1. ... for our health The Value of Research Participation for Practices: A Case Study Erin Leege, MPH Amy Irwin, MS Paul Smith, MD Wisconsin Research and Education Network (WREN), UW School of Medicine Department of Family Medicine

2. The Study: “The Toolkit” Agency for Healthcare Research and Quality (AHRQ) developed “The Toolkit” ▪ Workflow Assessment for Health IT Toolkit Purpose ▪ Provide tools and resources to better integrate technology into clinical care through workflow assessment Audience ▪ Small- and medium-sized primary care clinics

3. The Toolkit http://healthit.ahrq.gov/health-it-tools-and- resources/workflow-assessment-health-it-toolkithttp://healthit.ahrq.gov/health-it-tools-and- resources/workflow-assessment-health-it-toolkit

4. Project Objective Evaluate the usability and suitability of AHRQ’s Toolkit

5. Partners Oregon Rural Practice-Based Research Network (ORPRN) Wisconsin Health Information Technology Extension Center (WHITEC)

6. Methods Eight Wisconsin clinics met regularly for about 10 weeks to discuss the Toolkit ▪ Usually every other week ▪ Research coordinators had observational role Clinics self-identified workflow process needing improvement

7. Results: Clinic Demographics Number (n=8) Percent Setting Rural 562.5 Urban 225 Suburban 112.5 Ownership Private 675 Hospital 225 RangeMedian Staff MD/DO 1-71 PA/NP 0-31.5 RN/LPN 0-91.5 MA 1-53.5 Other staff 1-139 Total employees 4-3318.5

8. Number (n=8) EHR Status Implemented, and in use 8 Determining system requirements for new vendor 1 EHR Vendors Cerner eMD Epic Greenway Prime Suite Mac Practice Practice Choice Results: Electronic Health Records

9. Results: Self-Identified Projects Most (n=6) focused on lab workflows ▪ Ordering (future), processing, billing, notifying ▪ Wide range of lab-related processes 2 clinics worked on prescription refill processes 1 clinic began EHR vendor switch process

10. Results: Clinic 1 Changes Initial focus: Future labs (ensure follow up) Before: ▪ Complex ▪ Inefficient ▪ Missed opportunities

11. Results: Clinic 1 Workflow – PRE Current Process for Scheduling Future Orders – Urgent Visits (continued on next slide)

12. Results: Clinic 1 PRE, continued Current Process for Scheduling Future Orders – Planned Visits

13. Results: Clinic 1 Workflow – POST

14. Results: Clinic 1 Changes After: ▪ Streamlined ▪ Standardized ▪ Solving larger problem than initially planned ۰ Final product: all labs and visits

15. Results: Clinic 2 Changes Planned implementation of a new process (see next slide) Identified other areas needing improvement ▪ Vaccine inventory and administration Created manual for new employees describing workflow processes ▪ Incoming phone calls (how to funnel) ▪ Patient check-in ▪ Other administrative processes

16. Results: Clinic 2 Workflow – NEW

17. Results: Clinic 2 Changes Planned implementation of a new process (see next slide) Identified other areas needing improvement ▪ Vaccine inventory and administration Created manual for new employees describing workflow processes ▪ Incoming phone calls (how to funnel) ▪ Patient check-in ▪ Other administrative processes

18. BeforeAfter Poor tracking of preventive care (focus: women’s physical exams) Regular meetings with Planned Parenthood Limited staff exposure to workflow assessment Purchased Visio software to plan workflows throughout clinic Results: Clinic 3 Changes

19. Discussed future model of care: ▪ Clinic – preventive care ▪ Planned Parenthood – contraception ▪ Telemedicine

20. Lessons Learned Drivers of successful change ▪ Dedicated (paid) time ▪ Someone serving as a reminder ۰ Research Coordinator ▪ Small, diverse team ▪ Project champion

21. Conclusion In addition to completing the primary aim of this project, most clinics developed new workflow processes in their clinical practice. These results suggest that participation in practice-based research network (PBRN) projects may benefit clinical care in unanticipated ways.

22. Partner with WREN! Upcoming studies (clinics) ▪ Influenza Surveillance Join WREN (individuals) ▪ Listserv – participate in surveys impacting primary care, discuss “Hot Topics” ▪ Check out our website: wren.wisc.edu

23. ... for our health Questions?

24. ... for our health Thank you! Erin Leege, MPH, erin.leege@fammed.wisc.eduerin.leege@fammed.wisc.edu Milwaukee Research Coordinator Amy Irwin, MS, amy.irwin@fammed.wisc.eduamy.irwin@fammed.wisc.edu Northern and Western Research Coordinator Paul Smith, MD, paul.smith@fammed.wisc.edupaul.smith@fammed.wisc.edu Associate WREN Director