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Clinical Workflow Implementation
 

Clinical Workflow Implementation

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Planning the implementation of an EMR or EHR, then you need to understand the basics of defining your clinical workflow. This presentation was made at a variety of medical conferences

Planning the implementation of an EMR or EHR, then you need to understand the basics of defining your clinical workflow. This presentation was made at a variety of medical conferences

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    Clinical Workflow Implementation Clinical Workflow Implementation Presentation Transcript

    • 1
      Clinical Workflow: The Foundation of Systems Implementation
      The impact of Clinical Workflow on the Transformation Process
      Presented by:
      Edward A Stern, RN
      ed.stern@nothingbetter.com
    • 2
      Objectives
      Discuss workflow as it relates to transformation
      Basic workflow elements
      Current state
      Future state
      Original state
      Workflow process
      Cognitive workflow cluster theory
    • Clinical Transformation Process
      A never ending process to improve care delivery excellence through:
      Offering value
      Measurably quality improvement
      Enhancing services and solutions
      While reducing costs through the effective alignment of people, process and technology.
      Here’s where workflow plays a part
      3
    • 4
      Workflow Defined
      From Wikipedia, the free encyclopedia
      Workflow (WF) at its simplest is the movement of documents and/or tasks through a work process. More specifically, workflow is the operational aspect of a work procedure: how task are structured, who performs them, what their relative order is, how they are synchronized, how information flows to support the tasks and how tasks are being tracked. As the dimension of time is considered in Workflow, Workflow considers “throughput” as a distinct measure.
    • 5
      “It’s Workflows’ Fault”
      Workflow is often a common “fault” area in the implementation of a technology.
      The problem is that it is rarely ‘the’ workflow and more probably; that the wrong flow assessment, or not enough operations and systems workflows were considered.
    • What isClinical Informatics Assessment ?
      Simply stated, Clinical Informatics Assessment (CIA) is the process in which the clinical operation if broken down into fine step by step elements using an informatics work flow approach while remembering the clinical fundamentals
      Think of it as a “pulse check” for the workflow process
      6
    • More onClinical Informatics Assessment
      The focus is on clinical operations and how other business and systems elements interact with the clinical patient care environment
      Systems Operations + Clinical/Business Operations = Potential Software Product and Project Effectiveness?
      Consider how end-user usability plays into the product
      The net result is a focus on assuring quality patient care while assuring efficient use of clinical informatics solutions.
      7
    • Factors to considerwhen building your CIA plan
      It’s a Business Process but the Patient Comes First!
      ROI is a relative factor in the business model, so consider hard and soft ROIs to prove your point
      The depth of the process is relative to the complexity of the project
      Marketing concepts apply too… Your patient is your client, the provider may be your client, and who else is your client…
      8
    • 9
      Who benefits from CIA
      The Patient!
      Clinical needs are considered throughout the process
      The Business
      Business process and ROI is considered
      The Clinical Realm
      The needs for the clinical providers is recognized and built into the IT processes, as opposed to the clinical world having to “adapt” to the IT product.
    • 10
      How do YOU boil water?
      Exercise:
      Define the workflow for boiling water.
      Goal: A cup of hot water
      Please number each step you identify
    • 11
      How do YOU boil water?
      Exercise:
      Who thinks they “nailed” it?
      Let’s review the results
      Share your details with a person next to you.
      Compare your results, how far apart are they?
    • 12
      Think Playwright
      Writing a workflow is like writing a script.
      You have:
      A Plot
      What needs to happen – Goal of the flow
      Actors
      Elements in the workflow; staff, equipment, policies etc..
      Actions
      What the actors are doing
      Plot Twists
      Decisions that are made
    • 13
      Test the Workflow
      Reenactment
      What’s our “plot” (Goal)
      Select the cast while we walk through the workflow
      Actors
      Actions
      Decisions
    • 14
      Assess, Intervene, Reassess
      What we just did was “audit and review” a WF an Identified problems to correct.
      Aka – Shadow assessment of a workflow
      This is a common clinical nursing process…
      We always
      Assess the patient
      Intervene if necessary
      Reassess each intervention
      It’s no different when building a workflow
      Assess the current workflow you’ve documented
      Intervene to correct problems
      Reassess the workflow and see if it now matches your real process
    • 15
      How do YOU boil water?
      Simple Answer
      Fill Kettle with cold water
      Turn on Kettle
      Wait for water to boil
    • 16
      Boiling Water Workflow
      What if we broke it down even more?
      Simply adding water to the kettle can be more complex
      Take Kettle to Sink
      Turn on Cold Tap
      Open Kettle
      Move Kettle Under Tap
      Wait for Kettle to Fill
      Turn off Tap
      Return Kettle to Work surface
    • 17
      Boiling Water Workflow
      And… even more.
      How do we turn on a faucet?
      Grasp the tap mechanism
      Turn mechanism clockwise
      Wait until water pressure is high enough
      Stop Turning mechanism
    • 18
      Boiling Water Workflow
      Now bring it all together:
      Fill Kettle with cold water
      Take Kettle to Sink
      Pick up kettle
      Extend arm…(more)
      Walk to sink
      Turn on Cold Tap
      Grasp the tap mechanism
      Turn mechanism clockwise
      Wait until water pressure is high enough
      Stop Turning mechanism
    • 19
      Boiling Water Workflow
      What are the exercise conclusions?
      Don’t ask Ed to make you a cup of hot water
      Workflows are everywhere
      Workflows can be “considered complete” at almost any stage and any degree of complexity
      It’s up to the clinical informatics person to assure that patient care and business needs are met
    • 20
      Workflow Complexity
      Complexity varies based on the need of the audience
