Wellness Through Workflow: How Workflow Contributes to a Better Patient Experience in Healthcare

@wareFLO #POWHIThttp://ehr.bz/blabworkflow
A TelmedIQ Webinar Presentation:
Wellness Through Workflow: Structured Messaging Contributes to
Better Patient Experience
[The Webinar Will Begin Shortly]

Webinar Housekeeping

Outline
• Who Am I?
• The System Behind The Smiles
• Patient Experience and Workflow
• Healthcare’s Workflow Wall
• How Can Structured Messaging Help?
• Wrap-up & Synthesis

Charles Webster, MD, MSIE, MSIS
• Degrees
– Medicine
– Industrial Engineering
– Intelligent Systems (Medical Informatics)
– Accountancy (premed)
• 1st undergrad medical informatics program
• CMIO for EHR vendor for decade+
• Helped three medical practices win first three
consecutive HIMSS Davies Awards

Hear “Workflow”? Tweet @wareFLO

People & Organizations Fixing
Workflow with Health IT

People & Organizations Fixing
Workflow with Health IT
#POWHIT

Blab

The System
Behind
The Smiles

“What’s needed in
restaurants, car dealerships,
department stores, and every
place else is systems — not
just smiles — that guarantee
good service. Every business
is composed of systems.
Those systems must work
together to create a process
that is efficient and
responsive to a customer’s
wants.”

“The Systems Behind The Smiles”

“The Systems Behind The Smiles”
40%-60%

The Workflow
Behind
The Smiles

Patient Experience
"The sum of all interactions, shaped
by an organization's culture, that
influence patient perceptions across
the continuum of care.”
http://www.theberylinstitute.org/?
page=definingpatientexp

Patient Experience
(The Smiles)
Vision Values
Recognize
Understand
Remember

Patient Experience
(The Systems)

Interactions & Continuum
(The System)
The orchestrated touch-points of
people, processes, policies,
communications, actions, and
environment ... Before, during and
after the delivery of care

Orchestration & Choreography
• Two important terms from workflow tech
• Orchestration implies central workflow
conductor
• Choreography implies distributed workflow
control, more like a jazz ensemble
• Modern workflow systems are hybrids

W
orkflow
Technology
(Process-Aware
Info
System
s)

Secure
Structured
M
essaging

Interruption Statistics
• 50% of all healthcare errors are slips and
lapses, such as not executing intended
but interrupted actions
• 43% of interruptions affect care tasks
• ~50% of pages to physicians interrupt
direct patient care
• 42% of pages are non-urgent

The Workflow Prescription

What Is Workflow?
A series of steps, consuming
resources, achieving a goal.

What is Workflow
• Series of steps/tasks/activities
• Consuming resources/costs (HC system &
patient’s money, attention, time)
• Achieving goal(s)/benefits
• “Process” and “workflow” usually (not always)
synonymous

What is Workflow Technology?
• Generally?
– Any technology facilitating workflow…
• Narrowly?
– Executable models of work or workflow
– Consultable (by computer or human)
– Often visually represented
• Workflow diagrams
• Calendars & rules
• Dynamic checklists

Workflow Tech vs Info Tech
• Info tech “affects” workflow
–Influences workflow (+ or -)
• Workflow tech “effects” workflow
–Drives workflow (+)
• IT “hardcodes” workflow
• WT “softcodes” workflow

What Is Structured Messaging?
• Pre-build message structure
• Sent securely over Internet
• Structured messages occur in workflows
• Repeating same structures leads to familiarity
• Familiarity leads to speed & accuracy
• Structured data & workflow facilitates
automation via workflow technology

Structured Messaging (Calendar)
• Forms (and therefore data, recognition faster
than retrieval memory)
• Calendar (shared mental model shared with
workflow engine)
• Rules (proactive intelligence re routing &
escalation)

Structured Messaging (Calendar)
“softcoded” user
interface & workflow
Calendar Rules Forms
Shared mental/
machine model

Structured Messaging & Workflow
Automatic
Workflow engine drives
workflows without requiring
manual human intervention
(tho can be overridden)

Automatic
Transparent
Workflow engine tracks task
status, which can be
displayed to human users,
supervisors & administrators

Automatic
Transparent
displayed to human users,
Interruptions!

