email Programs • Information to Engage Members Managed Community • Content Marketing •Standard Community Above Programs • Member •Community Access Control • Data Analytics Connections & •Community Activity Reporting • Consulting Engagement •Plus Part-time HITC Community Manager©2012 The HIT Community, LLC. All Rights Reserved. 31
    • 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.©2012 The HIT Community, LLC. All Rights Reserved. 32
    • Questions?©2012 The HIT Community, LLC. All Rights Reserved. 33