Transcript Workflow and Process Redesign

Workflow and Process
HIT Toolkit
Redesign
Health Information
Technology Toolkit
for Critical Access
and Small Hospitals
http://www.stratishealth.org/HIT_Toolkit_hospitals
Presenter
• Margret Amatayakul
RHIA, CHPS, CPHIT, CPEHR, FHIMSS
President, Margret\A Consulting, LLC
Schaumburg, IL
• Independent consultant, who focuses on achieving value from
electronic health records, HIPAA/HITECH, and health information
exchange. Developer of tools in Toolkit
• Adjunct faculty College of St. Scholastica, Duluth, MN, masters
program in health informatics
• Founder and former executive director Computer-based Patient
Record Institute, associate executive director AHIMA, associate
professor University of Illinois
• Active participant in standards development, former HIMSS BOD,
and co-founder of and faculty for Health IT Certification
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Stratis Health
● Stratis Health is a nonprofit organization that leads
collaboration and innovation in health care quality
and safety, and serves as a trusted expert in
facilitating improvement for people and communities
● Stratis Health works toward its mission through
initiatives funded by federal and state government
contracts, and community and foundation grants,
including serving as Minnesota’s Medicare Quality
Improvement Organization (QIO)
● Stratis Health operates the Health Information
Technology Services Center for health care
organizations seeking to use health information
technology in support of their clinical transformation
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Agenda
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Purpose of Workflow and Process Redesign
Steps in Workflow and Process Redesign
Workflows and processes to map
Performing workflow and process mapping
Critical success factors in workflow and
process mapping
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Purpose: Create Ah Ha! Moments
• Workflow and process redesign
– Starts the process of identifying improvement
opportunities with HIT
– Helps users identify solutions for current problems
and today’s workarounds that will form the functional
requirements for your HIT
– Aids in setting expectations for achieving HIT goals
because users will now expect to see improvements
– Ensures that critical controls built into current
processes are retained or enhanced
Hardware
that enables
system use
Software
that directs
computer
devices
People
to support
and use
systems
Policy
that drives
adoption of
systems
Process
that helps
achieve
results
Copyright © 2009, Margret\A Consulting, LLC. Used with permission of author.
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Workflow and Process
• Process is the manner in which
work to be completed to achieve a
particular result is performed
– Example: Do you always verify
the timeliness of medication
administration?
• Work flow is the sequence of
steps and hand-offs taken within a
process
– Example: Is information
available to schedule patients for
labs in advance of a clinic visit?
• Workflow and process
mapping depicts the detailed
nature of the processes and
workflow to enable improvements
Copyright © 2007-8, Margret\A Consulting, LLC. Used with permission of the author.
Five Rights for Right EHR
● Right clinical data
● Right presentation
● Right decision
● Right work processes
● Right outcomes
EHR is Not about Automating Charts
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“Only automating form, content, and procedures of current patient records will
perpetuate their deficiencies and be insufficient to meet emerging user needs”
EHR is about automating & using
information to improve health care
EHRs “encompass a broader view of the record than today, moving from
notion of location for keeping track of patient care events to a resource
with much enhanced utility”
Institute of Medicine, 1991
Copyright © 2009, Margret\A Consulting, LLC. Used with permission of author.
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Steps in Mapping Current Processes
1. Identify processes to be mapped; e.g., those that will be impacted
by the HIT being acquired
2. Use individuals who actually perform the process; they know it
best and need to own the impending change
3. Instruct persons on process mapping – why it is being done and
how it is done
4. Map current processes. Avoid identifying opportunities for
improvement now, or critical controls built into current processes
may be overlooked
5. Validate maps to ensure they reflect current processes, all
variations, and the information payload
6. Collect all forms and reports that are part of processes to be
automated through HIT
7. Obtain benchmark data to define expectations for change
and for use in benefits realization studies
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Steps in Redesign
8. Identify potential problems in current workflows and processes
and determine their root cause
9. Identify changes that may resolve problems today
10. Educate about HIT and EHR and identify further changes that
will be possible
11. Document changes by creating improved map
12. Use new processes to create use case scenarios to identify
HIT functional specifications, and later to build out the HIT
application to achieve improvements
13. Test new workflows and processes
14. Train all on new workflows and processes
15. Incorporate changes into policy and procedure
16. Conduct benefits realization and celebrate successful
change/correct course as necessary
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What to Map
in Hospitals
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Admission
Medications reconciliation
H&P/results review/differential
diagnosis
Patient assessment
Care planning/pathways
Provider orders
Consultation management
Patient monitoring and charting
Medication administration
Surgery/recovery
Transfer of care/care coordination
Discharge/patient instructions
Charge capture/coding
Reporting/quality improvement
Departmental operations
in Clinics
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Scheduling/check-in and check-out
Patient intake
Results review
H&P/encounter notes
Care planning/guidelines
Medication management: medication
list maintenance/ prescribing/refills
Provider orders
E&M coding
Charge capture
Patient instructions/education
Patient follow up/health maintenance
Reporting/quality improvement
Copyright © 2007-8, Margret\A Consulting, LLC. Used with permission of the author.
