MEDCOM AHLTA Provider Satisfaction MAPS Clinical Workflow Analysis

MEDCOM AHLTA Provider Satisfaction (MAPS) Clinical Workflow Analysis Guidelines UNCLASSIFIED

MEDCOM AHLTA Provider Satisfaction (MAPS) Content 1. 2. 3. 4. 5. 6. 7. 8. What is a business process and BPR? Goals of Reengineering efforts/MAPS What is workflow Clinical workflow Evaluating routine tasks Process Maps - “As Is” vs “To Be” Metrics Outcomes LTC Hon Pak/(703) 703 -681 -3090/ hon. pak@amedd. army. mil UNCLASSIFIED Slide 1 of 12

MEDCOM AHLTA Provider Satisfaction (MAPS) Business Process and BPR • BUSINESS PROCESSES • Methods by which business is conducted on a daily basis. • Manual and automated activities to complete a task or function. • BUSINESS PROCESS REENGINEERING (BPR) • The analysis and redesign of workflow activities • The design of new patient-focused work processes that are not encumbered by the current ones and are designed to work in the AHLTA care environment • Not incremental change, but well-conceived changes to achieve results LTC Hon Pak/(703) 703 -681 -3090/ hon. pak@amedd. army. mil UNCLASSIFIED Slide 2 of 12

MEDCOM AHLTA Provider Satisfaction (MAPS) Goals of Reengineering Efforts • The implementation of electronic clinical information systems is the result of business and consumer pressures to help reduce medical errors and improve overall patient safety. Added benefits include enhancing efficiency and potential cutting costs. AHLTA was designed for providers by providers with the goal of optimizing information workflow for MHS providers. The goals of reengineering efforts with AHLTA are to: – Improved patient care and health – Increase the efficiency of clinic processes – Improve productivity of staff – Enhance collaborative care between PCPs and Specialists – Increase access to care and utilization management – Improve patient, stakeholder and healthcare staff satisfaction

MEDCOM AHLTA Provider Satisfaction (MAPS) Goals for MAPS • Achieve team documentation – Nurses and Medical Technicians play a key role in documentation • Reduced amount of time it takes for providers to document • Standardization in documentation and use of forms – – PC Generic AIM Form Questionnaires Macros for ancillary staff Handouts/instruction sheets • Simplified Coding • Go home on time! = Provider Satisfaction These are the same goals for the AF COMPASS Program

MEDCOM AHLTA Provider Satisfaction (MAPS) Process Flow • Process redesign methodology for successful implementation is built on understanding the future state, identifying gaps with the current environment, prioritizing re-design initiatives and then acting on them. – Assessment and Design Implementation – Confirm Future State & Develop Current MTF Baseline Introduce and confirm future state model Conduct executive interviews Conduct i nterviews with key staff (e. g. , clinic leadership and staff, data analysts, IM/IT, etc. ) Review and observe existing operations Gather data required for current environment assessment Identify Gap & Plan for Future State Assess current environment against operational objectives and process requirements Analyze demand capacity data Document recommendations for improvement Review recommendations with executive and clinic leadership Process Design and Reengineering Outline operational redesign options for future state Ambulatory Care Operations Analyze organization’s readiness for change Identify existing projects that are interdependent and recommend initiatives Implement and Measure Prioritize re -design initiatives Determine metrics and establish baseline Develop work plan and monitoring mechanisms Implement process change initiatives Monitor progress and modify reengineering activities as required

MEDCOM AHLTA Provider Satisfaction (MAPS) Workflow • What is Workflow ? § A defined series of tasks within an organization to produce a final outcome § A sequence of activities that produces a result of observable value § An established business process describing how the tasks are done, by whom, in what order and how quickly § The coordination of tasks, data, and people to make a business process more efficient, effective, and adaptable to change § Workflow systems provide a process control backbone for business processes: they mediate the flow of responsibility in a process from person to person and task to task

MEDCOM AHLTA Provider Satisfaction (MAPS) What is Clinical Workflow? § An established process describing § § § A series of tasks How they are accomplished By whom In what sequence At what priority that accomplishes a defined step in an activity in the clinical care of patients

MEDCOM AHLTA Provider Satisfaction (MAPS) What is Clinical Workflow? Clinical Patient Care ACTIVITIES STEPS TASKS

MEDCOM AHLTA Provider Satisfaction (MAPS) What is Clinical Workflow? • Providers are not accustomed to thinking of clinical care • • processes in such terms Examination of clinical workflow is not the same as “clinical pathways” Application of engineering analysis methods by physicians does not turn clinical care into engineering

MEDCOM AHLTA Provider Satisfaction (MAPS) What is Clinical Workflow? • Examples of Clinical Patient Care – – – – – Outpatient Visit Outpatient Procedure Surgery Cardiac Catheterization Labor/Delivery/C-Section Chemotherapy, Radiation Therapy In-patient (short stay) Rehabilitation-Physical Therapy Wound Therapy Occupational Therapy

