Interprofessional Healthcare Informatics is a graduate-level, hands-on interactive exploration of real informatics tools and techniques offered by the University of Minnesota and the University of Minnesota's National Center for Interprofessional Practice and Education. We will be incorporating technology-enabled educational innovations to bring the subject matter to life. Over the 10 modules, we will create a vital online learning community and a working healthcare informatics network. We will explore perspectives of clinicians like dentists, physical therapists, nurses, and physicians in all sorts of practice settings worldwide. Emerging technologies, telehealth, gaming, simulations, and eScience are just some of the topics that we will consider. Throughout the course, we’ll focus on creativity, controversy, and collaboration - as we collectively imagine and create the future within the rapidly evolving healthcare informatics milieu. All healthcare professionals and IT geeks are welcome!
Workflow Processes
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来自 University of Minnesota 的课程
跨领域医疗信息学
188 个评分
从本节课中
Quality Improvement/ Workflow Analysis/ Redesign
Week 5 begins! This week we examine informatics in relationship to new technologies in healthcare. Telehealth and technology are creating new ways to link people, and care, and health information. By the end of this week, you will be able to: examine applications of telehealth technologies and describe methods of engaging consumers in using health information technologies.
与讲师见面
Karen Monsen, Ph.D., RN, FAANAssistant Professor
School of Nursing
Hello, I'm Bonnie Westra. I'm an associate professor at the
University of Minnesota School of Nursing.
Today's presentation is on workflow processes.
It's really critical, that nurses and all healthcare providers are able to
understand how do you really look at the flow of work, and the information to
support the work that needs to be done in health care.
What I'm going to cover today is I'm going to go through an example of
workflow process management, and I'm going to apply this to a new type of
organization called an accountable care organization.
And to a specific process that's called the consumer engagement process.
This same technique can be applied to any process whether it is pressure ulcer
management, whether it's scheduling and managing a surgery, or whether it's a
specific process like consumer engagement.
First of all, we want to start with carefully identifying what is the
problem? So in this case, the problem is there was
a new accountable care organization that was formed, and their job was really
trying to engage consumers in effectively using the resources that they have
available. So the new accountable care organization
was composed of a hospital, a clinic, social services, and a payor.
And that they served a county, and I made up a fictitious county named Shuster
county, and that it existed in a large metropolitan area.
What's what happens is patients are offered an opportunity to be able to
enroll in accountable care organization. Which is really a different payment
mechanism where a healthcare system and the ACO would takes on responsibility for
a population, whether they're sick or well.
And so they get paid on a per patient basis, rather than for all the services
they've provided. So the goal is to prevent services and to
keep people as healthy as possible. So, after patients are enrolled in the
ACO, a follow up call is made to engage them in being able to know about the
services and to use the services that are available in order to stay healthy.
They also need to understand the agency, the ACL needed to understand, since it
was new, what are the processes that they are using?
And what are the opportunities for improving the way their processes are
being done? And the flow of information the
technologies behind that. And what they knew is that they had
multiple information systems where there were redundant processes.
And they knew there was an opportunity. So the goal was to really try to map that
out to clearly define the opportunities for them.
They weren't sure what the best practice was.
They had kept trying several different new practices, and so we actually, a
group of students and faculty got involved in analyzing their workflow
process. So the project goals were to improve the
efficiency. Of engaging people in the calling out to
consumers and to reach the greatest number of new clients through the
engagment calls. What happened was the agency would get a
whole list of here's the new people. Call them, let 'em know about the
services. And they were still at a new stage where
they didn't quite have the staffing up to par.
So this was added on to existing work. So they really needed to improve the
efficiency as much as they could in order to maximize the opportunity for engaging
consumers. Now when we think about workflow process,
there are some terms. and there are some people.
So one of the terms is called actors. When you do workflow processes, what you
try to define is who are the people that are involved.
Or even departments sometimes. We call those actors.
So a team can be an actor Or a single individual can be an actor.
When we do workflow process, each actor will have its own kind of what we call
swim lane. And I'll show you what that means.
And that swim lane is like a swimming lane in a swimming pool.
And its what are all the things they do in that swim lane, and how do they hand
off from one swim lane to the other as the process unfolds.
So we can understand that, if I get the call Or I need to tell somebody about it.
Who do I tell? How do I get the information across?
The actors in this case were the executive team.
The information systems staff. The engagement team.
But the leader had a different job. And so, therefore, she got her own swim
lane. Than the rest of the engagement team who
had different jobs. As we look at work flow diagramming, one
of the things we want to do is understand what's the current process?
No judgments, just what is it. So on this slide, what you can see is on
the left hand side at the bottom, is kind of the terminator.
Where did this end? And at the top in this, and that's the
exec, the executive team gets a report at the end.
Now if I were to do this over again, I'd actually put that on the far right, but
today it's here. Then you have the information system
person. So the information system person was
responsible to get who got enrolled this month What they would then do is they
would create a report in Excel. And then they would email the team leader
and tell the team leader that the Excel report of who all needs to have a call is
available on the server. If you go to the next swim lane.
Then what you can see is team leader for the engagement team.
So the team leader picks up the report, creates a split in the report based on
how many people are doing phone calls. Has excel spreadsheets set up for each
person who is going to do a call. Emails them and lets them know that their
reports ready of who they need to call that month.
Then, if you go to the next a, column you'll see, here's the engagement team.
