Make the Complex Simple… The Healthcare Knowledge Map …and Break Down the Silo’sDavid Shiple,Practice Leader, Advisory Services
Solving The Healthcare Knowledge GapThe Problem » Healthcare professionals often work and think “in silo’s”, but increasingly need to solve enterprise-wide problems » Seasoned hospital professionals with a comprehensive understanding of hospital processes typically acquired this knowledge after decades of hospital experience » New professionals coming into the field must quickly gain the same understanding as industry veterans in a period of hyper- change, and › Knowledge of only a single hospital “silo” is no longer an option › Knowledge and credibility in clinical areas is a critical success factor › Every process change can have an unintended cascading effect within a health system
Solving The Healthcare Knowledge GapThe Solution » How do we quickly help healthcare service professionals get their arms around the complex flow of a health system? » It would be nice if the major health system processes could be put into one, visually compelling map » It would be nice… and it’s been done.
People Learn Best by Seeing …We use large graphical models for rapid understanding … and to get everyone onthe same page (i.e. confirming the “current state”) “… if I can get everything onto one page, I can get mental control over it..” - Workshop Participant
Understanding Correlations Among WorkflowsOnce people can get the whole problem on a “workbench”, correlating workflowsand planning enterprise-wide changes can begin “ .. For the first time, managers from each discipline felt their colleagues had a good understanding of their business models, workflow, and issues…” - Workshop Participant
Sample Knowledge Map SectionsDetailed is carefully balanced: enough detail to make information meaningful, butnot too much information that would make the model unusable
How is the Knowledge Map Organized?The data points are color-coded to highlight key workflow steps, technologyenablers, and commentary on current issues of adoption, ROI, etc. Workflow Step Technology Enabler CommentaryExample from the physician’s workflow: Technology Enabler Commentary Workflow Step
How is the Knowledge Map Organized? (cont’d) Pictures, metrics tables, and reference material is embedded into the map to further drive accelerated understanding of the health system. Images help students to develop a rich “mental Performance Indicators Benchmark map” of the health system; LOS for Treat & Release 90 min the one on the left is from the O.R. workflow LOS for Admitted Patients 240 min Left Without Being Seen < 1% AMA 1% % of time on Diversion < 1% Triage Start to Triage End 5-7 min Triage End to Registration Start < 10 min The reference section of the model contains commonly used Registration Start to Registration End 3-5 min statistics, best practices criteria, and other Knowledge Registration End to Placed in Treatment Room < 20 min information which is commonly accessed by users of the Arrival to First RN Encounter 10 min model Arrival to First MD Encounter 30 min First MD Encounter to Disposition Order Written 60 – 75 minThe HIMSS 8-Stage EMR Maturity Model Disposition Order Written to time Patient Left the ED 15 min (discharged pt)Stage 7 - Medical records are fully electronic; hospital is able to contribute continuity of care document as 30 min (admitted pt)byproduct of EMR; data warehousing in useStage 6 – Physician documentation in structured templates; full clinical decision support system in use; fullradiologic and PACS in useStage 5 – Closed loop medication administration that addresses every step of medication use process Metrics help professionals understand how a givenStage 4 – Computerized physician order entry system in use; clinical decision support system in use forclinical protocols workflow is measured and what is seen as important -Stage 3 – Clinical documentation, clinical decision support system in use for error checking, PACS in use the table above is from the E.R. workflowoutside of radiologyStage 2 – Clinical data repository, controlled medical vocabulary, clinical decision support system; may havedocument imagingStage 1 – Ancillaries (lab, radiology, pharmacy) are installedStage 0 – None of the ancillaries are installed
How is the Knowledge Map Organized? (cont’d) Physician The patient experience underlies the entire model Office Acute Care Hospital Nurse Med/ ICU Surg Nurse/ Physician Interaction Physician Knowledge Material Emergency Dept.36” Operating Room Meaningful Use EMR 8-Stage Revenue Cycle Criteria Model Pharmacy Radiology Lab CMS Core Health System Measures KPIs • The model prints as a 36” x 48” color poster • The model contains roughly 200 workflow points • Other workflow modules are available that can be 48” “swapped in”: Supply Chain, Cardiology, Oncology, etc.
Who Needs the Big Picture? Health system IT professionals I need to solve my problem IT vendor professionals Board Members Silo Quality/ Safety Directors Marketing Professionals First year MHA & MPH students Lean Sigma Practitioners - OR - Ancillary Managers Nurse Managers Let’s solve our CMIO’s problems Admitting Dept. Managers Revenue Cycle Managers Health System Facilities Managers Performance Improvement Professionals
Used for Rapid Knowledge Infusion » Part of on-boarding or level-setting process for people new to the industry or new to an enterprise- wide project » Low-cost, 4-hour course to give participants an operational/ technology overview of a typical “ Our managers healthcare system using the Knowledge Map have dubbed the » Each student receives a full-sized Knowledge Map program, ‘death to the silos’…” to own, and to use during instruction - HR Director » Short competency exam is given at conclusion of the course » “Introduction to Hospital Operations” certification is given to each passing student » Students are encouraged to display the Knowledge Map in their office or hallway and internalize it over time
Used as a Performance Improvement Tool » Provides a compelling “one-stop-shopping” visual for illustrating the current and future states of enterprise improvements, e.g. “ .. People ask what the future state will » Reducing average length of stay look like…I say, ‘stop by my office – it’s » Increasing patient throughput hanging on my wall’ ” » Establishing EHR meaningful use - Lean Sigma Project Manager » Provides a “workbench” for process change teams to brainstorm, form cross-silo correlations, and form a high-level future map » Maps are easily modified and are inexpensive
The Value » Substitutes for 100’s of pages of text or slides (that never gets read and does not lend itself to building an integrated mental map) » Provides a map that can be gradually internalized on the wall of an office or cube » Helps bridges the communication gap between the various actors in the operation of a hospital – in days or weeks, not months and years » Gives all players in the healthcare system an appreciation for the complexity of care delivery and challenges facing each player » Visually compelling - people are drawn to large diagrams describing their line of work
Making a Difference in Healthcare » A Knowledge Map that includes the full workflow scope of the acute care hospital and physician office setting has not existed until now » Legions of people work in the “ecosystem” of healthcare – can we afford each to have only a piecemeal understanding? » The Knowledge Map can be easily customized for: » A specific hospital or health system » A set of technologies specific to a vendor » Emphasis on particular workflows (e.g. revenue cycle and supply chain) » The Knowledge Map is a powerful tool used during on- boarding, weekend workshops, certification programs, retreats, and performance improvement projects
Healthcare Knowledge Map 2.0DIVURGENT has begun integrating the knowledge content into aleading workflow tool to create a “living model” » Filter slide control gradually move user from high-level to detailed views » Zoom in and out of model for greater/ lesser detail » Workflows can be added/ changed easily » Workflow widgets (IT enablers, actors, illustrations) can be picked from palettes » Mouse-over workflow item to display IT enablers, metrics, issues, etc » Healthcare Knowledge Map 2.0 is planned for early 2012