EDM Workflow and Change Management Wendy Clark, 13 th March 2008.

EDM Workflow and Change ManagementEDM Workflow and Change Management

Wendy Clark, 13th March 2008

Outline

The Portsmouth brief Our approach Methods and tools – overview Learning points

The Portsmouth brief

Review of processes involving health records Identify how records are managed, accessed, referenced

and amended Provide input into the following activities:

The configuration of the EDM solution The development of appropriate workflows and working practices

for the deployed system Identification of potential cost savings that could be realised

through the rationalisation of clerical staff involved in the processing of paper-based records.

The approach

Generic patient journeys: Outpatients Planned Unplanned

Then variations by specialty

Current Records Process Interaction with the Patient Journey

Patient Journey

Patient History

Updates

Updated History

Pull File

Records Process

Effort and delay of pulling, tidying, preparing and filing

Everyone wants it, only one person has it

Where is it? – Tracking and searching…

2000+ forms in use!

Urgent cases are seen without history

The approach

Tribal model for workflow analysis Walking the process Using Visio to create swimlane diagrams and process

documents Creating ‘storyboards’ to engage with and involve users

Method and deliverables

Current State

File

ClerkDr.

Story-boards

1

2 3

4

Process models

1

2 DocSchedule

DocSchedule

o/p i/p A+E emerg

pull prep move file

codeSpeciality

Top level “map”

Final Report

• Exec. summary

• Intro & Background

• Context

• EDM Architecture, P.A.C.

• Current state

• Future state vision

• Future state processes

• Impacts, variances and migration issues

• Benefits realisation

• Conclusions and recommendations

• Appendices…

BenefitsDependency

Network(Visio)

OperationalGuidelines(MS-Word)

Stakeholder Map

Impacts, Issuesby dept.

speciality, role.Metrics

Impacts


Future StateCurrent State

1

2 3

4

To-be process models

1

2Top20Docs &Archi-tecture

Top20Docs &Archi-tecture

File

ClerkDr.

Story-boards

1

2 3

4

Process models

1

2 DocSchedule

DocSchedule

o/p i/p A+E emerg

pull prep move file

codeSpeciality

Top level “map”

ClerkDr.

To-Be Stories

EDM

Final Report

• Exec. summary


• Context


• Current state






• Appendices…


ImpactsFuture StateCurrent State

1

2 3

4


1



File

ClerkDr.

Story-boards

1

2 3

4

Process models

1

2 DocSchedule

DocSchedule

o/p i/p A+E emerg

pull prep move file

codeSpeciality

Top level “map”

ClerkDr.

To-Be Stories

EDM

BenefitsDependency

Network(Visio)


Stakeholder Map



Final Report


ImpactsFuture StateCurrent State

1

2 3

4


1



File

ClerkDr.

Story-boards

1

2 3

4

Process models

1

2 DocSchedule

DocSchedule

o/p i/p A+E emerg

pull prep move file

codeSpeciality

Top level “map”

ClerkDr.

To-Be Stories

EDM

BenefitsDependency

Network(Visio)


• Exec. summary


• Context


• Current state






• Appendices…

Stakeholder Map



Features

Rapid start-up Maximum staff engagement Minimum impact on departments and staff Live walkthrough environment captures “rich picture” Time to book events in busy diaries Maximum value from workshops from dynamic

storyboards “Best of both worlds” – detailed swimlanes and process

documents, plus visual storyboards

Swimlanes

Accident and Emergency – patient assessment

Rec

eptio

n C

lerk

Tra

nsfe

r N

urse

Maj

ors

Rec

eptio

n C

lerk

Min

or In

jurie

s N

urse

/Doc

tor

Str

eam

ing

Nur

se AE L1: CAS ready

AE B07: Collect CAS card from

box at reception and call patient

minor injury?

AE B08: Deliver CAS card to

minors and place in box in order

Yes

AE B09: Record patient treatment

on CAS card

Follow-up required?

AE B10: Photocopy CAS

card, place copy in pigeon hole for

clinic and log appt

Yes

AE B11: Create medical/surgical admission record

No

AE B12: Photocopy

completed Majors CAS card

AE B13: Majors CAS card is

transferred to MAU/SAU

AE B14: Code completed cards

directly onto system

No

AE O1: Patient transfered to MAU/SAU

AE L3: On

system

AE L4: A&E to MAU

AE L5: A&E to SAU

AE I4: Patient arrives via ambulance

80% of majors arrive this route

Storyboards

Followup?

Admit?

MINORS

MAJORS

UNPLANNED INPATIENTS FUTURE - Stage: A&E Treatment

20

UP TO 4 HOURS

01:00

»To scanning, or:MAU, SAU, other wards.

YES

YES

NO

NO

Allocate patient to stream

Record treatment details on CAS

card

Minor cards in order

Record details on CAS card.

Make out script.

Create admission record. Copy CAS card. Orig. may be

passed on

Patient transferred to assessment unit/ward or

theatre. May request Xrays / notes for out-of

area patients

Code completed

cards

Copy cardLog into

clinic book Put card into pigeon hole

EDM

Consult EDM

EDM

Consult EDM /

Graphnet

Opportunity / benefit:Early consultation of patient record=> admission avoidance

llllllllllllllll

Possible move to electronic booking in the future

If next day F/up, then retain paper

Workshop approach

Describe EDM softwarePresent storyboards slides (current => future)Q&A

Work with small groups around A1 posters + post-its

Update future state storyboards and log risks, issues, benefits, FAQs

Some EDM issues and challenges

Stakeholder engagement is vital Agreeing a standard EDM record structure Workflows are complex and inconsistent Variety of paper documents and ways of working How and when to scan Management of temporary notes, including tracking Significant information governance issues

Contact details – Wendy Clark

Email: [email protected]

Mobile: 07786 510490

Tribal Consulting, First Floor, 154 Great Charles Street, Queensway, Birmingham, B3 3HN

EDM Workflow and Change Management Wendy Clark, 13 th March 2008.

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