HIT Toolkit Workflow and Process Redesign Health Information Technology Toolkit for Critical Access...

HIT ToolkitWorkflow and Process Redesign

Health Information Technology Toolkit for Critical Access and Small Hospitals

http://www.stratishealth.org/HIT_Toolkit_hospitals

Presenter• Margret Amatayakul

RHIA, CHPS, CPHIT, CPEHR, FHIMSS

President, Margret\A Consulting, LLCSchaumburg, IL

• Independent consultant, who focuses on achieving value from electronic health records, HIPAA/HITECH, and health information exchange. Developer of tools in Toolkit

• Adjunct faculty College of St. Scholastica, Duluth, MN, masters program in health informatics

• Founder and former executive director Computer-based Patient Record Institute, associate executive director AHIMA, associate professor 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 leads collaboration and innovation in health care quality and safety, and serves as a trusted expert in facilitating improvement for people and communities

● Stratis Health works toward its mission through initiatives funded by federal and state government contracts, and community and foundation grants, including serving as Minnesota’s Medicare Quality Improvement Organization (QIO)

● Stratis Health operates the Health Information Technology Services Center for health care organizations seeking to use health information technology in support of their clinical transformation

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 today’s workarounds that will form the functional requirements for your HIT

– Aids in setting expectations for achieving HIT goals because users will now expect to see improvements

– Ensures that critical controls built into current processes are retained or enhanced

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Softwarethat directscomputerdevices

People to supportand usesystems

Policythat drivesadoption ofsystems

Hardwarethat enablessystem use

Processthat helpsachieveresults

Copyright © 2009, Margret\A Consulting, LLC. Used with permission of author.

Copyright © 2007-8, Margret\A Consulting, LLC. Used with permission of the author.

Workflow and Process• Process is the manner in which work

to be completed to achieve a particular result is performed– Example: Do you always verify the

timeliness of medication administration?

• Work flow is the sequence of steps and hand-offs taken within a process– Example: Is information available to

schedule patients for labs in advance of a clinic visit?

• Workflow and process mapping depicts the detailed nature of the processes and workflow to enable improvements

Five Rights for Right EHR● Right clinical data● Right presentation● Right decision● Right work processes● Right outcomes

EHR is Not about 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 care

EHRs “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.

Steps in Mapping Current Processes

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1. Identify processes to be mapped; e.g., those that will be impacted by the HIT being acquired

2. Use individuals who actually perform the process; they know it best and need to own the impending change

3. Instruct persons on process mapping – why it is being done and how it is done

4. Map current processes. Avoid identifying opportunities for improvement now, or critical controls built into current processes may be overlooked

5. Validate maps to ensure they reflect current processes, all variations, and the information payload

6. Collect all forms and reports that are part of processes to be automated through HIT

7. Obtain benchmark data to define expectations for change and for use in benefits realization studies

Steps in Redesign8. Identify potential problems in current workflows and processes

and determine their root cause

9. Identify changes that may resolve problems today

10. Educate about HIT and EHR and identify further changes that will be possible

11. Document changes by creating improved map

12. Use new processes to create use case scenarios to identify HIT functional specifications, and later to build out the HIT application to achieve improvements

13. Test new workflows and processes

14. Train all on new workflows and processes

15. Incorporate changes into policy and procedure

16. Conduct benefits realization and celebrate successful change/correct course as necessary

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What to Map in Hospitals in Clinics• Admission• Medications reconciliation• H&P/results review/differential

diagnosis• 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


• Process diagram

• Swim lane process chart

• Flow process chart

• Systems flow chart

• Software is available to aid in drawing charts, if desired

Select Tools


Basic Systems Flow Chart

• Ovals – start and end

• Rectangles – process

• Diamonds – decision

Used with permission from P. S. Rudie Associates, Duluth, MNRobert McDonald, MD and Mary Rapps


Annotating Processes

Courtesy of Dr. Hinck, Bloomington Lake Clinic, Minneapolis, MN

• It may be helpful to capture components of processes and workflows by simply making a list of all processes, or

• Use post-it notes to record processes as they are performed and then arrange them on a wall or large piece of (e.g., examining room) paper

● Process mapping is not new, and not even new to health care, but process mapping is foreign to clinicians

● Engaging clinicians, however, is critical because EHRs are designed for their use. It may be necessary to start a map for them and have them validate it – Real clinicians really do map!


Getting Started• Identify one complete

process – neither to large or to small

• Identify all potential starting points

• Follow each to its natural conclusion

• Significant delays can be annotated to the side if desired

Refill Processing

No

Yes

Place in MD Box

PatientCalls

Ask Pt to CallPharmacy

End

ChartReviewed

Write Rx & Give to Pt

Document inchart

End

Ave1 hr

Ave2 hr

PharmacyCalls

Request chart

Review chart

NurseOK?

Call Pharmacy

Document inchart

End

No

Yes

Document In chart

Speak toNurse

OK?


Reflect Variations

• Medication administration in a critical access hospital with five nurses administering medications

• Some processes can be corrected immediately; others will depend on acquiring an EMAR


Validate Process Maps• Initial pass at a swim lane map (clinic example):

• Map after validation:

DocumentRFV on Post-it

Throw Post-itaway


Identify (Potential) Problems• Review

current maps to identify:– Bottlenecks– Sources of delay– Rework due to

errors– Role ambiguity– Duplications– Unnecessary

steps– Cycle time

• Flow process charts help identify– Nature of tasks– Key questions


Determine Root Cause

• Use complementary tools as needed– Statistical charts

• Radar• Pareto

– Relations diagrams– Tree diagram– Affinity diagram

• Force field analysis– Cause & effect diagrams– Physical Layouts

A

B


Critical Success Factors• Map processes that will be impacted by HIT, unless other reason for

process 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

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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HIT Toolkit Workflow and Process Redesign Health Information Technology Toolkit for Critical Access...

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