HM312 Week 2 part 2 of 2
- 1. © 2017 American Health Information Management Association© 2017 American Health Information Management Association Health IT and EHRs: Principles and Practice, Sixth Edition Chapter 5: Healthcare Workflow and Process Mapping
- 2. © 2017 American Health Information Management Association Importance of Workflow and Process Improvement • Identifies opportunities for improvement • Aids in understanding functional requirements needed for health IT • Avoids unintended consequences of poorly designed health IT systems • Reduces costly rework after implementation • Helps manage change through: o Education o Team empowerment
- 3. © 2017 American Health Information Management Association Terminology and Methodologies • Process o Manner in which work is performed to achieve a particular result • Workflow o Sequence of steps and hand-offs taken within a process • Process mapping o Depiction of the workflow and process that is being studied • Process improvement o Analysis of current processes and workflows for efficiency and effectiveness o Also called: process redesign or process re- engineering
- 4. © 2017 American Health Information Management Association EHR Five Rights: • Right clinical data • Right presentation • Right decision • Right work processes • Right outcomes Process Improvement Goals • Achieve the right way! Old Way New Way MyWay YourWay Right Way Copyright © 2016, MargretA Consulting, LLC. Reprinted with permission.
- 5. © 2017 American Health Information Management Association Process Improvement Case Study
- 6. © 2017 American Health Information Management Association Benefits of Process Improvement Copyright © 2016 MargretA Consulting, LLC. Reprinted with permission.
- 7. © 2017 American Health Information Management Association Steps in Process Improvement 1. Identify processes to be assessed. 2. Create process assessment teams. 3. Select tools. 4. Map current process. 5. Validate accuracy of map. 6. Collect forms and reports to be automated. 7. Obtain baseline data. 8. Identify potential problems and root cause. 9. Identify changes for now, and with health IT 10.Identify other improvements. 11.Document proposed changes in new map. 12.Use new process to create use cases for health IT functional specification. 13.Test new processes. 14.Train on new processes. 15.Incorporate changes into policy and procedure. 16.Conduct benefits realization and celebrate success/correct course.
- 8. © 2017 American Health Information Management Association Processes to be Mapped for EHR Copyright © 2016. MargretA Consulting, LLC. Reprinted with permission.
- 9. © 2017 American Health Information Management Association Process Mapping Teams & Training • Teams should: o Be composed of those who will actually implement project o Be responsible for actual process analysis o Solicit input from potential users o Include those familiar with current processes o Include a coach and access to IT resources • Teams need training on: o Process improvement purpose and goals o Process mapping tools o EHR or other health IT features and functions
- 10. © 2017 American Health Information Management Association Thoughtflow • Coined by Sam Bierstock, MD, – “The process by which physicians obtain, assess, prioritize, and act on information.” • Many clinical processes are not visible to another person. They are mental processes • It is the mental processing that is at the core of a clinician practicing medicine, and needs to be at the core of using an EHR and other health IT
- 11. © 2017 American Health Information Management Association Process Mapping Validation • Ensures process map reflects how work is actually performed today • Includes not only the chart and people, but most importantly the information payload o Most clinical process entail a significant amount of mental processing, not directly observable • Many mappers are new to mapping and new to EHR, so need coaching to ensure thoroughness
- 12. © 2017 American Health Information Management Association Current Map Validation Copyright © 2016 MargretA Consulting, LLC. Reprinted with permission.
- 13. © 2017 American Health Information Management Association Process Changes • Allow team members the freedom to make change • Solve problems rather than symptoms • Stay focused on ultimate goal • Focus on primary customer • Study existing systems • See the big picture
- 14. © 2017 American Health Information Management Association Workflow and Process Mapping Tools • Process mapping denotes sequence of tasks in a process. • Process mapping charts can be simple or complex, often starting simple and progressing to the complex. • Tools o Process diagramming tools • Process Diagrams • Swim Lane Chart • Flow Process Chart • Systems Flow Chart o Use case o Document analysis o Baseline data collection o Benchmarking o Process improvement
- 15. © 2017 American Health Information Management Association Process Diagramming Tools • Process diagram • Swim lane chart • Flow process chart • Systems flow chart Copyright © 2016 MargretA Consulting, LLC. Reprinted with permission.
- 16. © 2017 American Health Information Management Association Flow Process Chart • Free-form illustration utilizing common set of symbols • May be combined with swim lane chart to illustrate simultaneous processing in different departments Copyright © 2016, MargretA Consulting, LLC. Reprinted with permission.
- 17. © 2017 American Health Information Management Association Swim Lane Process Map (Example) Copyright © 2016 MargretA Consulting, LLC. Reprinted with permission.
- 18. © 2017 American Health Information Management Association Flow Process Chart • Older tool uses a list structure with accompanying symbols to illustrate flow • Very suitable for those not comfortable drawing pictures, especially physicians • Excellent for marrying process mapping and baseline data collection
- 19. © 2017 American Health Information Management Association Flow Process Chart Template Copyright © 2012, MargretA Consulting, LLC. Reprinted with permission.
