1. Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b This material Comp10_Unit1b 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.

2. Clinical Workflow Learning Objectives 2 1.Describe the purpose for process analysis and redesign in the clinical setting (Lectures a, b) 2.Describe the role of a practice workflow and information management redesign specialist and contrast it with other roles such as technical support and implementation management (Lecture a) 3.Explain how health care process analysis and redesign and meaningful use are related (Lecture a) 4.Analyze a health care scenario and identify the components of clinical workflow (Lectures a, b) 5.Given a scenario of a health care analysis and redesign, analyze the responsibilities of each participant in the process and how the roles complement or overlap with one another (Lecture b) 6.Describe how the workflow processes used by a health care facility might differ depending on the type of facility (Lecture b) Health IT Workforce Curriculum Version 3.0/Spring 2012 Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

3. Role of Practice Workflow and Information Management Redesign Specialist Assist in reorganizing the work of a provider Take full advantage of health IT Help practices achieve meaningful use Ultimately improve health and care The overarching goal of the role is to assure that the clinical workflow supports the IOM’s requirements of safe, effective, efficient and timely health care that is patient-centered and equitable. 3 Health IT Workforce Curriculum Version 3.0/Spring 2012 Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

4. Types of Roles Roles requiring six month / short-term training Mobile adoption support positions Permanent staff of health care delivery and public health sites Roles requiring university-based training that culminates in a degree (BS, MS, PhD, etc.) 4 Health IT Workforce Curriculum Version 3.0/Spring 2012 Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

5. Related Roles Mobile Adoption Support Positions Practice Workflow and Information Management Redesign Specialist Clinician/Practitioner Consultant Implementation Support Specialist Implementation Manager Permanent Staff of Health Care Delivery and Public Health Sites Technical/Software Support Staff Trainer 5 Health IT Workforce Curriculum Version 3.0/Spring 2012 Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

6. Workflow is a Process Workflow includes: How tasks are accomplished − By whom − Task order − Task priority − Task timing Choices and decisions Location Information needs 6 Health IT Workforce Curriculum Version 3.0/Spring 2012 Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

7. Clinical Care Activities Interaction with patients Physical assessment Ordering and conducting diagnostic tests Decision making and diagnosis Developing a treatment plan Assessing compliance with treatment regimen Patient education Follow-up on test results Records creation and management Determination of confidentiality / privacy requirements 7 Health IT Workforce Curriculum Version 3.0/Spring 2012 Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

8. Administrative Activities Scheduling a patient visit Registering a patient Transporting and tracking a patient within a facility Submitting a claim for reimbursement Making a referral to a specialist Sending / receiving health information to / from another provider Food and laundry service 8 Health IT Workforce Curriculum Version 3.0/Spring 2012 Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

9. Grouped Activities (Tasks) Admission Surgery Specimen collection Reimbursement Discharge Handling of inpatient emergencies 9 Health IT Workforce Curriculum Version 3.0/Spring 2012 Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

10. Examples of Roles in Health Care Settings Providers Medical Assistants Phlebotomists Receptionists Billing Coordinators 10 Health IT Workforce Curriculum Version 3.0/Spring 2012 Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

11. Location, Location, Location Where tasks are performed can be important Physical layout of a clinic impacts workflow –Patient transportation –Hallway traffic –Distance clinic staff must travel to accomplish tasks –Patient privacy 11 Health IT Workforce Curriculum Version 3.0/Spring 2012 Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

12. Information Needs What information is used and generated in the course of a patient encounter? Do providers and clinic staff have ready- access to information they need when they need it? Do patients have access to information about their health before, after and between visits? 12 Health IT Workforce Curriculum Version 3.0/Spring 2012 Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

13. Unique Aspects of Health Care System of “experts” –Physicians and physician extenders are ultimately ethically, morally and legally responsible for everything that happens to a patient –Physicians have taken an oath to “above all, do no harm” Health care usually involves personal contact Decisions impact patient’s health and well being Patient care involves teams of people working in information-intense situations Patterns of fundamental clinical routines are the product of years and decades of evolution 13 Health IT Workforce Curriculum Version 3.0/Spring 2012 Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

14. Complexities of Health Care Each situation is unique Involve multiple people and organizations –Many opportunities for delays and variability Must take patient preference into account Continually changing priorities Many interruptions, options and exceptions Have overlapping roles and responsibilities Involves Humans and organizations Vary from practice to practice Subject to time and resource pressures 14 Health IT Workforce Curriculum Version 3.0/Spring 2012 Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

15. Complexities of Health Care Pause the slides and view the videos below about health care complexity http://www.youtube.com/watch?v=4kW4bIrYqPY http://www.youtube.com/profile?user=Saferhealthcare#p/u/4/jmh4FWapa80 15 Health IT Workforce Curriculum Version 3.0/Spring 2012 Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

16. Pulling it all Together Clinical Workflow Impacts Patients Problems, errors and delays are not just aggravating, inefficient or even infuriating In medicine, more than in other fields, problems, errors and delays can cause serious harm 16 Health IT Workforce Curriculum Version 3.0/Spring 2012 Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

