Workflow andHIT
Process
Toolkit
Redesign
Sponsors:
HIT Toolkit for Nursing Homes
• Sponsored by Aging Services of
Minnesota and its subsidiary, Alliance
Purchasing for nursing homes
• Produced by Stratis Health
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Presenter
• Margret Amatayakul
RHIA, CHPS, CPHIT, CPEHR, FHIMSS
President, Margret\A Consulting, LLC,
Schaumburg, IL
• Independent information management and
systems consultant, who focuses on achieving value from
electronic health records, HIPAA, and health information exchange
• 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, HIMSS BOD, and cofounder 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 Minnesota’s 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
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Agenda
• Purpose of Workflow and Process Redesign
• Steps in Workflow and Process Redesign
• Setting Expectations to Achieve Goals
through Workflow and Process Redesign
• Initiating Change Management through
Workflow and Process Redesign
• Tools and Tips to Support Workflow and
Process Redesign
• Practice Redesign
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Purpose: Create Ah Ha! Moments
• Workflow and process redesign
– Starts the process of identifying improvement
opportunities with HIT
– Helps users identify solutions for current problems
and today’s workarounds that will form the functional
requirements for your HIT
– Aids in setting expectations for achieving HIT goals
because users will now expect to see improvements
– Ensures that critical controls built into current
processes are retained or enhanced
Hardware
that enables
system use
Software
that directs
computer
devices
People
to support
and use
systems
Policy
that drives
adoption of
systems
Process
that helps
achieve
results
Copyright © 2009, Margret\A Consulting, LLC. Used with permission of author.
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Process Mapping
• Process is the manner in which work to be
completed to achieve a particular result is
performed
– Example: How do you verify the timeliness of medication
administration?
• Work flow is the sequence of steps and handoffs performed within a process
– Example: How does the physician’s order for medication
get to a pharmacy and the medication to the nurse?
• Workflow and process mapping depicts the
detailed nature of the processes and how they may
be redesigned to enable improvements with HIT
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Steps in Mapping Current Processes
1. Identify processes to be mapped; e.g., those that will be impacted
by the HIT being acquired
2. Use individuals who actually perform the process; they know it
best and need to own the impending change
3. Instruct persons on process mapping – why it is being done and
how it is done
4. Map current processes. Avoid identifying opportunities for
improvement now, or critical controls built into current processes
may be overlooked
5. Validate maps to ensure they reflect current processes, all
variations, and the information payload
6. Collect all forms and reports that are part of processes to be
automated through HIT
7. Obtain benchmark data to define expectations for change
and for use in benefits realization studies
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Processes to be Mapped
• Intake referral
management
• ADT, census
• Nursing assessments
• Care plans
• MDS
• Medication
administration
• Patient monitoring,
notes, treatments
• Dietary management
• Other ancillary
information (Lab,
Radiology)
• Physician order entry
– E-prescribing with safety
alerts and DUR
• H&P (if required)
• Physician notes
• Document
management
• Care communication/
coordination
• Financial services
• Case mix management
• Executive dashboard
•
See Goal Setting tool
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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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Expectations for Goal Achievement
Process mapping captures:
•
Specific
ways
information
is
Specific
used today and in future
data for metrics to
Measurable • Baseline
improve
Attainable
Realistic
Timely
• Changes people agree upon
• Changes people think they
can make
• Commitment to goal
achievement in future
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Managing Change
• Everyone facing the change brought about
by HIT or EHR needs to be a master of their
own destiny
• Process mapping, especially with coaching,*
highlights where staff can benefit from
improvements
– Example: EMAR at the point of service may
reduce amount of walking for nurses
* But don’t over coach to the extent you are taking
away the ah ha moments!
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Mapping
Tools
• Flowcharts describe
– Actions on
information
– Decisions made with
information
• Two basic symbols
– Rectangles describe
who does what
– Diamonds describe
what decisions are
made, with branches
to the results of the
decision
• A terminal symbol is
often used to show
where each flow
begins and ends
Copyright © 2009, Margret\A Consulting, LLC. Used with permission of author.
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Sticky Notes Alternative
• Give everyone performing a
process a pad of sticky notes
• Write down what you do as
you do it
• Put on a blank wall or large
sheet of paper (e.g., exam
room table paper)
• Let people make additions
and adjustments
• Use different color notes to
indicate variations
Copyright © 2009, Margret\A Consulting, LLC. Used with permission of author.
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Tips
• Any tool will work, as long as it is
accurate
• New mappers tend to map only
what they can see, e.g., chart
• Mappers need to think about how
they think about information
• Mappers often miss the decision
points – but this is where HIT and
EHR are most valuable
Copyright © 2009, Margret\A Consulting, LLC. Used with permission of author.
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EHR is Not about Automating Charts

“Only automating form, content, and procedures of current patient records will
perpetuate their deficiencies and be insufficient to meet emerging user needs”
EHR is about automating & using
Information to improve health care
EHRs “encompass a broader view of the record than today, moving from
notion of location for keeping track of patient care events to a resource
with much enhanced utility”
Institute of Medicine, 1991
Copyright © 2009, Margret\A Consulting, LLC. Used with permission of author.
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Redesign
• Review current maps to
identify:
• Pareto chart
– What factor
– Bottlenecks
contributes most
to this issue?
– Sources of delay
• Control chart
– Rework
– Where or when
– Role ambiguity
are most errors
made?
– Duplications
• Layout
– Unnecessary
– Do we have the
steps
physical
infrastructure to
– Cycle time issues
support
• Use other tools to determine
root cause if necessary
B
A C
efficiency and
effectiveness?
Copyright © 2009, Margret\A Consulting, LLC. Used with permission of author.
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Practice
Redesign
!
!
• Map of 5 nurses
performing
medication
administration
• Variation and risky !
practices exist
today
– Some can be
resolved today
– Others will need
EMAR to support
improvement
• Do not blame –find
all the issues
• Also find the good
practices
Copyright © 2009, Margret\A Consulting, LLC. Used with permission of author.
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Use Maps
• Fix broken processes today
• Refine goals
• Use maps as criteria for evaluating
systems
– Example: Will the EMAR being implemented
help overcome the issues identified?
• Use maps as a way for staff to
understand how HIT and EHR will
change things for the better
For More Support
• Contact:
Stratis Health
2901 Metro Dr., Suite 400
Bloomington, MN 55425
952-854-3306
1-877-787-2847 (toll free)
www.stratishealth.org
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