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Component 10 – Fundamentals of Health Workflow Process Analysis and Redesign Unit 1-2 – Clinical Workflow This material was developed by Duke University,

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Presentation on theme: "Component 10 – Fundamentals of Health Workflow Process Analysis and Redesign Unit 1-2 – Clinical Workflow This material was developed by Duke University,"— Presentation transcript:

1 Component 10 – Fundamentals of Health Workflow Process Analysis and Redesign Unit 1-2 – Clinical Workflow This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000024..

2 Topics – Unit 10.1-2 The Clinical Setting Common Health Care Processes Clinical Workflow Summary: What a Process Analysis and Redesign Specialist Does Component10/Unit 1-2Health IT Workforce Curriculum Version 2.0/Spring 2011 2

3 Role of Health Care Workflow Analysis and Redesign Specialist Workers in this role assist in reorganizing the work of a provider to take full advantage of the features of health IT in pursuit of meaningful use of health IT to improve health and care. Component10/Unit 1-2Health IT Workforce Curriculum Version 2.0/Spring 2011 3

4 Mission To assure that the clinical workflow supports the IOM’s requirements of safe, effective, efficient and timely health care that is patient centered and equitable. Component10/Unit 1-2Health IT Workforce Curriculum Version 2.0/Spring 2011 4

5 Workflow is a Process Workflow includes: How tasks are accomplished By whom Task order Task priority Choices and decisions Location Information needs Component10/Unit 1-2Health IT Workforce Curriculum Version 2.0/Spring 2011 5

6 Clinical Care Activities Interaction with patients Verbal and physical assessment Prescribing and conducting diagnostic tests Decision making and diagnosis Developing a treatment plan Assessing compliance with treatment regimen Patient education Records creation and management Determination of confidentiality / privacy requirements Component10/Unit 1-2Health IT Workforce Curriculum Version 2.0/Spring 2011 6

7 Administrative Activities Patient flow and efficient intake –Scheduling Patient tracking internally and externally –Transportation Coordination of billing for services Making consultations and referrals Facilities and supplies services and maintenance Component10/Unit 1-2Health IT Workforce Curriculum Version 2.0/Spring 2011 7

8 Grouped Activities (Tasks) Admission Surgery Specimen collection Reimbursement Discharge Handling of inpatient emergencies Component10/Unit 1-2Health IT Workforce Curriculum Version 2.0/Spring 2011 8

9 Roles Providers Medical Assistants Phlebotomists Receptionists Billing Coordinators Component10/Unit 1-2Health IT Workforce Curriculum Version 2.0/Spring 2011 9

10 Location, Location, Location Where tasks are performed can be important Physical layout of a clinic impacts workflow –Patient transportation –Hallway traffic –Distance clinic staff must travel to accomplish tasks –Patient privacy Component10/Unit 1-2Health IT Workforce Curriculum Version 2.0/Spring 2011 10

11 Information Needs What information is used and generated in the course of a patient encounter? Do providers and clinic staff have ready- access to information they need when they need it? Do patients have access to information about their health before, after and between visits? Component10/Unit 1-2Health IT Workforce Curriculum Version 2.0/Spring 2011 11

12 Unique Healthcare Requirements 1.System of “experts” –Physicians and physician extenders are ultimately ethically, morally and legally responsible for everything that happens to a patient –Physicians have taken an oath to “above all, do no harm” 2.Patient care involves teams of people 3.Patterns of fundamental clinical routines are the product of years and decades of evolution Component10/Unit 1-2Health IT Workforce Curriculum Version 2.0/Spring 2011 12

13 Complexities of Healthcare Each situation is unique Involve multiple people and organizations –Many opportunities for delays and variability Must take patient preference into account Continually changing priorities Many interruptions, options and exceptions Have overlapping roles and responsibilities Involves Humans and organizations Vary from practice to practice Subject to time and resource pressures Pause the slides and view the videos below about healthcare complexity http://www.youtube.com/watch?v=4kW4bIrYqPY http://www.youtube.com/profile?user=Saferhealthcare#p/u/4/jmh4FWapa80 Component10/Unit 1-2Health IT Workforce Curriculum Version 2.0/Spring 2011 13

