Process Engineering & Process Engineering & Health IT:Health IT:

Which Comes First - Which Comes First -

The Chicken or The Egg?The Chicken or The Egg?

Why It Matters…Why It Matters…Why It Matters…Why It Matters…

Primary Care TodayPrimary Care Today

HITHIT

PCMHPCMH

““P 4 P”P 4 P”

A Caveat…A Caveat…A Caveat…A Caveat…

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Healthcare IT is the means, but not the end, says Healthcare IT is the means, but not the end, says BlumenthalBlumenthal

September 16, 2009 | Diana Manos, Senior EditorSeptember 16, 2009 | Diana Manos, Senior Editor

I’m From The Government And I’m From The Government And I Am Here To Help You…I Am Here To Help You…

ARRA, RHITEC, &ARRA, RHITEC, &““MEANINGFUL USE”MEANINGFUL USE”

HITECH Priority Grants Program Rollout: Next HITECH Priority Grants Program Rollout: Next Steps Toward Nationwide Health Information Steps Toward Nationwide Health Information Exchange Exchange David Blumenthal, M.D., M.P.P.National Coordinator for Health Information Technology, DHHS

The White House has announced the rollout of the first two in a series of HITECH priority grant programs… Some Important Concepts:

•Meaningful UseMeaningful Use of certified EHR systems…

•Health Information Technology Regional Extension Health Information Technology Regional Extension CentersCenters

•Electronic information exchangeElectronic information exchange

Michigan PCMH Definition, NCQA Standard/PGIP Domain, Proposed PCMH Metrics, Michigan PCMH Definition, NCQA Standard/PGIP Domain, Proposed PCMH Metrics, Meaningful UseMeaningful Use

Health IT and Health IT and Transformed Health CareTransformed Health Care

Ultimate vision is to enable Ultimate vision is to enable significant and measurable significant and measurable improvements in population improvements in population health through a transformed health through a transformed health care delivery system.health care delivery system.*Adapted from National Priorities Partnership. National Priorities and Goals: Aligning Our Efforts to Transform America’s Healthcare. Washington, DC: National Quality Forum; 2008

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Another Caveat…Another Caveat…

HIT is NOT Part of HIT is NOT Part of “Your Father’s Medical “Your Father’s Medical

Practice”.Practice”.

.

It Can’t and Shouldn’t Be It Can’t and Shouldn’t Be Attempted Without A Change In Attempted Without A Change In Practice Culture And Practice Practice Culture And Practice

Workflow Re-EngineeringWorkflow Re-Engineering

Regional Centers must be Regional Centers must be capable of mapping and capable of mapping and redesigning work processes, redesigning work processes, updating roles and updating roles and responsibilities for clinicians responsibilities for clinicians and support staff, and leading and support staff, and leading continuous quality continuous quality improvement activities improvement activities involving rapid cycle feedback.involving rapid cycle feedback.

RHITEC Practice and RHITEC Practice and Workflow Design Workflow Design

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Go-CartGo-Cart

Practice RedesignPractice Redesign

&&

Preparing for Health ITPreparing for Health IT

Practice RedesignPractice Redesign

&&

Preparing for Health ITPreparing for Health IT

The The ““Magnificent Seven” Magnificent Seven”

Rules For HIT Rules For HIT Preparation...Preparation...

.

Culture Is Everything!Culture Is Everything!Culture Is Everything!Culture Is Everything!

Re-engineer Your Practice Workflows Re-engineer Your Practice Workflows BEFOREBEFORE You ElectronifyYou ElectronifyRe-engineer Your Practice Workflows Re-engineer Your Practice Workflows BEFOREBEFORE You ElectronifyYou ElectronifyCarefully Examine Carefully Examine ALLALL Of Your Functional Of Your Functional OptionsOptionsCarefully Examine Carefully Examine ALLALL Of Your Functional Of Your Functional OptionsOptionsBe A Knowledgeable And Very Wary Be A Knowledgeable And Very Wary ConsumerConsumerBe A Knowledgeable And Very Wary Be A Knowledgeable And Very Wary ConsumerConsumer

Train Like There Is No Tomorrow!Train Like There Is No Tomorrow!Train Like There Is No Tomorrow!Train Like There Is No Tomorrow!

Evaluate! Evaluate! Evaluate!Evaluate! Evaluate! Evaluate!Evaluate! Evaluate! Evaluate!Evaluate! Evaluate! Evaluate!

The Devil Devil Is In The InterfaceThe Devil Devil Is In The Interface

Rules For HIT PreparationRules For HIT Preparation

Prep Prep WorkWork

So, What’s a Body to Do?So, What’s a Body to Do?So, What’s a Body to Do?So, What’s a Body to Do?

What is PRISM?

• A physician driven, non-profit corporation formed A physician driven, non-profit corporation formed in cooperation with nine Michigan PO’s and PHO’sin cooperation with nine Michigan PO’s and PHO’s

• Providing comprehensive practice and culture Providing comprehensive practice and culture transformation services in Michigan and beyond transformation services in Michigan and beyond on a “no-lose”, gain-share basison a “no-lose”, gain-share basis

• Able and willing to assist the Michigan RHITEC Able and willing to assist the Michigan RHITEC (and others) in preparing primary care practices (and others) in preparing primary care practices to becoming “meaningful users” in the context of to becoming “meaningful users” in the context of helping them undergo transformation helping them undergo transformation

