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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 - PowerPoint PPT Presentation
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NU MMI 402 – Introduction to Clinical Thinking
Improving Efficiencies in the Outpatient Setting
Group 2 Final Project
Group 2Ramesh Gowda
Byung KangJoseph RyanZelie Ybanez
March 04, 2012
2
Presentation outline
• Background• Case Scenario• Current State & Workflow• Technologies Considered and their Benefits• Optimized State & New Workflow• Conclusion
3
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 Survey2. PR Newswire
4
Current State
Current State
Part of a large health
groupOutpatient
Only
No Residents, Use Med Students
Rounds&
Hospitalists
Multi-Specialty
GroupPaper
Records
Radiology Downstairs
Multiple Lab Vendors
Physicians dictate notes
Pharmacy downstairs
5
Scheduling Workflow
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
6
Front Desk Workflow
Patient arrivesfor visit
Gives the front desk her name and insurance
card
Front Desk ProcessCannot 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
7
Medical Assistant (MA) Intake Workflow
MA IntakeMA 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 misplaces the BP paper
and has to retake the BP
on patient
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
8
Physician Intake Workflow
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 Family History Allergies
PE/ROS Uses MedCalc3000
DiagnoseSigns point to rheumatoid
arthritis
Plan Orders
Radiology - X-Ray of the
hands
Orders Labs tests
Referrers to Rheumatologist, writes a script
Patient to schedule a 1 month follow
up
Charge Visit Charge Diagnosis Procedures
9
Checkout Workflow
Patient goes to check out pays the co-pay
Patient forgets to schedule the follow up
Patient has to schedule referral appointment
10
Consultant WorkflowPatient
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…..
11
Overview
12
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 Survey2. PR Newswire
13
Technology - EHR
Benefits of EHRs• Coordinated care• Enhanced communication between providers• Productivity improvement• Quality care• Convenience for patients• Better patient management
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.
14
Optimized State
Optimized State
Part of a large health group withHER & Hl7 Outpatient
Only[Standardized
Systems]
No Residents, but do have
Med Students
Round on patients
[Mobile EHR Solution]
Multi-Specialty
GroupOn a paper process-[EHR =
Single Chart + Private HIE]
Radiology Downstairs[Interfaced Results / CPEO]
Multiple Lab Vendors –
draw station in building [CPOE]
Physicians dictate notes
[Voice Recognition &
Template]
Pharmacy downstairs
[SureScripts connection w/
EHR]
15
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
Triage Nurse can schedule in PM/EHR
Patient can contact through PHR
Visit is scheduled
16
Optimized Front Desk Workflow
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
17
Optimized MA Intake Workflow
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.
18
Optimized Physician Workflow
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 Family History Allergies
PE/ROSEHR offers
several alerts to ensure full
documentation
DiagnoseSigns point to rheumatoid
arthritis
EHR alerts potential Joint
pain due to current
medication
Plan Orders
Radiology - X-Ray of the
hands
Orders Lab tests
Patient to schedule a 1 month follow
up
Charge Visit Charge Diagnosis Procedures
19
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
20
Conclusion