14 Pulling it all Together Clinical Workflow Impacts Patients Problems, errors and delays are not just aggravating, inefficient or even infuriating In medicine, more than in other fields, problems, errors and delays can kill people Component10/Unit 1-2Health IT Workforce Curriculum Version 2.0/Spring 2011 14

15 Common Health Care Processes Electronic Medical Record (EMR/EHR) MedComSoft 02, Parts 1-3: http://www.youtube.com/watch?v=hqYXOM0bMRM&feature=related http://www.youtube.com/watch?v=jl2b_z71zBY&feature=related http://www.youtube.com/watch?v=jz91yUBUbbU&feature=related Component10/Unit 1-2Health IT Workforce Curriculum Version 2.0/Spring 2011 15

16 Common Processes in Physician Practices Appointment scheduling New patient intake Existing patient intake Exam and patient assessment Ordering labs/receiving & communicating results Prescriptions Referrals out/in Diagnostic testing Billing Component10/Unit 1-2Health IT Workforce Curriculum Version 2.0/Spring 2011 16

17 Lab Process Example Locate the Lab Tests Ordering scenario in your course materials. Component10/Unit 1-2Health IT Workforce Curriculum Version 2.0/Spring 2011 17

18 Activities 1.Patient arrives 2.Patient checks in 3.Patient pays co-pay 4.Patient called back to exam room 5.Nurse asks reason for visit 6.Nurse takes vital signs 7.Nurse locates electronic chart 8.Nurse confirms medications 9.Patient removes shoe and sock 10.Doctor examines patient 11.Doctor makes working diagnosis Component10/Unit 1-2Health IT Workforce Curriculum Version 2.0/Spring 2011 18

19 Activities cont. 12.Doctor describes treatment options and requirements 13.Patient chooses course of action 14.Doctor orders lab tests 15.Nurse obtains lab supplies 16.Nurse completes lab requisition form 17.Nurse labels tubes 18.Nurse draws blood 19.Nurse immediately centrifuges and refrigerates samples 20.Nurse provides patient education 21.Courier picks tubes up and takes to lab Component10/Unit 1-2Health IT Workforce Curriculum Version 2.0/Spring 2011 19

20 Locations & Roles Locations Reception area Exam room Phlebotomy room Roles Patient Receptionist Nurse Doctor Courier Component10/Unit 1-2Health IT Workforce Curriculum Version 2.0/Spring 2011 20

21 Choices and Decisions 1.Working diagnosis (Doctor) 2.Patient preparation for Doctor (Nurse decides based on chief complaint) 3.Which treatment option (patient decision) 4.Required tests (determined for each treatment option by clinical guidelines) 5.What tests or treatments to order and when (Doctor based on clinical guidelines) Component10/Unit 1-2Health IT Workforce Curriculum Version 2.0/Spring 2011 21

22 Information Needs Co-pay amount Existing medications for medication reconciliation Treatment options for working diagnosis Required tests / follow-up for treatment options Patient and provider identifiers for lab test requisition Component10/Unit 1-2Health IT Workforce Curriculum Version 2.0/Spring 2011 22

23 Confusion about Workflow Most people are not accustomed to thinking of what they do everyday in terms of workflow Terms used in healthcare that may be confused with workflow or process analysis: –Regimented care –Clinical pathways, clinical guidelines –Accreditation and audit Component10/Unit 1-2Health IT Workforce Curriculum Version 2.0/Spring 2011 23

24 Workflow Changes Must first, do no harm Must improve processes –Increase efficiency –Decrease delays and cost –Increase quality and safety –Improve the work environment –Improve ability to care for patients –Create a better overall patient experience Component10/Unit 1-2Health IT Workforce Curriculum Version 2.0/Spring 2011 24

25 What a Workflow Analysis and Process Redesign Specialist Does Document context and process so that it can be analyzed Analyze process Recommend redesign options Implement redesign Evaluate, adjust and maintain changes Component10/Unit 1-2Health IT Workforce Curriculum Version 2.0/Spring 2011 25

26 References 1.Crossing the Quality Chasm: A New Health System for the 21st Century 2001 available from the National Academy Press (NAP), Available from: http://www.nap.edu/books/0309072808/html/ http://www.nap.edu/books/0309072808/html/ Component 10/Unit 1-1Health It Workforce Curriculum Version 2.0/Spring 2011 26

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