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Mapping medication management to increase cross-product alignment


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In this case study, Dani Nordin and Janna Dupree, of athenahealth and Nuance, discuss how they used cross-product research and experience mapping to bring alignment to teams across two flagship product lines.

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Mapping medication management to increase cross-product alignment

  1. 1. Mapping complex workflows to get cross-product alignment Janna Dupree, Nuance Dani Nordin, athenahealth
  2. 2. Dani Nordin Senior Manager, XD athenahealth Janna Dupree Principal Designer Nuance About us
  3. 3. Shameless plug: Come work with us!
  4. 4. A tale of two products
  5. 5. athenaCollector Software and services to help medical practices manage the revenue cycle, from billing to posting remittance and dealing with denials. Cloud-based Electronic Medical Records software to help clinicians and their staff record and document patient care. athenaClinicals
  6. 6. athenaOne for Hospitals An end-to-end solution for small hospitals, which includes: 1. Revenue cycle management 2. Electronic Health Record 3. Integration with lab/radiology systems 4. Medication management, administration and dispensing
  7. 7. The path from care delivery to billing consists of 4 distinct jobs. Register/Check in patient Document care Enter/confirm billing information Submit claim to payer
  8. 8. In hospital billing, the tasks subdivide a bit. Register/Check in patient Document care Enter/confirm billing information Submit claim to payer Capture charges Make sure chart is complete Enter billing codes
  9. 9. Lack of automatic charge capture for many medications led to extra work for pharmacy technicians. Problem 1 Capture charges
  10. 10. Reconciling medication charges was labor- intensive and frustrating. Pharmacy techs are responsible for dispensing and keeping inventory on medications in the hospital, as well as reviewing all the charges that come in over the course of the day. Our old system [EDIS] captured our charges... in ER, you would put in that you started an IV and it would capture the charges for it. – Medication Nurse, Holton Community Hospital
  11. 11. Coding staff need a read-only view of the chart to do their jobs. Our solution made it hard to find the information they needed. Problem 2 Make sure chart is complete Enter billing codes
  12. 12. Documents in the chart were poorly formatted, disorganized, and lacked key information. To code a patient’s chart, users had to hunt and peck through dozens of documents to get basic information to do their jobs. The [Medication Administration Report], to me, is totally... I don't like it. The only way I really know to go into it is Coding View, and there's time and dates that are totally worthless... I don't know if it's a scanning error, or if the nurses are doing it inconsistently, or what. - Coder, Holton Community Hospital A lot of times we won't see the stop time [for an IV medication]... that stop time is when they're discharged, which is not the same as a stop time. - HIM Director, Greenwood Community Hospital
  13. 13. Grabbing clinical information required creating a hack on top of already fragile code Chart documents could only be pulled into Collector as raw HTML, limiting customization options. But it was hard for the Collector teams to make an impact on these issues. Cross-functional partners across the two products were talking past each other Conversations about the issues often focused on explicit technical asks that zeroed in on narrow slices of the problem.
  14. 14. Our clients buy athenaOne for Hospitals... The Big Problem:
  15. 15. ...But we sat SO FAR AWAY from each other
  16. 16. How do we get these teams to start working together? We had three main goals: Give teams on both sides visibility into the end-to-end workflow as users experienced it Map the Medication Management experience from ordering > preparation > administration > billing Pinpoint the problems within those workflows that create the negative outcomes we’re trying to fix
  17. 17. Experience Map of current state Mapping the end-to-end steps within the workflow as understood via: ● Product walkthroughs ● Tutorial videos blueprinting-with-mural-d147674641e2
  18. 18. Cross-product site visits with 2 clients ● Identify communication gaps/breakdowns between providers, pharmacy and HIM ● Experience and guide each other through Clinicals and Collector worlds/users
  19. 19. Insights ● Multiple areas in the medication ordering and fulfillment cycle created negative downstream impacts if a mistake was made ● Reliance on paper and multiple sources of information caused rework and confusion ● Incomplete workflows result in distributed responsibility and lower adoption - Nurses, Rad Lab and Pharm techs adopting billing/coding work
  20. 20. Action ● Pivoted release plans to focus on medication ordering and fulfillment accuracy ● Increased efforts to automate charge capture ● Made dramatic improvements to a key document – the Medication Administration Report – to benefit both coders and hospital nurses/pharmacy techs.
  21. 21. Cross-product understanding
  22. 22. Applying the approach to other problem spaces
  23. 23. Goals of this research 1. Understand the modes and workflows by which charge entry happens 2. Learn more about the breakdown of roles, responsibilities and tools required to do this work across different practices 3. Understand how the different paths used to create claims might impact financial performance We conducted 8 site visits in January-February 2019 in a variety of geographies, specialties, and sizes. The sample included both Visit Beta and non-beta clients. We also mined previous research and analytics to find additional context for what we saw on site. This provided an opportunity to better understand the workflows across a representative sample of clients, and explore the impact of differences between Beta and Legacy workflows.
  24. 24. “I need you to make one of your things… that visual thing that’s hanging up in 5200, for this other team.” - Product Management Lead
  25. 25. Okay... So how do we do this?
  26. 26. Map the current state of things Use a tool like Mural or Miro to capture each step in the workflow inside and outside the system. Include: • Screenshots of UI • Non-computer steps as applicable • Observations from research • Known problems Get information from: • Product walkthroughs and tutorials • User research reports
  27. 27. Flesh it out with research Validate the map with all the information you can find from: ● Internal SMEs ● User interviews ● Client site visits Add additional observations and pain points as the elements of the map become more clear.
  28. 28. Bring people along for the ride ● Provide regular touchpoints with cross-functional and cross-product colleagues. ● Share what you’re learning, and the various artifacts you’re creating to support the story. ● Make the work visible around your organization – put it on the walls, bring it to meetings.
  29. 29. Takeaways ● Silos don’t break down overnight – it requires time and patience ● Designers are powerful when we work together ● Taking people step by step through the process helps drive alignment
  30. 30. Thank you!