      Here’s where some typical clinical “assessment” and critical thinking aspects come into play.
      Who’s your audience?
      What do they need to know?
      What will they be doing with the information?
      Where will this be used?
      When will they need it defined?
      When will it need to be updated?
      Why do they need it documented and defined?
      How does this play a role in the patient care and business processes?
    • Workflow States
      Current
      Original
      Future
    • 22
      “Current State”
      The exercise we just went through was a “current state” definition process
      We defined the current operational state for a process… “boiling water to fill a cup”
      The typical next step is “future state”
      I disagree
    • 23
      What’s Original State
      You’ll note that in the earlier “boiling water” exercise we didn’t consult any policy manual or printed instruction.
      We all know that the way something was “originally intended” to work as been modified by those doing the task. Sometimes that modification is dramatic.
      Original State: is going back to the “stone age” of process
      The way it was originally intended to be done
      e.g. Boiling water with fire!
    • 24
      Original State Integration Decisions
      Review the original policy manual
      Determine how far from the documented current state the original state is.
      Decide if there is a need to change the “current state” or change the “original state” (e.g. update the policy)
      If the policy needs to be updated, you might as well wait until after the “future state” is defined
      Decide if there is a need to integrate the two
    • 25
      Problem, Action and Response
      Another nursing clinical action plays a role in assessing Current and Original State: Identify the Problem, Document the Required Action and Response
      Does the miss match of “original” and “current state” cause a problem for operations today and/or in your future?
      What action do you need to take now, if any?
      What will staff and management response be?
    • 26
      Future State
      What you just developed is the Future State
      When defining your future you have flexibility within the parameters of the software application
      You need to make sure you understand the potential and assess and test your theoretic ideas
    • 27
      Future State Design Principles
      • Support evidence-based care guidelines
      • Reduce duplication of effort and data
      • Enhance access to care information
      • Facilitate collaboration and communication among care providers
      • Support timely clinical decision support
      • Reduce variability of care
      • Drive measurable improvements in quality and safety
      • Support continuity of care across the continuum of services and settings
      • Support interdisciplinary care and model of collaborative practice
      Compliments of Dearborn Advisors
    • Future State Design Sessions
      Future State
      Integration
      & Signoff
      Future State
      Discovery
      Future State
      Validation
      Future State
      Consensus
      Current State
      Confirmation
      Facilitated
      Session
      Work Group
      Session
      Facilitated
      Session
      Facilitated
      Session(s)
      Nursing
      Facilitated
      Session
      Work Group
      Session
      Facilitated
      Session
      Facilitated
      Session(s)
      Facilitated
      Session
      Pharmacy
      Facilitated
      Session
      Facilitated
      Session
      Facilitated
      Session(s)
      Work Group
      Session
      Physicians
      Workflow Redesign Management and Coordination
      Compliments of Dearborn Advisors
      28
    • 29
      Documentation Process
      Outline format
      PowerPoint
      Pen and Paper
      “Flow” tools
      Visio
      RF Flow
      etc
    • Cross Functional Flowsheet
      Primary Actors for one WF:
      • ED Providers
      • ED Staff
      • ED Nurse
      • Admitting
      • Bed Management
      • Receiving
      • In Patient, & Surgical Services
      • “other”
      30
    • Example of aSimple Swim Lane Flow
      Send the Patient Home
      31
    • Same “Plot” but anIntegrated Workflow
      Send the Patient Home
      32
    • 33
      Previously Separate Variable
      Discharge to In-Patient
    • Specific Factor flow
    • Defining Workflow by Categoryin Your Organization
      Functional Systems Workflows
      How the software system will function in the work process
      “Click here, then enter this, and drag that”
      Business Operational Workflows
      How the business (patient care and operations business) model operates and physically gets executed
      “Go down the hall, make a left, pick up the form, and complete”
      Integrated Workflows
      Integrated Department
      Integrated Software modules
      Integrated systems and operations workflows as one.
      Touch Points
      Where Operational and Systems “bump” into one another
      35
    • 36
      Example of Integrated Workflow
      Order for CBC
      Order placed in System by MD
      RN acknowledges order in system and notes it is a “nurse draw”
      Print lab specimen label
      Obtain blood collection supplies
      Draw Blood using hospital procedure 554.123
      Affix completed labels
      Tube to Lab using hospital procedure 554.124
      Indicate in system blood drawn and to lab
      Wait for results in system
    • Example of Integrated Workflow
      Order for CBC
      Order placed in System by MD
      RN acknowledges order in system and notes it is a “nurse draw”
      Print lab specimen label
      Obtain blood collection supplies
      Draw Blood using hospital procedure 554.123
      Affix completed labels
      Tube to Lab using hospital procedure 554.124
      Indicate in system blood drawn and to lab
      Wait for results in system
      TP
      OP
      SYS
      OP
      OP
      OP
      OP
      TP
      SYS
      TP
      OP
      37
    • Cognitive Cluster
      A growing trend in “micro time decision process” documentation
      Workflows are relatively linear and Mind Maps® are not often structured enough for application development
      A cognitive cluster (CC) enables a way to demonstrate same time sequence decision processes
      It is not a “cheat” for singular thought processes
    • Simple Cluster
      This simple cluster demonstrates a relatively simple 3 part question
    • Complex Cognitive Clusters
    • Complex Cognitive Clusters
      • There are times when a cluster is a “micro time decision process” so complex it can only be handled by the “human cognitive process” due to the multitude of immediate decisions
    • 42
      Questions?
      Remember a copy of this presentation is available online at
      www.nothingbetter.com