Now you're going to notice that there some differences when you look at the,
the style of the, you know, whether it's an oval, or a diamond, or a rectangle.
And you're going to see some differences in some things are in yellow and gold,
and some things are in red. The red were the opportunities for
improvement as we went through the process.
So what happens is the engagement team then picked up the report and they
printed it out. And they put it next to their phone.
And what they also found is they had to look up phone numbers.
Because not everybody had a phone number. When they looked up the phone numbers,
the phone numbers might've been in one system or another system.
They weren't all in the same system. And then what they would do is they would
make calls. And so as they made calls, they had to
make decisions, noted by a diamond here. And if the person was available, then
they would verify information. Or if not they would have to figure out
whether they had time to recall or just end the process.
So as they went through the process it was very much a paper-driven process.
And they would make, they would handwrite phone numbers, they would use yellow
highlighters to note which patients they had called, any notes about what they
found as they went through. So it's very much a paper-driven process.
And then when they got to the end. They would take and they would give that
information back to the team leader and email and let her know that she was done
but meanwhile all of their notes were on paper.
So the pieces of paper got handed back to the I.T.
person who then had to enter the information.
And after that person entered the information.
Then they went through, and they created a report off of it.
And handed it off back to the executive team.
On a m-, as a monthly summary. One of the things that's really important
is to go through, and to use, 1, the right symbols.
So a start symbol and an n symbol are ovals.
Or in some cases, you might use circles. Steps in a process are denoted by the
rectangular shapes. And diamonds are denoted by the symbols.
So those are important pieces, if you're trying to communicate with an information
technology person. If you made a decision around circle,
they would never understand what you were saying.
So learning to use the right symbols. And how to really delineate who does
what. And when, in he process, they do
something. So kind of in summary when we look at
some of the challenges first of all there was a print out of individual sheets.
Secondly is they had to look up phone numbers in two seperate systems Next they
had to, if they didn't reach the clients when they were trying to call them they
ended the call. Or in some cases they would not, they
would say there's no phone number or there is a mailbox not set up, or leave a
message. and so when they knew there's a
possibility of getting back they would try a call again if they had time.
And then, they would highlight the client's name on the printout, they would
document a narrative back in one information system and then they would go
into the electronic health record and document information in that system.
And then, as they got done then that report needed to be synthesized so these
were some opportunities that were highlighted in red on the previous slide.
Where improvements could be made. So what happened is you then design
what's the ideal system. Where are the opportunities for
improvement when you're doing work flow. So every place there was a red box
previously then the system got changed. In this case the recommendations, kind of
in summary were don't print. You know, you could use the yellow
highlighter in, in excel on the spreadsheet so all the information stays
in excel. Another recommendation is maybe the IT
person could look up all of the phone numbers instead of everybody having to go
into 2 systems to be able to look up phone numbers you know, and so there are
a number of different recommendations about how to stream line this process and
when the data is handed back it's handed back electronically.
In Excel spreadsheet, so it's quicker to combine it to be able to do the report in
a much more efficient way. So, in summary, what I wanted to point
out from this example is not all the details about engaging somebody, but much
more so, how do you think about who the actors are, how to communicate a process,
a start and end, or decision points, and how to look at where the opportunities
for improvement are. And then use this as a way of being able
to communicate the opportunities. Now, when you get started it is best to
start with what we call a storyboard. First time I heard that I'm like, say
what? And what that really means is you need to
first of all sit down and just discuss what is the process.
Trying to diagram it before you discuss it makes it actually much more difficult
to do. So what's the process?
What's the setting in which the process occurs?
Who starts the process? When does the process end?
What are the steps in the process? Who does the steps in the process?
And then mostly, how does the information get captured, and how does it get handed
off, and how does the person who's getting it handed off to them actually
know there's anything there to go get? So those are all really critical pieces
to really fully be able to describe before you diagram, once you have gone
through and done a good description, you then can go through and start by creating
your swim lanes. Now, my students taught me how to
actually do something I had no clue about in Word, which is you can go, and in
Word, the program you can do Insert, Table, and Draw, and it actually gives us
these wonderful diagrams, or these wonderful swim lanes, that you then can
just put in who are the actors at the top of the swim lanes.
There are also, now you can very complex in symbols, but we try to keep it just
very simple as a starting point. So a terminator, which is an oval or it
can be actually a circle, means that it's either the beginning or the end of the
whole process. When you look at a process step, it's a
rectangle. You connect your steps in the process, by
using arrows, and they -- you have to pay attention to the direction of the arrows,
like who's handing off to whom, and then diamonds indicate whether there's a
decision. So if the answer is no, then you go one
path, and if it's yes, you go another path.
When you're working on a flow diagram you start by putting in your terminators, who
starts, who ends and you can notice here I put the executive team on the far right
hand side. As I mentioned earlier I would change the
process because that's where it ends. And then you just start going through the
steps in the process and add your arrows in as you move through one step to the
other. So in summary, what we've covered today
is, how to do workflow process diagramming, starting with a storyboard,
then looking at who are the actors, what are the steps in the process, going
through what is the current process and then looking at what's the ideal process.
What are the opportunities for improvement?
This is a wonderful communication tool that can be used very effectively between
clinicians, quality improvement people and your information technology folks who
might be making changes. In how hand, information is handed off
for one to another. So, thank you very much and enjoy.
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