Fundamentals of Workflow Process Analysis and Redesign Slides

Fundamentals of Workflow Process Analysis and Redesign Slides compiled by Drs. Zhang and Shahriar

Goals • Objectives of Process Analysis • Steps for Process Analysis • Process Variations and Exceptions • Identifying EHR functionality from Process Analysis 2

“You can only elevate individual performance by elevating that of the entire system. ” 1 - W. Edwards Deming The process analysis methodology covered in this unit focuses on identifying processes in use at a clinic, and translating information about the processes into a list of Electronic Medical Record functions that are needed at that clinic Public domain photograph of W. Edwards Deming obtained from http: //commons. wikimedia. org/ 3

Definitions: • Process 2 • Process Analysis • Process Improvement 4

Process • Series of actions or operations conducing to an end - a continuous operation or treatment • Continuous operation or treatment 5

Process Analysis • Examination of a process to understand its elements such as steps and actions; and the relationships between them, including: • The order of steps, • What things can be done in parallel versus sequentially, • Who or what performs the steps, and • Maybe where they are performed. • Goal of “analysis” is to ultimately improve a process by looking for • Gaps • Lack of conformity with best practice • undue delays • Redundancy • Rework • Lack of efficiency 6

Process Improvement Making changes to a process to make it better in some way 7

Process Analysis Skills • • At ease with data and data system concepts At ease with clinical workflow concepts Able to communicate such concepts Able to identify problem areas 8

Framework for Process Analysis • Form an objective picture of the process, process variations and exceptions • Translate this information into a list of Electronic Medical Record functions needed at a clinic 9

Steps for Process Analysis • Start with process inventory and diagrams – Context diagram showing clinic functions – Flowchart for each process • For each process, list – Variations applicable to the clinic – Exceptions • Report findings – Major observations – EHR functionality necessary to support clinic functions – Opportunities for improvement 10

Process Inventory • Identification of main clinic processes • Analyst works with clinic leadership to identify high priority processes • Select processes are analyzed – – – Some can’t be improved Some the gain is too small Some can be improved, but by means other than use of health IT 11

Practice Functions Lab tests Other Diagnostic tests (depends on specialty) Billing Medical Practice Write prescriptions Disease management Referrals / consults Procedures Office visits New patient Existing patient 12

Practice Process List • • • Patient check-in Patient visit Prescriptions Assimilating received documentation Labs Other Diagnostic Tests Referral / consult Disease Management Billing 13

Process Inventory • List of the main processes used by a practice • Specifies common variations and exceptions 14

Process Variations and Exceptions Variations: processes used by the clinic Exceptions: errors or common odd things that occur during the process 15

Common Process Variations & Exceptions: Patient Check-In Patient check-in variations – New patient – Existing patient – Walk-in Patient check-in exceptions – No insurance / non-covered service – Change in insurance information 16

Common Process Variations & Exceptions: Patient Visit Patient visit variations – Referral needed – Procedure needed – Diagnostic test needed Patient visit exceptions – Emergency reason to stop visit – Non-covered service needing separate visit – Need to be seen by different provider 17

Common Process Variations & Exceptions: Prescription variations – – Paper Electronic Refill call-in needed Other call-in needed Prescription exceptions – – No insurance / non-covered service Samples provided Prescriptions to multiple pharmacies Prescription can’t be filled at pharmacy (patient to carry on prescription to pharmacy) 18

Common Process Variations & Exceptions: Received Documentation Received documentation variations – Paper – Electronic – Triggers patient contact Received documentation exceptions – Inadequate patient identification – Inadequate source identification – Unintelligible or ambiguous information 19

Common Process Variations & Exceptions: Labs Lab variations – Sample taken in clinic, test done in clinic – Sample taken in clinic, test done externally – Sample and test done at central lab Lab exceptions – Bad sample – need another – Results not received – Lab results not physiologically possible 20

Common Process Variations & Exceptions: Diagnostic Tests Diagnostic test variations – – Test done in clinic Test done externally Report expected Image or test result data expected Diagnostic test exceptions – No insurance / non-covered service – Test error / unintelligible results – Results from external test not received 21

Common Process Variations & Exceptions: Referral variations – – Paper via patient Paper provider to provider Electronic Multiple referrals Referral exceptions – Referee does not accept the referral 22

Common Process Variations & Exceptions: Disease Management Disease management variations – Paper – Electronic Disease management exceptions – – Insufficient data Data errors Care fragmentation Contraindications 23

Common Process Variations & Exceptions: Billing variations – – Paper (superbill as source) Electronic Where coding is done Billing & collections done externally Billing exceptions – – No insurance / non-covered service Claim denied Coding errors Data errors 24

Process Analysis Example As a process analyst working with Suburban Family Clinic, you have listed appointment scheduling on the process inventory. See the “By Phone Appointment Scheduling Scenario” next slides. 25

Role-Based Flowchart Suburban Family Clinic By Phone Appointment Scheduling Patient yes Desires office visit Calls clinic Requests provider Time ok? no To far Out? yes Receptionist no Answers Phone or message States next available time Can you identify the process variations? Schedule office visit Visit not scheduled 26

Process Variations & Exceptions Suburban Family Clinic: Phone Appointment Scheduling: – Appointment scheduling variations • By phone – Appointment scheduling possible exceptions • Receptionist doesn’t answer, patient leaves message • Someone other than patient calls • Requested provider not available • Available appointment time slots not acceptable 27

Process Variations & Exceptions Could you recommend EHR feature for above 4 exceptions? - #1 -A reminder at computer to check voice message - #2 -Verify patient identify with stored credentials - #3, 4 - enable schedules of all providers to find suitable time slots 28

Translating Analysis Results to EHR Functionality Existing Clinic Processes Process Analysis EHR Functionality Process Redesign 1. 2. Process variations → needed functionality Common process exceptions → needed functionality 29

After the Process Analysis • The list of processes and exceptions are compiled together in one document and provided to the clinic management • This list corresponds to needed EHR functionality – Included in process analysis report – Ultimately included in a request for proposal intended for EHR software vendors • Where process diagrams are created as part of the process analysis, they are included in the report 30

Process Analysis Report Should Include • • • Information about the analysis Process inventory Process variations and exceptions Process diagrams List of EHR functionality needed for the practice 31

References 1. 2. 3. Deming, W. Edwards. Out of Crisis. MIT Press, Cambridge, Massachusetts 1982. Merriam-Webster Online Dictionary, July 17, 2010, Available from http: //www. merriam-webster. com/dictionary/process. American Society of Quality Glossary, Available from http: //asq. org/glossary/p. html. 32