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

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Presentation outline

• Background• Case Scenario• Current State & Workflow• Technologies Considered and their Benefits• Optimized State & New Workflow• Conclusion

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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

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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

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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

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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

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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

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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

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Checkout Workflow

Patient goes to check out pays the co-pay

Patient forgets to schedule the follow up

Patient has to schedule referral appointment

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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…..

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Overview

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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

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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.

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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]

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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

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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

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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.

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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

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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

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Conclusion