1. Using Technology to Modify Clinic Workflows Promoting
Patient Engagement and Restoring Fun in Clinic Exam Rooms
2. More Accurately . A story of failure How Ive been totally
unable to convince colleagues and health care systems to put more
technology in primary care clinics .
3. Or the power of the second screen Photograph: Colin
Anderson
4. Objectives and Goals Objectives Define and identify clinic
workflows and designs Discuss variations that promote patient
engagement Review technologies and techniques that can restore
creativity and fun to the clinic experience Goal Show and outline
current states Illustrate and map out variations that reduce work
for everyone Demonstrate tools that add spark and help create aha
moments in our exam rooms
5. Form follows Function It is the pervading law of all things
organic and inorganic, of all things physical and metaphysical, of
all things human and all things superhuman, of all true
manifestations of the head, of the heart, of the soul, that the
life is recognizable in its expression, that form ever follows
function. This is the law. Louis Sullivan, The Tall Office Building
Artistically Considered 1986
6. First, a personal story All of us are somewhere along a
personal trip that defines who we are and helps understand where we
are today. This will help you understand this presentation and help
you evaluate the relevance of this session to your own
situation.
7. Proposed Modular Design
8. Multiple modules in a Clinic
9. Expanded Design
10. Became Reality
11. Trouble in paradise Management outsourced to outside group
No experience with novel clinic settings Continued traditional
visits Form incompatible with function Very little interactivity
with technology at the point of care Only minimal amount of patient
engagement Has gradually changed over time but basic design of the
suite remains
12. Observations Changing World Decreasing autonomy Increasing
regulation Meaningful Use Issues Volume to Value migration
Lifestyle diseases Population Health Increasing transparency Here
to stay and growing EMRs, EHRs, PMRs, PHRs Imaging &
Photography Patient satisfaction and engagement Patient originated
information Telemedicine & virtual visits License expansion
High cost of physical space
13. Change, change and more change Rapid adaption key to
survival Industry responses Move transaction processing as close to
customer as possible Decreasing costs Increasing value Changing who
does what, where and how things are viewed Medically allowing
patients to participate in the process Medical inertia drags down
required adaptation
14. What can be changed? Element Cost Workflow Who does what
Who does where Low Technology Whats in the room Tools to help
Medium Design Architectural design Bricks and mortar High
15. Secret fact: Computer is More for the patient than the
physician
19. Second attempt: Heartland Health Suburban ambulatory clinic
Community hospital 60 clinics spread out over a 22 county area in
NW Missouri and NE Kansas Engaged staff open to experiments
20. Existing Building: Architectural Layout Patterned after
Greg Korneluk International Council for Quality Care No planning
for information technology Brought in to take offices into a
paperless environment Carved out pilot to allow for rapid
expirimentation Providers Rooms Providers Rooms Providers Rooms
Providers Rooms Providers Rooms Providers Rooms Functional Unit
Functional Unit Functional Unit Functional Unit
21. Each provider had own workflow Exam Room In Drs Office
Rooms Pt Takes Vitals Rooms Pt Review Meds, Allergies &
Problems Documents HPI & ROS Rooms Pt Review Meds, Allergies
& Problems Documents HPI & ROS Rooms Pt Review Meds,
Allergies & Problems Documents HPI & ROS Prints Sheet for
Physician Nurse Area Exam Room Physician Sees/Exams Using Paper
Dictates Note Physician Sees/Exams Using Paper Physician Sees/Exams
Uses Computer & Nurse Note Dictates Note In Drs Office Reviews
and Signs Note Reviews and Signs Note Documents Note in Comptuer
Documents Note in Computer Using Nursing Note Prints Sheet for
Physician Traditional paper based with role stratification
Traditional paper based with role expansion Collaborative, computer
based with role expansion Collaborative, computer based, role
expansion and at point- of-care Work Flows
22. Variable contributions and Trade Offs 0 1 2 3 4 5 6 7 8 9
10 Paper No Chart Same Tool 0 1 2 3 4 5 6 7 8 9 10 Paper Paper +
Comp Comp + Dict Comp Nurses Time Documenting Physicians Time
Documenting
23. Time spent in exam room
24. Exam Room Technology My own experience
25. Evolution of in-room technology
26. Enabling point of care interactivity
27. Second Screen Concept Primarily for the patient Doesnt have
to be a computer screen Smart Phone Attached device Procedure
instrument screen Examples Dentist office Accountant Grocery
Store
28. Current State
29. Web tools
30. Point of Care Diagnostic Devices Proscope HR Proscope Micro
Earscope Firefly Dino-Lite Cellscope Camera(s) Spirometers
31. Design Revisited Whats out there now
32. Typical designs
33. Few designed with computer in mind
34. A good design
35. Summary
36. Change is Inevitable .adaptation is the key to survival
Workflows are the least expensive approach to change Internal
policies and procedures (based on paper workflows) may be the
hardest obstacle next to Reimbursement rule interpretations Exam
room technology is the next least costly approach Computer(s) in
room are for everyone in the room Use them to work in parallel
Think outside the exam room Architecture is the most expensive
Biggest enabler but requires 10-15 year foresight