Transcript Slide 1

NU MMI 402 – Introduction to Clinical Thinking
Improving Efficiencies in the Outpatient Setting
Group 2 Final Project
Group 2
Ramesh Gowda
Byung Kang
Joseph Ryan
Zelie Ybanez
March 04, 2012
Presentation outline
• Background
• Case Scenario
• Current State & Workflow
• Technologies Considered and their Benefits
• Optimized State & New Workflow
• Conclusion
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Background
• US spends more per capita, but is ranked as the 37th in the world.
• Health care industry in US is quite complex and fragmented.
• Majority of medical records in the US still on paper and the average
appointment taking 13 pages to document. 1
• Only 6.3% of physicians use a fully-functional Electronic Health
Record system in their practice according to the CDC. 2
• At least 1.5 million Americans are sickened, injured or killed each
year by errors related to according to the Institute of Medicine. 2
• ARRA/HITECH Act has allocated to $19 Billion to promote the use of
Health Information Technology (HIT) especially for EHRs.
1. Practice Fusion Survey
2. PR Newswire
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Current State
Part of a
large health
group
Pharmacy
downstairs
Outpatient
Only
No
Residents,
Use Med
Students
Physicians
dictate
notes
Current
State
Rounds
&
Hospitalists
Multiple Lab
Vendors
MultiSpecialty
Group
Radiology
Downstairs
Paper
Records
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Scheduling Workflow
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Patient calls her
primary care
physician’s
office
Sore wrist and joint
pain and wants to
see if she needs
to schedule a visit
Triage Nurse
receives call
from front desk
Phone transfer,
and front desk logs
call on paper
Triage Nurse
advises the
patient to
schedule an
appointment
Transfers back to
the front desk
Then transfers the
patient to
scheduling
Scheduling tells
the patient no
openings till
next month
Patient complains
and says that the
Triage Nurse said
to come in as soon
as possible
Scheduler has to
place patient on
hold and discuss
with the triage
nurse
Triage nurse tells
scheduler to “fit”
the patient in to
see her doctor for
an acute visit
Visit is scheduled
Front Desk Workflow
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Patient arrives
for visit
Gives the front desk
her name and
insurance card
Front Desk Process
Cannot find the chart
and unsure if the
patient has ever
completed any intake
forms
E.g. Compliance, end
of life care, HIPAA
documents, new patient
questionnaire
Patient then has to fill
out everything before
they can see the
physician
Medical Assistant (MA) Intake Workflow
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MA Intake
MA is ready but
patient is still
filling out
paperwork
MA takes
patient back
MA finds a
“shadow chart”
for the patient
The MA does
weight check
not height,
takes BP
The MA writes
down the BP
MA has to run
over to another
MA for a triage
call
MA rooms the
patient
MA places chart
in the door flags
to indicate the
patient is ready
Physician
doesn’t see the
flag
The patient is
there for over
40 minutes
The patient is
stressed, appear
clammy, slightly
pale, dehydrated
and elevated BP
MA misplaces
the BP paper
and has to
retake the BP
on patient
Physician Intake Workflow
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Physician
Intro
Physician
rattles the door
as he takes off
the chart
Patient’s
anxiety
increases
Patient’s
appearance
Chief
Complaint
Physician asks
the patient
about wrist pain
(not joint pain)
Physician asks
open/closed
ended
questions
Physician
learns about
the joint pain
Physician
takes History
Medication
History Lexapro
Past Medical
History
Past Social
History
PE/ROS
Uses
MedCalc3000
Diagnose
Signs point to
rheumatoid
arthritis
Plan
Orders
Radiology - XRay of the
hands
Orders Labs
tests
Charge
Visit Charge
Diagnosis
Referrers to
Rheumatologist,
writes a script
Procedures
Family History
Patient to
schedule a 1
month follow
up
Allergies
Checkout Workflow
Patient goes to check out pays the co-pay
Patient forgets to schedule the follow up
Patient has to schedule referral appointment
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Consultant Workflow
Patient
schedules
appointment
and arrives
Patient didn’t know that
they need a prior
authorization to see
rheumatologist but
scheduled anyways.
