10 - Fundamentals of Health Workflow Process Analysis and Redesign - Unit 6 - Process Redesign - Lecture C

Fundamentals of Health Workflow
Process Analysis and Redesign

Process Redesign
Lecture c
This material Comp10_Unit6c 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.
Process Redesign
Learning Objectives
2
1. Identify the factors that optimize workflow processes in health care
settings (Lecture a)
2. Describe how information technology can be used to increase the
efficiency of workflow in health care settings (Lectures a, b)
3. Identify aspects of clinical workflow that are improved by EHR
(Lecture b)
4. Propose ways in which the workflow processes in health care
settings can be re-designed to ensure patient safety and increase
efficiency in such settings (Lecture c)
5. Use knowledge of common software functionality and meaningful
use objectives to inform a process redesign for a given clinic
scenario (Lectures c, d)

Health IT Workforce Curriculum
Version 3.0/Spring 2012
Fundamentals of Health Workflow Process Analysis & Redesign
Process Redesign
Lecture c
Process Redesign
Topics Lecture c
Objectives, Skills and Knowledge for Process
Redesign
Common process problems
Solutions to process problems
Human-Centered Design Framework applied
to Process Redesign
Matching common clinic system functionality
to solve process problems

3
Process Redesign
Lecture c
Big D and Little d
For large software systems such as
electronic health records, we distinguish
two types of design:

D design of the software itself
d configuration of the system to make it work
for a particular clinics processes

To select an electronic health record that matches well with clinic needs and to
configure one once it has been purchased, you need to be familiar with the
functionality of such systems.

4
Process Redesign
Lecture c
Common Software Interfaces in
Small to Mid-size Clinics
5
Process Redesign
Lecture c
Clinical
Practice
EMR
Practice
Management
System
Claims
Clearinghouse or
3
rd
party payer
Central Lab
Central Lab
Information System
Patient Portal
Local HIE
Interface with local
health care Facilities
Imaging device
PACS
Pharmacies
Practice Management System
(PMS)
PMS systems handle clinic office functions
Store
Patient demographic information
Provider information
Patient insurance information
Store contact information for third party payers
Schedule appointments
Perform billing tasks
Electronically
Track status of claims
Generate reports on stored information
6
Process Redesign
Lecture c
PMS-EHR Workflow
Pushed to EHR
Patient demographics captured at registration
Scheduled appointment in PMS
Pushed to PMS
Diagnoses and services captured in EHR
For billing

7
Process Redesign
Lecture c
Lab Information Management
System (LIMS) Functions
LIMS is a general
term for software
that handles and
automates the
functions of a
clinical or research
laboratory

8
Process Redesign
Lecture c
Tests done
In-clinic
Tests not
Done in clinic
Electronic interface
wants Doesnt want

LIMS Functionality
Printing sample labels
Sample tracking
Lab instrumentation interface
EMR/EHR interface
Ordering lab tests
Results reporting
Lab quality control support
Billing support

9
Process Redesign
Lecture c
LIMS-EHR Workflow
Pushed to LIMS
Lab tests ordered in EHR
Label printing enabled
Pushed to PMS
Lab tests ordered in EHR
Codes for labs
For billing
Pushed to EHR
LIMS lab test results

10
Process Redesign
Lecture c
Imaging Functions
When a clinic provides image-based diagnostic testing
services, the imaging device will produce images
Static
Moving pictures
Both
Images require storing and organizing,
Usually done by a Picture Archiving and Communications
System (PACS)
Clinics may have just an imager
Or may also have a PACS
Images may be viewed in the imager software
Or through the EHR
If integrated with an EHR

11
Process Redesign
Lecture c
Imager-PACS-EHR Workflow
Image ordered in EHR
Order pushed to imager
Imager creates images
Pushes to PACS
Images from imager or PACS
Viewable through EHR

