Maximizing Clinic Maximizing Clinic Efficiency with Efficiency with RelayHealthRelayHealth

Maj Matthew Barnes, MD

IntroductionIntroductionNovel WorkflowsDeploymentImplementationSustainment

Streamline Team Based Streamline Team Based CareCare

Stop printing things out! Send it by RelayHealth!

Appointments – Direct to Central ApptsMedication Refills – Direct to Pharmacy for

refillingConsult Renewals – Low risk? No

intervention on your part? Consider nurse refilling

Clinic has protocols? Use MiCare if possible

Asynchronous WorkflowAsynchronous WorkflowWebvisits:

◦MISNOMER! Webvisits imply no in-person care

◦Can be used to PRIOR to the visit to ensure standard of care documentation is done

◦Can be used with templated directions

◦Not directed – if an early adopter, try it!

Webvisit WorkflowWebvisit WorkflowTeam Based Workflow:

◦During huddle, “Scrub the list” one week ahead, and send out Webvisits to patients with templated instructions Consider engaging appointment line

◦On patient screening, have tech cut and paste into HPI, medication list, etc…

Added benefit – patient is engaged with their record!

Disease ManagementDisease ManagementCreate Patient Lists

◦ Can be done by Disease Manager/Nurse◦ Based on Disease, Demographic, etc…

Can be used to proactively send information to the right people

Send something once a week, over a peak time (i.e. Wed @ 3 PM)

AdoptionAdoptionChances are, you already have

RelayHealth!RelayHealth’s utility hinges on

adoptionYou may have RelayHealth, but your

patients may not be using it! ◦You might not be either.

What are your numbers? Do you know how many patients signed up?

Key PlayersKey PlayersAre you the Champion?

◦Someone in the field; respected◦Their role is to advocate for change

among providers◦Needs to be given time to do this

Are you the Sponsor?◦Back the champion!◦You are the “big stick!”

Change ManagementChange ManagementCan be done ANYTIMEADKAR

◦Awareness◦Desire◦Knowledge◦Action◦Reinforcement

Awareness/Desire/Awareness/Desire/KnowledgeKnowledge• Marketing• Posters–Waiting Room–Pharmacy

• In-processing• Social Media

• DO THIS FOR CLINICIANS! A LOT!• Did I mention this needs to be done

for clinicians?• No seriously. Do this for all

clinicians.

The Adoptees?The Adoptees?• Who are your early adopters in

clinic?• Who are your late adopters?

• Who are your key individuals?–Leveraging key individuals makes

change happen

• Do NOT ignore risks/weaknesses• Address them – ask for advice!

ImplementationImplementationTeam Approaches work best.Top Down for Early AdoptersBottom Up for Late Adopters

Time for Training◦ Role Based Training is Ideal

Time for Sustainment Training◦Establish Secure Messaging ◦High Performance Teams

Early Adopter ModelEarly Adopter Model• 26 yo Male Provider who’s

comfortable with Information Technology

• Not a champion• He created novel workflows for his

team for sign-up for secure messaging

• Success was REWARDED by offering a three day pass

• Not much intervention required.

Late Adopter ModelLate Adopter Model• 63 yo Male Contract Provider who is very

uncomfortable with computers, much less Health IT

• Has a strong, early adopting technician who understands, and champions RelayHealth among patients

• Provider gets assistance when he needs it

• Requires ADKAR – must have Awareness, Desire, Knowledge, Action, and Reinforcement

• Pitfall: DON’T PUNISH YOUR EARLY ADOPTERS BY RUINING THEIR TEAM.– Every change to a PCMH team has to be RARE

What About FailuresWhat About FailuresADKAR? Where did it go wrong?Key Personnel were negative

◦Need to address them up front, and often

Unanticipated ObstaclesFailure to Address Potential

Obstacles/Conflict

Sign-upSign-up• Air Force gives the option to increase

registration rates via face-to-face registration, e-Registration, and telephone registration

• Army/Navy have flexible registration processes too

• SEAL THE DEAL!!!–By Cell Phone, By Kiosk (if available), By

Non-network computers–Those signing up: ~ 8% without; ~ 90%

with–Went from lowest in clinic to highest in Air

Force

SustainmentSustainment• Create workflows for on-boarding• Create periodic sustainment training• After Action Reports– On-record: finding good things can lead to more

resources– Off-record: make them BRUTAL

• Reinforcement, Reinforcement, Reinforcement

• Avoid “punishing” those that do well

Workflow DesignWorkflow DesignTwo main areas need workflow:

◦Invitations High up front work Low back-end work Ensure patients are given

enrollment opportunities at every point of service (i.e. PHA Clinics, Front Desk...)

◦Patient Care Low up-front work High back-end work

Could consider doing this for Sustainment

Invitation WorkflowInvitation Workflow

Get help if you can: GPM, Disease Managers, Case Managers

Draw it out! Use a Swiss Cheese Model v.

Process Diagram◦Who◦Level of Effort/Risk◦Yield◦Potential Return

EXAMPLE Workflow Design EXAMPLE Workflow Design for Invitationsfor Invitations

Appointment Line:

High Effort, High Yield

70%

Front Desk:Low Effort, High

Yield100%

Med Tech:High

Effort, Med Yield

30%

Provider:

High Effort, Low Yield20%

Pharmacy:High Effort,

Medium Yield50%

Patient Care WorkflowPatient Care WorkflowGet help if you can: GPM,

Nursing, Medical TechniciansDraw it out! Use a Layered Model

◦Who◦Purpose◦Level of Effort◦Potential Return

EXAMPLE Workflow Design EXAMPLE Workflow Design for Patient Carefor Patient Care

TipsTipsEnrollment is your first barrier

◦ Use processes which already occur (i.e. base orientation, TAPS)

Engagement is your second barrier◦ Use processes which already occur (i.e.

appointment line, pharmacy)Put as little on the care team as possibleContractingDo not forget about

sustainment/reinforcementGet top cover – and keep it!

ConclusionConclusionNovel workflowsChange managementWorkflow Diagrams

Any Questions?Any Questions?