Loses the referral
script and doesn’t have
a authorization
numbers
Rheumatology has to
call the PCP office to
get the script & contact
insurance company to
get the authorization
number
Patient sees
Rheumatologist
The physician asks the
patient about meds
and history
Physician orders a
rheumatology panel
Physician then
believes Lexapro is the
source of the joint pain
Patient then
schedules a follow
up visit with her
primary care
physician
The physician
explains the results
of the referral…..
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Overview
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Technology Considered
• Electronic Health Records (EHR)
• Clinical Decision Support System (CDSS)
• Health Information Exchange (HIE)
• Mobile Technology (e.g. smart phone and tablets)
1. Practice Fusion Survey
2. PR Newswire
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Technology - EHR
What is EHR?
Electronic Health Rerecords (EHR) include comprehensive patient data such as patient
demographics, medical history, vital signs, medication, allergies, immunization status, lab
test results, images (radiology, MRI, CT scan, etc.) and insurance, billing information.
EHRs goes beyond the digital form of the charts, conceptually they focus on the total
health of the patient.
Benefits of EHRs
• Coordinated care
• Enhanced communication between providers
• Productivity improvement
• Quality care
• Convenience for patients
• Better patient management
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Optimized State
Pharmacy
downstairs
[SureScripts
connection w/
EHR]
Part of a
large health
group with
HER & Hl7
Outpatient
Only
[Standardized
Systems]
Physicians
dictate notes
[Voice
Recognition
& Template]
No
Residents,
but do have
Med Students
Optimized
State
Multiple Lab
Vendors –
draw station
in building
[CPOE]
Round on
patients
[Mobile EHR
Solution]
Radiology
Downstairs
[Interfaced
Results /
CPEO]
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On a paper
process[EHR =
Single Chart
+ Private
HIE]
MultiSpecialty
Group
Optimized Scheduling Workflow
Patient calls her
primary care
physician’s office to
discuss issue
Sore wrist and joint
pain and wants to
see if she needs to
schedule a visit
Triage Nurse
receives call from
front desk
Phone transfer, and
triage nurse
documents call in
EHR, forwards note
to physician to sign
Visit is scheduled
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Triage Nurse can
schedule in
PM/EHR
Patient can contact
through PHR
Optimized Front Desk Workflow
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Patient arrives for
visit
Gives the front
desk her name and
insurance card
Front Desk reviews
the insurance card
in the system and
the one given to
confirm no change
Front Desk
Process
Confirm all check in
forms have been
completed
Front Desk marks
patient as arrived
Intake staff are
signaled of arrived
patient
Optimized MA Intake Workflow
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MA Intake
MA brings
patient back
MA takes
patient back
MA goes to
weight/height
station
MA brings up
patient
Weight and
height from
scales transfers
to EHR, vitals
MA rooms the
patient
MA enters Chief
Complaint
Using EHR
patient’s Med
History and Med
List retrieved
MA changes
patient status to
Provider Ready
Provider is
alerted via EHR
patient is ready
MA is alerted if
patient is not
attended
within10 min.
Optimized Physician Workflow
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Physician
Intro
The physician
knocks on the
door and
enters
Physician
talks with the
patient access
EHR
Chief
Complaint
(CE)
Providers
reads it in the
EHR
Physician asks
open/closed
ended
questions
Physician
learns about the
joint pain and
updates CE
Physician
takes
History
Medication
History –
reviews what
MA Put in
Past Medical
History
Past Social
History
PE/ROS
EHR offers
several alerts to
ensure full
documentation
Diagnose
Signs point to
rheumatoid
arthritis
EHR alerts
potential Joint
pain due to
current
medication
Plan
Orders
Radiology - XRay of the
hands
Orders Lab
tests
Patient to
schedule a 1
month follow
up
Charge
Visit Charge
Diagnosis
Procedures
Family History
Allergies
Optimized Checkout Workflow
Physician tells patient all medications will be ready at the pharmacy
When patient goes to the front desk, the front desk schedules the follow up
Front desk hands patient visit summary
PHR will show all appointments
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Conclusion
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