The Portsmouth brief
Review of processes involving health records Identify how records are managed, accessed, referenced
and amended Provide input into the following activities:
The configuration of the EDM solution The development of appropriate workflows and working practices
for the deployed system Identification of potential cost savings that could be realised
through the rationalisation of clerical staff involved in the processing of paper-based records.
Current Records Process Interaction with the Patient Journey
Patient Journey
Patient History
Updates
Updated History
Pull File
Records Process
Effort and delay of pulling, tidying, preparing and filing
Everyone wants it, only one person has it
Where is it? – Tracking and searching…
2000+ forms in use!
Urgent cases are seen without history
The approach
Tribal model for workflow analysis Walking the process Using Visio to create swimlane diagrams and process
documents Creating ‘storyboards’ to engage with and involve users
Method and deliverables
Current State
File
ClerkDr.
Story-boards
1
2 3
4
Process models
1
2 DocSchedule
DocSchedule
o/p i/p A+E emerg
pull prep move file
codeSpeciality
Top level “map”
Final Report
• Exec. summary
• Intro & Background
• Context
• EDM Architecture, P.A.C.
• Current state
• Future state vision
• Future state processes
• Impacts, variances and migration issues
• Benefits realisation
• Conclusions and recommendations
• Appendices…
BenefitsDependency
Network(Visio)
OperationalGuidelines(MS-Word)
Stakeholder Map
Impacts, Issuesby dept.
speciality, role.Metrics
Impacts
Method and deliverables
Future StateCurrent State
1
2 3
4
To-be process models
1
2Top20Docs &Archi-tecture
Top20Docs &Archi-tecture
File
ClerkDr.
Story-boards
1
2 3
4
Process models
1
2 DocSchedule
DocSchedule
o/p i/p A+E emerg
pull prep move file
codeSpeciality
Top level “map”
ClerkDr.
To-Be Stories
EDM
Final Report
• Exec. summary
• Intro & Background
• Context
• EDM Architecture, P.A.C.
• Current state
• Future state vision
• Future state processes
• Impacts, variances and migration issues
• Benefits realisation
• Conclusions and recommendations
• Appendices…
Method and deliverables
ImpactsFuture StateCurrent State
1
2 3
4
To-be process models
1
2Top20Docs &Archi-tecture
Top20Docs &Archi-tecture
File
ClerkDr.
Story-boards
1
2 3
4
Process models
1
2 DocSchedule
DocSchedule
o/p i/p A+E emerg
pull prep move file
codeSpeciality
Top level “map”
ClerkDr.
To-Be Stories
EDM
BenefitsDependency
Network(Visio)
OperationalGuidelines(MS-Word)
Stakeholder Map
Impacts, Issuesby dept.
speciality, role.Metrics
Final Report
Method and deliverables
ImpactsFuture StateCurrent State
1
2 3
4
To-be process models
1
2Top20Docs &Archi-tecture
Top20Docs &Archi-tecture
File
ClerkDr.
Story-boards
1
2 3
4
Process models
1
2 DocSchedule
DocSchedule
o/p i/p A+E emerg
pull prep move file
codeSpeciality
Top level “map”
ClerkDr.
To-Be Stories
EDM
BenefitsDependency
Network(Visio)
OperationalGuidelines(MS-Word)
• Exec. summary
• Intro & Background
• Context
• EDM Architecture, P.A.C.
• Current state
• Future state vision
• Future state processes
• Impacts, variances and migration issues
• Benefits realisation
• Conclusions and recommendations
• Appendices…
Stakeholder Map
Impacts, Issuesby dept.
speciality, role.Metrics
Features
Rapid start-up Maximum staff engagement Minimum impact on departments and staff Live walkthrough environment captures “rich picture” Time to book events in busy diaries Maximum value from workshops from dynamic
storyboards “Best of both worlds” – detailed swimlanes and process
documents, plus visual storyboards
Swimlanes
Accident and Emergency – patient assessment
Rec
eptio
n C
lerk
Tra
nsfe
r N
urse
Maj
ors
Rec
eptio
n C
lerk
Min
or In
jurie
s N
urse
/Doc
tor
Str
eam
ing
Nur
se AE L1: CAS ready
AE B07: Collect CAS card from
box at reception and call patient
minor injury?
AE B08: Deliver CAS card to
minors and place in box in order
Yes
AE B09: Record patient treatment
on CAS card
Follow-up required?
AE B10: Photocopy CAS
card, place copy in pigeon hole for
clinic and log appt
Yes
AE B11: Create medical/surgical admission record
No
AE B12: Photocopy
completed Majors CAS card
AE B13: Majors CAS card is
transferred to MAU/SAU
AE B14: Code completed cards
directly onto system
No
AE O1: Patient transfered to MAU/SAU
AE L3: On
system
AE L4: A&E to MAU
AE L5: A&E to SAU
AE I4: Patient arrives via ambulance
80% of majors arrive this route
Storyboards
Followup?
Admit?
MINORS
MAJORS
UNPLANNED INPATIENTS FUTURE - Stage: A&E Treatment
20
UP TO 4 HOURS
01:00
»To scanning, or:MAU, SAU, other wards.
YES
YES
NO
NO
Allocate patient to stream
Record treatment details on CAS
card
Minor cards in order
Record details on CAS card.
Make out script.
Create admission record. Copy CAS card. Orig. may be
passed on
Patient transferred to assessment unit/ward or
theatre. May request Xrays / notes for out-of
area patients
Code completed
cards
Copy cardLog into
clinic book Put card into pigeon hole
EDM
Consult EDM
EDM
Consult EDM /
Graphnet
Opportunity / benefit:Early consultation of patient record=> admission avoidance
llllllllllllllll
Possible move to electronic booking in the future
If next day F/up, then retain paper
Workshop approach
Describe EDM softwarePresent storyboards slides (current => future)Q&A
Work with small groups around A1 posters + post-its
Update future state storyboards and log risks, issues, benefits, FAQs
Some EDM issues and challenges
Stakeholder engagement is vital Agreeing a standard EDM record structure Workflows are complex and inconsistent Variety of paper documents and ways of working How and when to scan Management of temporary notes, including tracking Significant information governance issues
Contact details – Wendy Clark
Email: [email protected]
Mobile: 07786 510490
Tribal Consulting, First Floor, 154 Great Charles Street, Queensway, Birmingham, B3 3HN