1. Business Process Reengineering in Health Care IT
Types of BPR
Project Management Implications
Examples from the Field
4/6/2017
Group 4: Farabaugh, John, Katzovitz, Lott, Patki, Pearce, Snow

2. Group 4: Project Agenda
Overview of Business Process Redesign models used in healthcare.
Applicability of principles of Business Process redesign related to overall Project Management methodologies.
Effectiveness of such models as part of a Healthcare IT initiative.
Examples where organizations have used such a model as part of a Healthcare IT initiative.
Class exercise and questions.

3. Health Care Challenges that encourage BPR
Medical errors and high costs of healthcare
Underinsured or uninsured population
Increasing number of heterogeneous and older population,
Globalization/ medical outsourcing,
Maintaining quality for given cost and cost minimization for given quality
Shortage of clinical and nursing staff

4. Expectations from BPR models
Increase in efficiency
Reduce medical and medication errors
Health care cost reduction
Better access and quality in healthcare
Procedure optimization
Time effectiveness
Customer and health care provider satisfaction

5. Highlighted solutions
Automating and monitoring processes in healthcare
Redesigning or improving clinical processes where necessary and possible
Identifying patient expectations and improving patient care processes for better customer services.
BPR models: The business process redesign (BPR) models are the processes that target improvisation and optimization of process outputs while maintaining quality.

6. Six Sigma (Six sigma was invented by Motorola in the 1980s)
Analytical approach to indentify the inefficiencies and inadequacies in the process and provide a step by step solution based on analysis of real time data.
Process must have < 3.4 defects per million occurrences (Carrigan, 2006)
Statistical calculation that suggests customer needs /satisfaction to meet % or 6-Sigma level. (Caldwell 2006)
Focuses on customer satisfaction, process improvement and cost reduction. (Breyfogle, 2003)
Uses structured methodology and powerful statistical tools that provide a scientific approach to process improvement and patient safety. (
Six sigma was invented by Motorola in the 1980s. Although Lean and Six Sigma are originally business management models, in recent years the potential of these techniques in health care and in software development is been recognized. (Schweikhart et al 2009)

7. Six Sigma Sub methodologies
DMAIC: Define, Measure, Analyze, Improve, and Control; (improve existing processes )
DMADV: Define, Measure, Analyze, Design, Verify; (develop new processes or products at Six Sigma quality levels) (
Implementing 6sigma:
“Black Belt” = organize of Six Sigma project
“Green belt” = implement and monitor the project.
Define and describe the potential critical processes. Determine measures such as accuracy standards, reproducibility of each process, idendify and verify cause effect relationship between variables, implement the improvement design and establish control over new system via policies/ regulations and document to prevent recurring issues. DMADV has last 2 steps different: Design new process and verfy that the solution fits the problem. People in an organization are certified to implement Six Sigma by allotting them “Black Belt” or “Green belt” status. Black belts organize the Six Sigma project and green belts implement and monitor the project.
Sigma is a statistical calculation that suggests customer needs /satisfaction to meet % or 6-Sigma. Majority of the times healthcare processes rarely go beyond 93% or 3 sigma.

8. Applications of BPR models:
Scheduling appointments
Emergency room allotment
Diagnostic imaging
Patient follow up appointments
Cancer screenings
Bed allotment systems
Minimizing duplication of records, bills, scheduling of follow ups and refills
Reduce “off time” of the systems to improve accessibility and promptness
Reducing wait times at Dr.’s office and many more.

9. BPR Obstacles
Internal and external challenges such as resistance to change, financial challenges, hierarchical tensions, changing workforce, lack of commitment, lack of implementation
Six Sigma requires a clear goal setting, ample training of employees and commitment to implement the projects thoroughly.
success is not guaranteed (Corn 2009)

10. Business Process Reengineering and Health Care IT
IT often plays a support role in BPE in health care
“What has to happen when you design the new process, you find how information technology is going to be used to support that new process, and if you don’t have that technological capability, you’re going to have to go and get it.” (George W. Whetsell)
CIO has to understand BPR as it applies to his or her specific organization and be innovative in applying that understanding to the IT function within the organization.
4/6/2017
Group 4: Farabaugh, John, Katzovitz, Lott, Patki, Pearce, Snow