EVIDENCE-BASED MEDICINE

EVIDENCE-BASED MEDICINE

LEAN THINKING

LEAN THINKING

INFORMATION TECHNOLOGY

INFORMATION TECHNOLOGY

CULTURE CHANGE

CULTURE CHANGE

PROFITABILITYPROFITABILITY

CUSTOMER SATISFACTION

CUSTOMER SATISFACTION

CURREN

T STATE

CURREN

T STATE

ANTICIPATED ANTICIPATED OUTCOMESOUTCOMES

Strategy For Sustainability & Spread Strategy For Sustainability & Spread of Practice Transformation in of Practice Transformation in Michigan & BeyondMichigan & Beyond

PRISMPRISM

PCPCPP

PCPCPP

PCPCPP

PCPCPP

PCPCPP

PCPCPP

PCPCPP

PCPCPP

PCPCPP

PCPCPP

PCPCPP

PCPCPP

PCPCPP

PCPCPP

PCPCPP

PCPCPP

PCPCPP

PCPCPP

PCPCPP

# of PCP’s Not LimitedBy Grant Resources

Sustainability & Spread Assured

• No Risk To PCPNo Risk To PCP

•Funded from Funded from Waste RemovedWaste Removed

•Physician Physician DirectedDirected

• Staffed by FT Staffed by FT ProsPros

• Consistency Consistency

PO PO #1#1

PO PO #3#3

PO PO #5#5

PO PO #6#6

PO PO #2#2

PO PO #4#4

PO PO #7#7

PO PO #9#9

PO PO #8#8

The ASQ The ASQ Marshall Marshall

PlanPlanakaaka

PRISM-litePRISM-lite

Would Like To Partner with Communities, Medical Associations, and Medical Groups To Assist In The Redesign

of Their Practices

A Modern-Day A Modern-Day “Marshall Plan For “Marshall Plan For Healthcare”Healthcare”

A Fishing Pole, A Fishing Pole, Not A FishNot A Fish

Getting to Sustainability and Spread…

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Communities Considering This ApproachCommunities Considering This Approach

Community Sponsor(s)Anticipated Start Date

Akron, OHEmployer Health

Coalition1st QTR, 2010

York, PALocal Health Care

System1st QTR, 2010

Milwaukee, WIMedical Society & Employer Health

Coalition1st QTR, 2010

Findlay, OHEmployer & Local

Hospital1st QTR, 2010

Erie, PALocal Health Care

System2d QTR, 2010

One Example Of One Example Of Process Re-Process Re-

Engineering At Work Engineering At Work In A Medical In A Medical Practice…Practice…

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Meet SJ Family Meet SJ Family Medical CenterMedical Center

I Call I Call Them The Them The

33

Their StoryTheir Story

Current StateCurrent StateManagement Of Patient Medical FormsManagement Of Patient Medical Forms

Receive Form When

Patient Presents

Receive Form From

Patient in Room

Inquire Re:

DX Codes

In Box Message:Is Form

Completed?

Receive Patient Phone Call: Is Form

Ready?

MA Distributes

Form To Doctor Box

Receive Form By

Mail / Fax

Form Is Placed In MA Box

In Box Message:

Is Form

Completed?

DoctorCompletes

Form

Receive Call

About Form Error

Receive Form From

Patient in Room

FormError

Receive Call:

Is FormReady?

FileForm

At FrontDesk

Give Form

ToPatient

Inbox Message

To Doctor re:

Error

Is Form

Ready?

InquireAboutForm

InquireAboutForm

Correction Done / Form

Completed

PatientCalls Re: :

FormStatus

ReceiveCall

ComplaintRe:

Form Status

Practice Performance In The Current StatePractice Performance In The Current State

First Time Quality (FTQ)First Time Quality (FTQ) = 1% !!!!!= 1% !!!!!

Value/Cost of Total Practice Time Spent / Yr In Process Value/Cost of Total Practice Time Spent / Yr In Process = = $ 169,780$ 169,780

Receives Finished Form

FromDoctor

Contact Patient to Pick

up Form

Management Of Patient Medical FormsManagement Of Patient Medical FormsFuture StateFuture State

END

Practice Performance In The Future StatePractice Performance In The Future State

First Time Quality (FTQ)First Time Quality (FTQ) = = 72% !!!72% !!!

Value/Cost of Total Practice Time Spent / Yr In Process Value/Cost of Total Practice Time Spent / Yr In Process = = $ $ 80,44880,448

PLUS: Process Throughput Time For Forms Cut in Half!!!PLUS: Process Throughput Time For Forms Cut in Half!!!

The COCQ Applied In One The COCQ Applied In One Family PracticeFamily Practice

•Hard Dollar Annual Savings of Hard Dollar Annual Savings of $90,000$90,000 In In Only One ProcessOnly One Process

•Energized staff and physicians eager for Energized staff and physicians eager for more improvementmore improvement

•Dramatically Improved First Time QualityDramatically Improved First Time Quality

•Once learned, can be done by practice Once learned, can be done by practice itself without outside helpitself without outside help

In Closing, I’d Like to In Closing, I’d Like to Leave You with A Song Leave You with A Song

About Health IT…About Health IT…

Dr. Sam Bierstock is an ophthalmologist, an electrical engineer, and a consultant for medical information systems management and design. He has published more than 50 articles on medical information systems, and written a book about medical office computerization.

The EMR Blues: “Paper Won’t Be The EMR Blues: “Paper Won’t Be Here Long…“Here Long…“Dr. Sam & the Managed Care Blues Dr. Sam & the Managed Care Blues BandBand

“…“…Too many tests Too many tests A thick chart - for you to read A thick chart - for you to read An EMR - is what you need An EMR - is what you need

You like to think that you're You like to think that you're immune to the stuff, oh yeah immune to the stuff, oh yeah

It's closer to the truth, you know - It's closer to the truth, you know - Like it or not you knowLike it or not you know

You're gonna have to face it – You're gonna have to face it – PAPER WON'T BE HERE LONGPAPER WON'T BE HERE LONG…” …”