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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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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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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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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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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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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Reflect

Variations Medication

administrationin a criticalaccess hospitalwith five nursesadministering

medications Someprocesses canbe correctedimmediately;others will

depend onacquiring anEMAR


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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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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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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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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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1.2Workflow and Process Redesign

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