. . . for our health

The Value of ResearchParticipation for Practices:

A Case StudyErin Leege, MPH

Amy Irwin, MS Paul Smith, MD

Wisconsin Research and Education Network (WREN),

UW School of Medicine Department of Family Medicine

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

The Toolkit

• http://healthit.ahrq.gov/health-it-tools-and-resources/workflow-assessment-health-it-toolkit

Project Objective

• Evaluate the usability and suitability of AHRQ’s Toolkit

Partners

• Oregon Rural Practice-Based Research Network (ORPRN)

• Wisconsin Health Information Technology Extension Center (WHITEC)

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

Results: Clinic Demographics

Number (n=8) Percent

SettingRural 5 62.5Urban 2 25Suburban 1 12.5

OwnershipPrivate 6 75Hospital 2 25

Range Median

StaffMD/DO 1-7 1PA/NP 0-3 1.5RN/LPN 0-9 1.5MA 1-5 3.5Other staff 1-13 9

Total employees 4-33 18.5

Number (n=8)

EHR StatusImplemented, and in use 8Determining system requirements for new vendor 1

EHR VendorsCernereMDEpicGreenway Prime SuiteMac PracticePractice Choice

Results: Electronic Health Records

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

Results: Clinic 1 Changes

• Initial focus: Future labs (ensure follow up)• Before:

▪ Complex▪ Inefficient▪ Missed opportunities

Results: Clinic 1 Workflow – PRECurrent Process for Scheduling Future Orders – Urgent Visits(continued on next slide)

Results: Clinic 1 PRE, continuedCurrent Process for Scheduling Future Orders – Planned Visits

Results: Clinic 1 Workflow – POST

Results: Clinic 1 Changes

• After:▪ Streamlined▪ Standardized▪ Solving larger problem than initially planned

۰ Final product: all labs and visits

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

Results: Clinic 2 Workflow – NEW

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

Before After

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

Results: Clinic 3 Changes

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

Lessons Learned

• Drivers of successful change▪ Dedicated (paid) time▪ Someone serving as a reminder

۰ Research Coordinator

▪ Small, diverse team▪ Project champion

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.

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

. . . for our health

Questions?

. . . for our health

Thank you!Erin Leege, MPH, erin.leege@fammed.wisc.edu

Milwaukee Research Coordinator

Amy Irwin, MS, amy.irwin@fammed.wisc.edu Northern and Western Research Coordinator

Paul Smith, MD, paul.smith@fammed.wisc.eduAssociate WREN Director