Professional Documents
Culture Documents
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
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
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 Minnesotas 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
Five Rights for Right EHR Right clinical data Right presentation Right decision Right work processes Right outcomes
Only automating form, content, and procedures of current patient records will perpetuate their deficiencies and be insufficient to meet emerging user needs
Steps in Redesign
8. 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
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
in Clinics
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
Copyright 2007-8, Margret\A Consulting, LLC. Used with permission of the author.
Select Tools
Process diagram Swim lane process chart
Copyright 2007-8, Margret\A Consulting, LLC. Used with permission of the author.
Used with permission from P. S. Rudie Associates, Duluth, MN Robert McDonald, MD and Mary Rapps
Annotating Processes
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!
Copyright 2007-8, Margret\A Consulting, LLC. Used with permission of the author.
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 Patient Calls Ask Pt to Call Pharmacy End Request chart End Review chart Ave 1 hr Ave 2 hr Nurse OK? Yes Document in chart Call Pharmacy End No Place in MD Box OK? Yes Document In chart Speak to Nurse No
Pharmacy Calls Chart Reviewed
Copyright 2007-8, Margret\A Consulting, LLC. Used with permission of the author.
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
Copyright 2007-8, Margret\A Consulting, LLC. Used with permission of the author.
Copyright 2007-8, Margret\A Consulting, LLC. Used with permission of the author.
Copyright 2007-8, Margret\A Consulting, LLC. Used with permission of the author.
B A
Copyright 2007-8, Margret\A Consulting, LLC. Used with permission of the author.
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
Copyright 2007-8, Margret\A Consulting, LLC. Used with permission of the author.