Maximizing Clinic Efficiency with RelayHealth Maj Matthew Barnes, MD.
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Transcript of Maximizing Clinic Efficiency with RelayHealth Maj Matthew Barnes, MD.
Maximizing Clinic Maximizing Clinic Efficiency with Efficiency with RelayHealthRelayHealth
Maj Matthew Barnes, MD
IntroductionIntroductionNovel WorkflowsDeploymentImplementationSustainment
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
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!
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!
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)
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?
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!”
Change ManagementChange ManagementCan be done ANYTIMEADKAR
◦Awareness◦Desire◦Knowledge◦Action◦Reinforcement
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.
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!
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
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.
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
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
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
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
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
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
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%
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
EXAMPLE Workflow Design EXAMPLE Workflow Design for Patient Carefor Patient Care
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!
ConclusionConclusionNovel workflowsChange managementWorkflow Diagrams
Any Questions?Any Questions?