- 20. © 2017 American Health Information Management Association Basic Systems Flowchart • Most common tool for information process mapping • Terminator symbol contains information on the boundaries of the system being mapped (where process begins and ends) • Process is the performance of an operation. It should be described precisely for each and every step in a process • Decision symbol describes decisions made within an operation. There must always be at least two choices (e.g., Y/N). Three choices might reflect <, =, or >; or action A, B, or C Terminator Process Decision
- 21. © 2017 American Health Information Management Association Basic Structure of Systems Flowchart Start Choice Action Action Action ChoiceAction No No Yes Yes End Basic Flowchart
- 22. © 2017 American Health Information Management Association For Complex Decision-Making: Choices? A B C D E Decision Table Copyright © 2016, MargretA Consulting, LLC. Reprinted with permission.
- 23. © 2017 American Health Information Management Association Special Systems Flowchart Symbols Copyright © 2016 MargretA Consulting, LLC. Reprinted with permission.
- 24. © 2017 American Health Information Management Association Sample Current Process Map
- 25. © 2017 American Health Information Management Association Use Case • Another way to describe workflows and processes; especially to illustrate roles of user and computer • Two forms: o Graphic notations following the standard Unified Modeling Language symbols o Essential use case, aka use case scenario, uses narrative that is often preferred by users not accustomed to diagrams
- 26. © 2017 American Health Information Management Association Use Case Diagram
- 27. © 2017 American Health Information Management Association Essential Use Case Example Copyright © 2016, MargretA Consulting, LLC. Reprinted with permission.
- 28. © 2017 American Health Information Management Association Document Analysis • Ensures that all data needs are accounted for in the process assessment o For direct patient care o For reporting purposes • Collect all forms and reports. • Analyze their data elements. o Who collects the data, for what purpose? o Who uses, how, when, frequency?
- 29. © 2017 American Health Information Management Association Document Analysis Copyright © 2016, MargretA Consulting, LLC. Reprinted with permission.
- 30. © 2017 American Health Information Management Association Data Element Analysis • In a database, record all data used in all applicable documents o Identify source o Identify use • Used in clinical decision making? • Intent is to capture data once and use many times to avoid repetitive work and errors.
- 31. © 2017 American Health Information Management Association Data Element Analysis Copyright © 2016 MargretA Consulting, LLC. Reprinted with permission.
- 32. © 2017 American Health Information Management Association Compare Processes • Compare process maps drawn by people essentially performing the same process, but in different locations (such as nursing units, clinic sites). • Identify variations o Compare maps directly o Use a spreadsheet • Evaluate variations o Are some variations necessary? (such as different nursing staff may have different credentials) o How can processes be made more standardized to reduce variation and potential errors?
- 33. © 2017 American Health Information Management Association Process Variation (Clinic Example) Copyright © 2016, MargretA Consulting, LLC. Reprinted with permission.
- 34. © 2017 American Health Information Management Association Baseline Data Collection • Purpose – Identifies opportunities for improvement – Helps set goals and expectations for what can be accomplished with EHR – Benchmark how well the EHR is performing the desired goals
- 35. © 2017 American Health Information Management Association Baseline Data Collection • Baseline data collection captures current: o Volume of work o Time to complete steps o Number of errors or near misses • Helps: o Identify opportunities for improvement o Set goals o Conduct benefits realization studies
- 36. © 2017 American Health Information Management Association Benchmarking • Process of comparing process performance against an industry best practice or industry standard • Often used in comparison with organization’s baseline data
- 37. © 2017 American Health Information Management Association Process Redesign • Team Empowerment o Process assessment requires teams of various skills and knowledge o Teams should be given responsibility and appropriate authority o A system of checks and balances must be established so no group can be an outlier • Group Leader o Facilitates proceedings o Keeps group on track o Encourages participation by all Source: Schuman (2004). Reprinted with permission from the Institute of Cultural Affairs, ICS-USA, Chicago, IL
- 38. © 2017 American Health Information Management Association Group Facilitation • Brainstorming • Round Robin • Double reversal • Nominal group process • Probing
- 39. © 2017 American Health Information Management Association Opportunities for Improvement • Bottlenecks • Sources of delay • Rework due to errors • Role ambiguity • Unnecessary duplications • Long cycle time • Lack of adherence to standards • Lack of information • Lack of quality controls
- 40. © 2017 American Health Information Management Association Effecting Change • Change management is the process by which an organization gets to its future state • Facilitates adoption of health IT, through: o Education o Providing feedback o Reducing fear o Process assessment
- 41. © 2017 American Health Information Management Association HIM and IT Professionals • Frequently are trained explicitly in workflow and process mapping and can help train, coach, and facilitate • To be effective in these roles, however, they must be neutral and unbiased