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From boiling water   fin
 

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    From boiling water   fin From boiling water fin Presentation Transcript

    • From Boiling Water to Workflow… The Clinical Informatics Assessment (CIA) Method By: Edward A Stern, RN
    • Objectives
      • Define and Discuss Workflow and it’s benefits
      • Define the Workflow Process
      • Outline Workflow variables and clarify their nature in the healthcare setting
      • Look at Workflow as a “Nursing Clinical Informatics Assessment (CIA) Model”
      • Benefits of the CIA model
    • Public Perception?
      • “ The information systems at any McDonald's are more advanced, and more useful, than those in your doctor's office.”
      “ Record Time” – April ‘06
    • Public Perception-Workflow Forgotten
      • … and last summer, with his staff of three, he switched everything over to the new system. Patient information was entered on a screen instead of on a form attached to a clipboard; Saleh took notes and made orders using a sleek black tablet PC.
      • Within days, the office was in meltdown. Patients piled up in the waiting room, and Saleh all but lost control of his day-to-day work. Delays grew so bad, Saleh installed a TV to distract patients, and Cerner Corp., the company supplying his software, trundled in refreshments as a goodwill gesture. "I was running an hour-and-a-half or two-hours late," says Saleh. "That's the kiss of death for your practice. It was crazy.
      • A few months later, Saleh shows off his file rooms, filled floor to ceiling with paper charts. "No paper has been added to these since summer," he says proudly.
      “ Record Time” – April ‘06
    • “BFI” Implementation Study Complaints (“concerns”) Efficiency Time of implementation Go Live + X Days
    • “BFI” Down Time Study Complaints (“concerns”) Efficiency Time of Outage Outage Back Up
      • Anomaly Variables:
      • Why did “you” go down?
      • “ We have to back load all that data?”
    • Workflow Defined
              • From Wikipedia, the free encyclopedia
      • Workflow 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 .
    • How do YOU boil water?
      • Exercise:
        • Define the Boiling Water Workflow
      ?
    • How do YOU boil water?
      • Define the Boiling Water Workflow
        • Simple Answer
          • Fill Kettle with cold water
          • Turn on Kettle
          • Wait for water to boil
    • 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
    • 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
    • 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
    • Boiling Water Workflow
      • What if we added a decision process?
        • Boil Water
          • Do you want to use the stove or a microwave
            • If Microwave, select a microwave safe cup…
            • If Stove, see workflow 1
    • 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
    • Workflow Complexity
      • Complexity varies based on the need for 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?
    • Why Workflow?
      • Why do we need go to all this trouble to define, document, and update workflow?
    • Send the Patient Home Simple
    • “Send the Patient Home” Integrated
    • Discharge to In-Patient New Variables
    • Commonly Defined “Workflows”
      • Workflow really can mean different things to lots of different people.
      • It’s critical that your operational plans include the role and definition of “workflow” from the very beginning
    • “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.
    • Potential Workflow Group Definitions
      • Functional Systems Workflow
        • 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
    • 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 TP OP OP OP OP SYS TP OP
    • Example of Integrated Workflow
      • Operations Units for 1 WF:
      • ED Providers
      • ED Staff
      • ED Nurse
      • Admitting
      • Bed Management
      • Receiving
      • In Patient, & Surgical Services
      • “ other”
    • Nursing Assessment Meets Workflow
      • All too often in the middle of the intense technical (a.k.a. ‘geek’) process we loose focus on the patient and the clinical process.
      • That’s a critical benefit of “Nurse Informatics”
      • What if we were to integrate workflow with an evidenced based nursing assessment practice?
    • Change…
      • Let’s face it, the nursing industry is a “slow” change industry
        • Opportunity for the “Change Management Nurse”
      • “Who moved my cheese” mentality – consider the changing paradigm of our non-clinical side of the industry.
          • “Who Moved my Cheese” by: Spencer Johnson, M.D
    • What is Clinical 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
    • What is Clinical 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.
    • Factors to consider when 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…
    • When & How Can CIA Be Applied
      • Apply the concept any time clinical aspects need to be considered in a business model
      • Working very closely with the “IT side” of the process.
      • Be the link between the IT and business process
        • The clinical link, which is (or should be) the focus of all medical processes
    • 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.
    • Questions?