MEDCOM AHLTA Provider Satisfaction (MAPS) Clinical Workflow • Standard Tasks in Clinical Patient-Care: – – – – – Locate Patient Gather Data Evaluate Data Examine Patient Synthesize Data and Examination Determine Next Step in Patient Care Document Findings and Decisions Direct Care of patient – clinical orders Perform Procedures as needed

MEDCOM AHLTA Provider Satisfaction (MAPS) Clinical Workflow • Examples of activities in clinical care: – Vital Signs – Hospital rounds – Pre-op/pre-procedure preparation of a patient – Admission – Discharge

MEDCOM AHLTA Provider Satisfaction (MAPS) Clinical Workflow • Examples of steps in clinical care – Patient Assessment – Patient Evaluation • Initial = admission or outpatient visit • Subsequent – – – – Return visits Daily rounds Transfer Discharge Consultation (patient evaluation specific to expertise/problem) Bedside Procedures Specialized Procedures Teaching/Instructions

MEDCOM AHLTA Provider Satisfaction (MAPS) Clinical Workflow • Examples of tasks leading to the defined steps – – – Find patient Find chart, nurse, doctor, lab results Write progress/nurses’ notes Enter orders Check x-rays, reports Write prescriptions, prepare discharge summary

MEDCOM AHLTA Provider Satisfaction (MAPS) Clinical Workflow • Why go through this detail? Only by breaking down necessary and routine duties into steps and tasks can staff: • Understand the complexity, priority and importance of every step that seems second nature to them • Analyze care processes and pinpoint redundancies, workarounds, defects, etc. • Communicate the results of that analysis to colleagues and others who will be designing new process flow and tools to improve efficiency • Ensure that future processes will: – Encompass and allow for all the needed steps to be undertaken successfully – Eliminate steps that are redundant and unnecessary – Improve and streamline care processes without doing harm

MEDCOM AHLTA Provider Satisfaction (MAPS) Clinical Workflow So what is the next step? Future State

MEDCOM AHLTA Provider Satisfaction (MAPS) Clinical Workflow – the next step – Analyze “present state” to reveal “defects” or flaws in workflow • • Redundancies Barriers Bottlenecks Delays Failures Inappropriately Human Intensive Activities Defective Decision Making Others – Elimination of these through careful design and thought will yield the future state and improved workflow

MEDCOM AHLTA Provider Satisfaction (MAPS) Clinical Workflow – the next step • Document current state, the “As Is”, with the use of process maps – Data to support and measure the current state • • • Low patient volume Low RVUs- poor coding Delayed visits in clinic Patient Complaints Provider satisfaction • Document future state, the “To Be”, with the use of process maps – Determine performance goals. Data to support and measure the future state

MEDCOM AHLTA Provider Satisfaction (MAPS) Family Practice “As Is” Process Map

MEDCOM AHLTA Provider Satisfaction (MAPS) Family Practice “To Be” Process Map

MEDCOM AHLTA Provider Satisfaction (MAPS) Step 1. Confirm Future State • Introduce and confirm future state model • Conduct interviews • Review and Observe existing operations • Gather data required for current environment assessment

MEDCOM AHLTA Provider Satisfaction (MAPS) Step 2. Identify Gap and Plan for Future State • Assess current environment against operational objectives and process requirements • Analyze demand capacity data • Document recommendations for improvement • Review recommendations with MTF and/or Clinic Leadership

MEDCOM AHLTA Provider Satisfaction (MAPS) Step 3. Process Design and Reengineering • Outline operational redesign options for future state • Analyze organization’s readiness for change • Identify existing projects that are interdependent and recommend initiatives

MEDCOM AHLTA Provider Satisfaction (MAPS) Step 4. Implement and Measure • Prioritize re-designed initiatives • Determine metrics and establish baseline • Develop work plan and monitoring mechanisms • Implement process change initiatives • Monitor progress and modify reengineering activities as required

MEDCOM AHLTA Provider Satisfaction (MAPS) Metrics Achieving Goals • Team Documentation in place • Reduced amount of time it takes for providers to document • More provider-to-patient face time • Standardized forms used by entire clinic • Completed and signed encounters the same day • Simplified Coding • Go home on time!

MEDCOM AHLTA Provider Satisfaction (MAPS)

MEDCOM AHLTA Provider Satisfaction (MAPS) Outcomes • Provider/Staff Satisfaction = increased staff retention in the military • Patient Satisfaction • In RVU production • Patient Visits or in Patient Visit Delays “Practice-based feedback reports help physicians better understand the care they deliver and where they should focus their efforts to redesign the clinical workflow in their practices to continuously improve the quality of care for their patients. ” Kevin Fergusson, MD, MSHA, A roadmap for quality improvement in physician offices.