17. Common Processes in Physician Practices Appointment scheduling New patient intake Existing patient intake Exam and patient assessment Ordering labs/receiving & communicating results Prescriptions Referrals out/in Diagnostic testing Billing 17 Health IT Workforce Curriculum Version 3.0/Spring 2012 Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

18. Common Health Care Processes Electronic Medical Record (EMR/EHR) Videos, Parts 1-3: http://www.youtube.com/watch?v=hqYXOM0bMRM&feature=related http://www.youtube.com/watch?v=jl2b_z71zBY&feature=related http://www.youtube.com/watch?v=jz91yUBUbbU&feature=related 18 Health IT Workforce Curriculum Version 3.0/Spring 2012 Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

19. Video Part I Processes Referral Following up on lab tests Billing Obtaining insurance pre-approval Monitoring patient outcomes Reporting performance measures 19 Health IT Workforce Curriculum Version 3.0/Spring 2012 Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

20. Video Part II Processes Include Prescription refills Billing Following-up appointment no-shows Scheduling same-day appointments Tracking accounts receivable and resubmission of unpaid claims Scanning old charts, i.e., getting old data into the new EHR system Referrals 20 Health IT Workforce Curriculum Version 3.0/Spring 2012 Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

21. Video Part III Clinical Processes Receiving and reviewing electronically acquired data Patient exam Posting payments Viewing practice financials Answering call 21 Health IT Workforce Curriculum Version 3.0/Spring 2012 Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

22. Lab Process Example Locate the Ordering Lab Results -Using an EMR scenario in your course materials (Appendix of the Instructor’s Manual). 22 Health IT Workforce Curriculum Version 3.0/Spring 2012 Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

23. Activities 1.Patient arrives 2.Patient checks in 3.Patient pays co-pay 4.Patient called back to exam room 5.Nurse asks reason for visit 6.Nurse takes vital signs 7.Nurse locates electronic chart 8.Nurse confirms medications 9.Patient removes shoe and sock 10.Doctor examines patient 11.Doctor makes working diagnosis 23 Health IT Workforce Curriculum Version 3.0/Spring 2012 Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

24. Activities cont. 12.Doctor describes treatment options and requirements 13.Patient chooses course of action 14.Doctor orders lab tests 15.Nurse obtains lab supplies 16.Nurse completes lab requisition form 17.Nurse labels tubes 18.Nurse draws blood 19.Nurse immediately centrifuges and refrigerates samples 20.Nurse provides patient education 21.Courier picks tubes up and takes to lab 24 Health IT Workforce Curriculum Version 3.0/Spring 2012 Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

25. Locations & Roles Locations Reception area Exam room Phlebotomy room Roles Patient Receptionist Nurse Doctor Courier 25 Health IT Workforce Curriculum Version 3.0/Spring 2012 Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

26. Choices and Decisions 1.Working diagnosis (Doctor) 2.Patient preparation for Doctor (Nurse decides based on chief complaint) 3.Which treatment option (Patient decision) 4.Required tests (determined for each treatment option by clinical guidelines) 5.What tests or treatments to order and when (Doctor based on clinical guidelines) 26 Health IT Workforce Curriculum Version 3.0/Spring 2012 Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

27. Information Needs 27 Health IT Workforce Curriculum Version 3.0/Spring 2012 Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b Co-pay amount Existing medications for medication reconciliation Treatment options for working diagnosis Required tests / follow-up for treatment options Patient and provider identifiers for lab test requisition

28. Confusion about Workflow Most people are not accustomed to thinking of what they do everyday in terms of workflow Terms used in health care that may be confused with workflow or process analysis: –Regimented care –Clinical pathways, clinical guidelines –Accreditation and audit 28 Health IT Workforce Curriculum Version 3.0/Spring 2012 Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

29. Workflow Changes Must first, do no harm Must improve processes –Increase efficiency –Decrease delays and cost –Increase quality and safety –Improve the work environment –Improve ability to care for patients –Create a better overall patient experience 29 Health IT Workforce Curriculum Version 3.0/Spring 2012 Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

30. Fundamentals of Health Workflow Process Analysis & Redesign Summary What a Practice Workflow and Information Management Redesign Specialist Does Document context and process so that it can be analyzed Analyze process Recommend redesign options Implement redesign Evaluate, adjust and maintain changes 30 Health IT Workforce Curriculum Version 3.0/Spring 2012 Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

31. Clinical Workflow References – Lecture b 31 Health IT Workforce Curriculum Version 3.0/Spring 2012 Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b References Allied health professionals. (n.d.). Retrieved December 29, 2011, from Association of Schools of Allied Health Professions: http://www.asahp.org/definition.htmhttp://www.asahp.org/definition.htm Committee on Quality of Health Care in America and Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century 2001. Washington: National Academies Press. Eligible provider meaningful use meaningful use core measures measure 5of 15 -Stage 1. (2010, November 7). Retrieved December 29, 2011, from www.cms.gov/EHRIncentivePrograms/Downloads/5_Active_Medication_List.pdf www.cms.gov/EHRIncentivePrograms/Downloads/5_Active_Medication_List.pdf