Automatic
Transparent
displayed to human
Flexible
Workflow engine does what
workflow rules tell it to do,
workflow rules are “softcoded”
therefore easy to change

Automatic
Transparent
displayed to human
Flexible
Workflow engine does what
workflow rules tell it to do,
workflow rules are “softcoded”
therefore easy to change
Improvable
Time-stamped task status data
can be used to find, eliminate
bottlenecks & rework, improving
cycle time and consistency

Value-Add Ons…
• Multimedia (text, voice, images)
• Converting between voice & text
• EHR integration
• HIPAA compliance (of course!)
• Cross-platform (mobile, desktop)
• Intelligent message routing & escalation

Thought Experiment
What if we had
automated workflow
first, instead of data?

How Do We Get To This?
Data
(resources/costs)
Goals/Benefits
End
Start
@wareFLO #POWHIT

We Can Add Data To Workflow
Data
(resources/costs)
Goals/Benefits
End
@wareFLO #POWHIT

We Can Add Data To Workflow
Data
(resources/costs)
Goals/Benefits
End
Start
@wareFLO #POWHIT

We Can Add Workflow To Data
Data
(resources/costs)
Goals/Benefits
@wareFLO #POWHIT

We Can Add Workflow To Data
Data
(resources/costs)
Goals/Benefits
End
Start
@wareFLO #POWHIT

Which Order Makes Most Sense?
• I’d argue adding data to workflow.
• We’re stuck w/adding workflow to data
• Need to extremely flexible workflow
tech to existing data investments
• Argument for structured messaging as a
“platform”

Experience & Engagement

Effect of Technology

Consumerization

Workflow (including Messaging)

Re-Integrating Data & Workflow
MSIE, MSIS

MSIE, MSIS
DATAWORKFLOW

MSIE, MSIS
DATA
EHR
Health IT
Medical
Informatics
WORKFLOW
TQM
Six Sigma, Lean
Process
Improvement

MSIE, MSIS
DATA
EHR
Health IT
Medical
Informatics
WORKFLOW
TQM
Six Sigma, Lean
Process
Improvement
Workflow Technology
Process-Aware Info Systems

MSIE, MSIS
DATA
EHR
Health IT
Medical
Informatics
WORKFLOW
TQM
Six Sigma, Lean
Process
Improvement
Structured Messaging

Wellness & Workflow
• State of being in good physical and mental
health
• Series of steps, consuming resources,
achieving a goal
Resources/Costs
Goals/Benefits
Sickness
Wellness
@wareFLO #POWHIT

In Closing…
• Thank you!
• Questions/Comments
• Tweet me at @wareFLO using #POWHIT
• ChuckWebsterMD@gmail.com
• Join Blab on Workflow & Patient Experience
– Top of the hour
– http://ehr.bz/blabworkflow
– Chrome or Firefox browsers

About CGH Medical Center
100 Bed Acute
Care Facility
140+ Physicians/
1400 Staff
140+ Physicians

Structured Messaging + Workflows
at CGH
Existing Patient
New Patient
Admissions
On-Call Physician
• Over 10+ messages types that get
automatically triaged
• Communication around recurring
events are now highly streamlined (ex.
Radiology orders)
• A more reliable system than using
phones and voice messages

Message Types and Getting the
Right Communications Data
The Benefits of Workflow and Structure
•Regimenting communications data
•Critical information for specific events is now
required
•Communication issues such as patient handoffs are
now more reliable

Making Communications
More Intelligent

Q&A

Thank You for Attending
Visit www.TelmedIQ.com to learn more
Or contact us directly at:
p. 1.888.364.9305
e. sales@telmediq.com
to receive a free demo of our solutions.

Wellness Through Workflow: How Workflow Contributes to a Better Patient Experience in Healthcare

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