Maximizing Clinic Efficiency with RelayHealth Maj Matthew Barnes, MD.
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Transcript of Maximizing Clinic Efficiency with RelayHealth Maj Matthew Barnes, MD.
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Maximizing Clinic Maximizing Clinic Efficiency with Efficiency with RelayHealthRelayHealth
Maj Matthew Barnes, MD
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IntroductionIntroductionNovel WorkflowsDeploymentImplementationSustainment
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Streamline Team Based Streamline Team Based CareCare
Stop printing things out! Send it by RelayHealth!
Appointments – Direct to Central ApptsMedication Refills – Direct to Pharmacy for
refillingConsult Renewals – Low risk? No
intervention on your part? Consider nurse refilling
Clinic has protocols? Use MiCare if possible
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Asynchronous WorkflowAsynchronous WorkflowWebvisits:
◦MISNOMER! Webvisits imply no in-person care
◦Can be used to PRIOR to the visit to ensure standard of care documentation is done
◦Can be used with templated directions
◦Not directed – if an early adopter, try it!
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Webvisit WorkflowWebvisit WorkflowTeam Based Workflow:
◦During huddle, “Scrub the list” one week ahead, and send out Webvisits to patients with templated instructions Consider engaging appointment line
◦On patient screening, have tech cut and paste into HPI, medication list, etc…
Added benefit – patient is engaged with their record!
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Disease ManagementDisease ManagementCreate Patient Lists
◦ Can be done by Disease Manager/Nurse◦ Based on Disease, Demographic, etc…
Can be used to proactively send information to the right people
Send something once a week, over a peak time (i.e. Wed @ 3 PM)
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AdoptionAdoptionChances are, you already have
RelayHealth!RelayHealth’s utility hinges on
adoptionYou may have RelayHealth, but your
patients may not be using it! ◦You might not be either.
What are your numbers? Do you know how many patients signed up?
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Key PlayersKey PlayersAre you the Champion?
◦Someone in the field; respected◦Their role is to advocate for change
among providers◦Needs to be given time to do this
Are you the Sponsor?◦Back the champion!◦You are the “big stick!”
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Change ManagementChange ManagementCan be done ANYTIMEADKAR
◦Awareness◦Desire◦Knowledge◦Action◦Reinforcement
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Awareness/Desire/Awareness/Desire/KnowledgeKnowledge• Marketing• Posters–Waiting Room–Pharmacy
• In-processing• Social Media
• DO THIS FOR CLINICIANS! A LOT!• Did I mention this needs to be done
for clinicians?• No seriously. Do this for all
clinicians.
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The Adoptees?The Adoptees?• Who are your early adopters in
clinic?• Who are your late adopters?
• Who are your key individuals?–Leveraging key individuals makes
change happen
• Do NOT ignore risks/weaknesses• Address them – ask for advice!
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ImplementationImplementationTeam Approaches work best.Top Down for Early AdoptersBottom Up for Late Adopters
Time for Training◦ Role Based Training is Ideal
Time for Sustainment Training◦Establish Secure Messaging ◦High Performance Teams
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Early Adopter ModelEarly Adopter Model• 26 yo Male Provider who’s
comfortable with Information Technology
• Not a champion• He created novel workflows for his
team for sign-up for secure messaging
• Success was REWARDED by offering a three day pass
• Not much intervention required.
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Late Adopter ModelLate Adopter Model• 63 yo Male Contract Provider who is very
uncomfortable with computers, much less Health IT
• Has a strong, early adopting technician who understands, and champions RelayHealth among patients
• Provider gets assistance when he needs it
• Requires ADKAR – must have Awareness, Desire, Knowledge, Action, and Reinforcement
• Pitfall: DON’T PUNISH YOUR EARLY ADOPTERS BY RUINING THEIR TEAM.– Every change to a PCMH team has to be RARE
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What About FailuresWhat About FailuresADKAR? Where did it go wrong?Key Personnel were negative
◦Need to address them up front, and often
Unanticipated ObstaclesFailure to Address Potential
Obstacles/Conflict
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Sign-upSign-up• Air Force gives the option to increase
registration rates via face-to-face registration, e-Registration, and telephone registration
• Army/Navy have flexible registration processes too
• SEAL THE DEAL!!!–By Cell Phone, By Kiosk (if available), By
Non-network computers–Those signing up: ~ 8% without; ~ 90%
with–Went from lowest in clinic to highest in Air
Force
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SustainmentSustainment• Create workflows for on-boarding• Create periodic sustainment training• After Action Reports– On-record: finding good things can lead to more
resources– Off-record: make them BRUTAL
• Reinforcement, Reinforcement, Reinforcement
• Avoid “punishing” those that do well
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Workflow DesignWorkflow DesignTwo main areas need workflow:
◦Invitations High up front work Low back-end work Ensure patients are given
enrollment opportunities at every point of service (i.e. PHA Clinics, Front Desk...)
◦Patient Care Low up-front work High back-end work
Could consider doing this for Sustainment
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Invitation WorkflowInvitation Workflow
Get help if you can: GPM, Disease Managers, Case Managers
Draw it out! Use a Swiss Cheese Model v.
Process Diagram◦Who◦Level of Effort/Risk◦Yield◦Potential Return
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EXAMPLE Workflow Design EXAMPLE Workflow Design for Invitationsfor Invitations
Appointment Line:
High Effort, High Yield
70%
Front Desk:Low Effort, High
Yield100%
Med Tech:High
Effort, Med Yield
30%
Provider:
High Effort, Low Yield20%
Pharmacy:High Effort,
Medium Yield50%
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Patient Care WorkflowPatient Care WorkflowGet help if you can: GPM,
Nursing, Medical TechniciansDraw it out! Use a Layered Model
◦Who◦Purpose◦Level of Effort◦Potential Return
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EXAMPLE Workflow Design EXAMPLE Workflow Design for Patient Carefor Patient Care
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TipsTipsEnrollment is your first barrier
◦ Use processes which already occur (i.e. base orientation, TAPS)
Engagement is your second barrier◦ Use processes which already occur (i.e.
appointment line, pharmacy)Put as little on the care team as possibleContractingDo not forget about
sustainment/reinforcementGet top cover – and keep it!
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ConclusionConclusionNovel workflowsChange managementWorkflow Diagrams
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Any Questions?Any Questions?