11. Group 4: Farabaugh, John, Katzovitz, Lott, Patki, Pearce, Snow
Denver Health (Lean)
Pure IT project: patient scheduling application development
Project timeline reduced 50%, outside consulting cost reduced 36%.
IS had previously sat “on the sidelines” in lean initiatives, but sought to use lean to make the department more efficient
Challenge was to fit lean concepts to a longer term IT project.
4/6/2017
Group 4: Farabaugh, John, Katzovitz, Lott, Patki, Pearce, Snow

12. Group 4: Farabaugh, John, Katzovitz, Lott, Patki, Pearce, Snow
Denver Health (Lean)
Rapid Improvement Event (RIE) model was tweaked to fit this specific project
Embedded into project cycle, redefining how project was managed
Custom templates created
Special attention given to lean tools, activity flow, and frequency of RIE events
Involvement of end users
“Red phone” mentality
Used MS Sharepoint to bring stakeholders up to speed with 15 mins of relevant information
Delta team of 3 individuals replaced project governance and took day-to-day responsibility for decision making
25% reduction in internal resource time spent on the project
Training time reduced because trainers were involved from the beginning and became application experts.
Training materials were available before launch, and 80-90% of users were trained ahead of time.
4/6/2017
Group 4: Farabaugh, John, Katzovitz, Lott, Patki, Pearce, Snow

13. VA’s VistA QUERI system (TQM)
Quality Improvement initiative within the VA, where data from the organization’s nationwide interoperable VistA EMR system is integral to the total process of improving patient outcomes.
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Group 4: Farabaugh, John, Katzovitz, Lott, Patki, Pearce, Snow

14. Group 4: Farabaugh, John, Katzovitz, Lott, Patki, Pearce, Snow
the structure of the VA and the access to data provided by VistA make it a natural fit for research activities seeking to improve quality, clinical outcomes, and patient satisfaction. As Kizer et al state, “The VHA’s unique portfolio of providing patient care, teaching, conducting research, and continuously measuring outcomes, combined with its large size and national presence, provide for a broad and stable patient base for taking research discoveries and quickly putting them to work, either to improve patient care or to enhance system efficiency. QUERI attempts to purposely link research activities (which generate scientific evidence) to clinical care in as close to real time as possible, thereby leading to rapid adoption of best clinical practices and improvement in patient outcomes.” (Kizer, Demakis, & Feussner, 2000).
Hynes, D. M., Perrin, R. A., Rappaport, S., Stevens, J. M., & Demakis, J. G. Informatics Resources to Support Health Care: Quality Improvement in the Veterans Health Administration. Journal of the American Medical Informatics Association. 2(5),
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Group 4: Farabaugh, John, Katzovitz, Lott, Patki, Pearce, Snow

15. Group 4: Farabaugh, John, Katzovitz, Lott, Patki, Pearce, Snow
Virginia Mason (Lean)
IT served as a support role to improve areas identified as cost-centers
Implementation of CPOE to reduce unnecessary prescriptions and reduce ER visits due to low refill allowances
Implementation of decision support to alert clinicians when tests fall into the “not useful” category
The problem: high cost for treating migraines and GERD, initially attributed to specialists, but through process scrutiny, late attributed to primary care docs and ED docs.
4/6/2017
Group 4: Farabaugh, John, Katzovitz, Lott, Patki, Pearce, Snow

16. Bibliography
Corn, J.B., Six Sigma in Health Care, Radiologic Technology. September/October 2009; 81(1): 92-95
Bergman, R. (1994). Reengineering Healthcare. Hospitals & Health Networks. 5 February, 1994,
Breyfogle, F.W., Implementing Six Sigma: Smarter Solutions Using Statistical Methods, 2nd ed. 2003, Wiley, New York, NY.
Carrigan MD, Kujawa D. Six Sigma in health care management and strategy. Health Care Management. 2006;25(2):
Caldwell, C., Lean-Six Sigma tools for rapid cycle cost reduction, Healthcare Financial Management. Oct 2006, 60 (10)
McQueen, H. E. (1993). The healthcare CIO’s role in business process redesign. Computers in Healthcare. February, 1993,
Schweikhart SA, Dembe AE. J Investig Med Sep 2
Shaffer, Vi. (2008). Case Study: Denver Health Leverages ‘Lean’ for a Breakthrough in Enterprise Patient Scheduling Implementation. Gartner Industry Research. 17 December, 2008.