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7/28/2019 1.2Workflow and Process Redesign
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HIT Toolkit
Workflow and Process
Redesign
Health InformationTechnology Toolkitfor Critical Accessand Small Hospitals
http://www.stratishealth.org/HIT_Toolkit_hospitals
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Presenter
Margret AmatayakulRHIA, CHPS, CPHIT, CPEHR, FHIMSS
President, Margret\A Consulting, LLC
Schaumburg, IL
Independent consultant, who focuses on achieving value fromelectronic health records, HIPAA/HITECH, and health informationexchange. Developer of tools in Toolkit
Adjunct faculty College of St. Scholastica, Duluth, MN, mastersprogram in health informatics
Founder and former executive director Computer-based PatientRecord Institute, associate executive director AHIMA, associateprofessor 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
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Stratis Health is a nonprofit organization that leadscollaboration and innovation in health care qualityand safety, and serves as a trusted expert infacilitating improvement for people and communities
Stratis Health works toward its mission throughinitiatives funded by federal and state governmentcontracts, and community and foundation grants,including serving as Minnesotas Medicare QualityImprovement Organization (QIO)
Stratis Health operates the Health InformationTechnology Services Center for health careorganizations seeking to use health informationtechnology in support of their clinical transformation
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Agenda
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 todays workarounds that will form the functionalrequirements for your HIT
Aids in setting expectations for achieving HIT goalsbecause users will now expect to see improvements
Ensures that critical controlsbuilt into current
processes are retained or enhanced
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Software
that directs
computer
devices
People
to support
and use
systems
Policy
that drives
adoption of
systems
Hardware
that enables
system use
Process
that helps
achieve
results
Copyright 2009, Margret\A Consulting, LLC. Used with permission of author.
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Copyright 2007-8, Margret\A Consulting, LLC. Used with permission of the author.
Workflow and Process
Processis the manner in whichwork to be completed to achieve aparticular result is performed
Example: Do you always verifythe timeliness of medicationadministration?
Work f lowis the sequence ofsteps and hand-offs taken within aprocess
Example: Is informationavailable to schedule patients for
labs in advance of a clinic visit?
Workf low and processmappingdepicts the detailednature of the processes andworkflow to enable improvements
Five Rights for RightEHR
Right clinical data
Right presentation
Right decision
Right work processes
Right outcomes
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EHR is Notabout 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 careEHRs 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
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1. Identify processes to be mapped; e.g., those that will be impactedby the HIT being acquired
2. Use individuals who actuallyperform the process; they know itbest and need to own the impending change
3. Instruct persons on process mapping why it is being done and
how it is done4. Map currentprocesses. Avoid identifying opportunities for
improvement now, or critical controls built into current processesmay be overlooked
5. Validate maps to ensure they reflect current processes, all
variations, and the information payload6. Collect all forms and reports that are part of processes to be
automated through HIT
7. Obtain benchmark data to define expectations for changeand for use in benefits realization studies
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Steps in Redesign
8. Identify potential problems in current workflows and processesand determine their root cause
9. Identify changes that may resolve problems today
10. Educate about HIT and EHR and identify further changes thatwill be possible
11. Document changes by creating improved map
12. Use new processes to create use case scenarios to identifyHIT functional specifications, and later to build out the HITapplication to achieve improvements
13. Test new workflows and processes14. Train all on new workflows and processes
15. Incorporate changes into policy and procedure
16. Conduct benefits realization and celebrate successfulchange/correct course as necessary
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Copyright 2007-8, Margret\A Consulting, LLC. Used with permission of the author.
What to Map
in Hospitals in Clinics Admission Medications reconciliation
H&P/results review/differentialdiagnosis
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
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
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Copyright 2007-8, Margret\A Consulting, LLC. Used with permission of the author.
Process diagram
Swim lane process chart
Flow process chart
Systems flow chart
Software is available toaid in drawing charts, ifdesired
Select Tools
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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
Used with permission from P. S. Rudie Associates, Duluth, MN
Robert McDonald, MD and Mary Rapps
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Copyright 2007-8, Margret\A Consulting, LLC. Used with permission of the author.
Annotating Processes
Courtesy of Dr. Hinck, Bloomington Lake Clinic,
Minneapolis, MN
It may be helpful to capture components of processes and workflowsby simply making a list of all processes, or
Use post-it notes to record processes as they areperformed and then arrange them on a wall orlarge piece of (e.g., examining room) paper
Process mapping is not new,and not even new to healthcare, but process mapping isforeign to clinicians
Engaging clinicians, however,is critical because EHRs aredesigned fortheiruse. It maybe necessary to start a mapfor them and have themvalidate itReal cl in iciansreal ly do map!
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Copyright 2007-8, Margret\A Consulting, LLC. Used with permission of the author.
Getting Started
Identify one completeprocess neither to
large or to small
Identify all potentialstarting points
Follow each to its
natural conclusion
Significant delays canbe annotated to the
side if desired
Refill Processing
No
Yes
Place inMD Box
Patient
Calls
Ask Pt to CallPharmacy
End
Chart
Reviewed
Write Rx &Give to Pt
Document inchart
End
Ave
1 hr
Ave
2 hr
Pharmacy
Calls
Request chart
Review chart
Nurse
OK?
Call Pharmacy
Document inchart
End
No
Yes
DocumentIn chart
Speak toNurse
OK?
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Copyright 2007-8, Margret\A Consulting, LLC. Used with permission of the author.
Reflect
Variations Medication
administrationin a criticalaccess hospitalwith five nursesadministering
medications Someprocesses canbe correctedimmediately;others will
depend onacquiring anEMAR
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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):
Map after
validation:
Document
RFV on Post-it
Throw Post-itaway
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Copyright 2007-8, Margret\A Consulting, LLC. Used with permission of the author.
Identify (Potential) Problems
Reviewcurrent mapsto identify:
Bottlenecks Sources of delay
Rework due toerrors
Role ambiguity Duplications Unnecessary
steps Cycle time
Flow process charts help identify Nature of tasks
Key questions
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Copyright 2007-8, Margret\A Consulting, LLC. Used with permission of the author.
Determine Root Cause
Use complementarytools as needed Statistical charts
Radar
Pareto
Relations diagrams
Tree diagram
Affinity diagram Force field analysis
Cause & effect diagrams
Physical Layouts
A
B
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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 forprocess 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
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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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