Select Tools
• Process diagram
• Swim lane process chart
• Flow process chart
• Systems flow chart
• Software is available to
aid in drawing charts, if
desired
Copyright © 2007-8, Margret\A Consulting, LLC. Used with permission of the author.
Basic Systems Flow Chart
• Ovals – start and end
• Rectangles – process
• Diamonds – decision
Copyright © 2007-8, Margret\A Consulting, LLC. Used with permission of the author.
Used with permission from P. S. Rudie Associates, Duluth, MN
Robert McDonald, MD and Mary Rapps
Annotating Processes
• It may be helpful to capture components of processes and workflows
by simply making a list of all processes, or
• Use post-it notes to record processes as they are
performed and then arrange them on a wall or
large piece of (e.g., examining room) paper
● Process mapping is not new,
and not even new to health
care, but process mapping is
foreign to clinicians
● Engaging clinicians, however,
is critical because EHRs are
designed for their use. It may
be necessary to start a map
for them and have them
validate it – Real clinicians
really do map!
Copyright © 2007-8, Margret\A Consulting, LLC. Used with permission of the author.
Courtesy of Dr. Hinck, Bloomington Lake Clinic,
Minneapolis, MN
Getting Started
• Identify one complete
process – neither to
large or to small
• Identify all potential
starting points
• Follow each to its
natural conclusion
• Significant delays can
be annotated to the
side if desired
Refill Processing
Patient
Calls
Pharmacy
Calls
Chart
Reviewed
Ask Pt to Call
Pharmacy
Write Rx &
Give to Pt
End
Document in
chart
Request chart
End
Review chart
Ave
1 hr
Ave
2 hr
Copyright © 2007-8, Margret\A Consulting, LLC. Used with permission of the author.
Nurse
OK?
Yes
No
Place in
MD Box
OK?
Document in
chart
Yes
Document
In chart
Call Pharmacy
Speak to
Nurse
End
No
Reflect
Variations
• Medication
administration
in a critical
access hospital
with five nurses
administering
medications
• Some
processes can
be corrected
immediately;
others will
depend on
acquiring an
EMAR
Copyright © 2007-8, Margret\A Consulting, LLC. Used with permission of the author.
Validate Process Maps
• Initial pass at a swim lane map (clinic example):
Document
RFV on Post-it
• Map after
validation:
Copyright © 2007-8, Margret\A Consulting, LLC. Used with permission of the author.
Throw Post-it
away
Identify (Potential) Problems
• Review
current maps
to identify:
• Flow process charts help identify
– Nature of tasks
– Key questions
– Bottlenecks
– Sources of delay
– Rework due to
errors
– Role ambiguity
– Duplications
– Unnecessary
steps
– Cycle time
Copyright © 2007-8, Margret\A Consulting, LLC. Used with permission of the author.
Determine Root Cause
• Use complementary
tools as needed
– Statistical charts
• Radar
• Pareto
– Relations diagrams
– Tree diagram
– Affinity diagram
• Force field analysis
– Cause & effect diagrams
– Physical Layouts
B
A
Copyright © 2007-8, Margret\A Consulting, LLC. Used with permission of the author.
Critical Success Factors
• Map processes that will be impacted by HIT, unless other reason for
process improvement
• Engage persons actually performing the process. Leave bias and
blame at the door – reward those who find the most warts!
• Avoid getting ahead of mapping current processes, but make sure
they are complete and address the information flow – remember,
information is being automated, not the staff member or the patient
• Get to the root cause of problems when looking for improvements.
Address immediate opportunities; use others as key functional
requirements for your HIT
• Use workflow and process mapping to create Ah ha! moments that
initiate the change process. Follow up that changes are adopted and
celebrate success once change is implemented
Copyright © 2007-8, Margret\A Consulting, LLC. Used with permission of the author.
For More Support
• Contact:
Stratis Health
2901 Metro Dr., Suite 400
Bloomington, MN 55425
952-854-3306
1-877-787-2847 (toll free)
www.stratishealth.org
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