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Using Technology to Modify Clinic Workflows Promoting Patient Engagement and Restoring Fun in Clinic Exam Rooms
| Date post: | 19-Jul-2015 |
| Category: |
Health & Medicine |
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Using Technology to Modify
Clinic WorkflowsPromoting Patient Engagement and Restoring Fun in Clinic Exam Rooms
More Accurately
…. A story of failure
How I’ve been totally unable to convince colleagues and
health care systems to put more technology in primary care
clinics ….
Or …the power of the second screen
Photograph: Colin Anderson
Objectives and Goals
Objectives
Define and identify clinic
workflows and designs
Discuss variations that promote
patient engagement
Review technologies and
techniques that can restore
creativity and fun to the clinic
experience
Goal
Show and outline current states
Illustrate and map out variations
that reduce work for everyone
Demonstrate tools that add
“spark” and help create “aha”
moments in our exam rooms
“Form follows Function”
“It is the pervading law of all things organic and inorganic, of all things physical and metaphysical, of all things
human and all things superhuman, of all true manifestations of the head, of the heart, of the soul, that the life
is recognizable in its expression, that form ever follows function. This is the law.”
Louis Sullivan, “The Tall Office Building Artistically Considered” 1986
First, a personal story
All of us are somewhere along a personal trip
that defines who we are and helps
understand where we are today.
This will help you understand this
presentation and help you evaluate the
relevance of this session to your own
situation.
Proposed Modular Design
Multiple modules in a Clinic
Expanded Design
Became Reality
Trouble in paradise
Management outsourced to outside group
No experience with novel clinic settings
Continued traditional visits
Form incompatible with function
Very little interactivity with technology at the point of care
Only minimal amount of patient engagement
Has gradually changed over time but basic design of the “suite” remains
Observations
Changing World
Decreasing autonomy
Increasing regulation
Meaningful Use Issues
Volume to Value migration
Lifestyle diseases
Population Health
Increasing transparency
Here to stay and growing
EMR’s, EHR’s, PMR’s, PHR’s
Imaging & Photography
Patient satisfaction and
engagement
Patient originated information
Telemedicine & virtual visits
License expansion
High cost of physical space
Change, change and more change
Rapid adaption key to survival
Industry responses
Move transaction processing as close to customer as possible
Decreasing costs
Increasing value
Changing who does what, where and how things are viewed
Medically … allowing patients to participate in the process
Medical inertia drags down required adaptation
What can be changed?
Element Cost
Workflow
• Who does what
• Who does where
Low
Technology
• What’s in the room
• Tools to help
Medium
Design
• Architectural design
• Bricks and mortar
High
Secret fact:
Computer is More for the patient than the physician
A closer look at workflow
Typical
Office
workflows
1 2
3 4 5
8
6
9 10
11
7
12
13 14
1 2
3 4 5
8
6
9 10
11
7
12
13
1 2
3 4 5
8
6
9 10
11
7
12
13
14
15 16 17 18 19 20
212223
24 26 27 28 29 30
31323334
1
2 3
4 5 6
78 8b 9
10
11
1112
131415 12
Technology Enabled Simplified Work Flows
1 2 3
4 5 6 7
7
8
8
9
10 11 12 13 14
1516
1 ‣ 5
9 ‣ 6
9 ‣ 7
Second attempt: Heartland Health
Suburban ambulatory clinic
Community hospital
60 clinics spread out over a 22 county area in NW Missouri and NE Kansas
Engaged staff open to experiments
Existing Building: Architectural Layout
Patterned after Greg Korneluk
International Council for Quality Care
No planning for information
technology
Brought in to take offices into
a paperless environment
Carved out “pilot” to allow for
rapid expirimentation
Provider’s Rooms
Provider’s Rooms
Provider’s Rooms
Provider’s Rooms
Provider’s Rooms
Provider’s Rooms
Functional Unit Functional Unit
Functional Unit Functional Unit
Each provider had own workflow
Exam Room In Dr’s Office
Rooms Pt
Takes Vitals
Rooms Pt
Review Meds,
Allergies & Problems
Documents HPI &
ROS
Rooms Pt
Review Meds,
Allergies & Problems
Documents HPI &
ROS
Rooms Pt
Review Meds,
Allergies & Problems
Documents HPI &
ROS
Prints Sheet
for Physician
Nurse Area Exam Room
Physician
Sees/Exams
Using Paper
Dictates
Note
Physician
Sees/Exams
Using Paper
Physician
Sees/Exams
Uses Computer
& Nurse Note
Dictates
Note
In Dr’s Office
Reviews and
Signs Note
Reviews and
Signs Note
Documents
Note in
Comptuer
Documents Note
in Computer
Using Nursing
Note
Prints Sheet
for Physician
Traditional paper based
with role stratification
Traditional paper based
with role expansion
Collaborative,
computer based with
role expansion
Collaborative,
computer based, role
expansion and at point-
of-care
Work Flows
Variable contributions and Trade Offs
0
1
2
3
4
5
6
7
8
9
10
Paper No Chart Same Tool
0
1
2
3
4
5
6
7
8
9
10
Paper Paper +
Comp
Comp +
Dict
Comp
Nurses Time DocumentingPhysicians Time
Documenting
Time spent in exam room
Exam Room TechnologyMy own experience
Evolution of in-room technology
Enabling point of care interactivity
Second Screen Concept
Primarily for the patient
Doesn’t have to be a computer screen
Smart Phone
Attached device
Procedure instrument screen
Examples
Dentist office
Accountant
Grocery Store
Current State
Point of Care Diagnostic Devices
Proscope HR
Proscope Micro
Earscope
Firefly
Dino-Lite
Cellscope
Camera(s)
Spirometers
Design RevisitedWhat’s out there now
Typical designs
Few designed with computer in mind
A good design
Summary
Change is Inevitable
….adaptation is the key to survival
Workflows are the least expensive approach to change
Internal policies and procedures (based on paper workflows) may be the hardest
obstacle next to
Reimbursement rule interpretations
Exam room technology is the next least costly approach
Computer(s) in room are for everyone in the room
Use them to work in parallel
Think outside the exam room
Architecture is the most expensive
Biggest enabler but requires 10-15 year foresight