12
Process Redesign
Lecture c
Patient Portal
Used for health care facilities to interact
with patients
Most offer self-service features
Appointment scheduling
Advance registration or payment
Viewing health data
Communicating with providers
Can come with a clinic EHR
Or be independent systems

13
Process Redesign
Lecture c
Example Patient Portal
Source: Healthview Patient Login. (n.d.)

14
Process Redesign
Lecture c
Health Information Exchange
Ability to do this is one of the requirements
of meaningful use
Infrastructure that facilitates exchange of
such health information

15
Process Redesign
Lecture c
HIE Workflow
Patient is seen in the local emergency department
Care summary is pushed to primary care provider
Primary care provider refers a patient to a
specialist; pushes relevant information to specialist
Specialist sees patient and pushes back
documentation from the specialist visit
Reportable disease documented in EHR and EHR
pushes to local health department

16
Process Redesign
Lecture c
Process Redesign Example
A fairly new five-provider clinic has been in business for
seven years. They have a practice management system
in place, and they are fairly happy with it but are not
determined to stay with that product. The diagnostic
services that the clinic provides are blood counts from an
in-house analyzer and urine dipstick (glucose, keytones,
urine blood, protein, nitrite, pH, urobilinogen, bilirubin,
leukocytes, and specific gravity, and pregnancy). Other
blood-based samples and urine, are sent to the local
office of a national laboratory testing chain for
processing. Today, results are returned to the lab on
paper sheets. The practice currently does not do
ePrescribing but would like to.

17
Process Redesign
Lecture c
Q1: Context Diagram
18
Process Redesign
Lecture c
Clinical
Practice
EMR
Practice
Management
System
Claims
Clearinghouse or
3
rd
party payer
Central
Lab
Interface with HIE or local
health care Facilities
Internal
Lab analyzer
?
?
Pharmacies
needed
Patient portal
?
Q2: Three things about which you
need more information to make
redesign recommendations
Local HIEs or health facilities with which
you need an interface?
Patient portal?
Electronic claims?

19
Process Redesign
Lecture c
Q3: Four redesign
recommendations and what EHR
functions are needed?
1. ePrescribing, requires EHR with this
functionality
2. Integration with existing PMS or EHR that
has PMS functionality and migrating data
from current PMS will be a harder
implementation, but workflow and ongoing
maintenance may be easier
3. Patient portal to increase self-service
opportunities
4. Automate appointment reminders

20
Process Redesign
Lecture c
Q4: System Interfaces
PMS
Internal lab analyzer
Central lab
ePrescribing
Patient portal
Need more information to know about HIE
and interfaces with local health care
facilities

21
Process Redesign
Lecture c
Process Redesign
Summary Lecture c
22
You are now ready to:
Identify the factors that optimize workflow processes in health
care settings,
Describe how information technology can be used to increase
the efficiency of workflow in health care settings,
ID aspects of clinical workflow that are improved by EHR,
Propose ways in which the workflow processes in health care
settings can be redesigned to ensure patient safety and
increase efficiency in such settings, and
Use knowledge of common software functionality to inform a
process redesign for a given clinic scenario.

Process Redesign
Lecture c
Process Redesign
References Lecture c
References
None for this lecture.
Images
Slide 5: Clinical Practice EMR interfaces. Nahm, M., Duke University. (2012).
Slide 8: Chart showing whether a clinic may want to interface with a lab's LIMS. Nahm, M., Duke University. (2012).
Slide 14: Healthview Patient Login. (n.d.). Retrieved February 28, 2012, from DukeMedicine website:
http://www.dukehealth.org/patients_and_visitors/healthview/index
Slide 18: Q1: Context Diagram. Nahm, M., Duke University. (2012).
23
Process Redesign
Lecture c

10 - Fundamentals of Health Workflow Process Analysis and Redesign - Unit 6 - Process Redesign - Lecture C

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Fundamentals of Health Workflow

Process Analysis and Redesign

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