Wellness Through Workflow: How Workflow Contributes to a Better Patient Experience in Healthcare

@wareFLO #POWHIThttp://ehr.bz/blabworkflow

A TelmedIQ Webinar Presentation:

Wellness Through Workflow: Structured Messaging Contributes to Better Patient Experience

[The Webinar Will Begin Shortly]


Webinar Housekeeping


Outline

• Who Am I?• The System Behind The Smiles• Patient Experience and Workflow • Healthcare’s Workflow Wall• How Can Structured Messaging Help?• Wrap-up & Synthesis


Charles Webster, MD, MSIE, MSIS• Degrees– Medicine– Industrial Engineering– Intelligent Systems (Medical Informatics)– Accountancy (premed)

• 1st undergrad medical informatics program• CMIO for EHR vendor for decade+• Helped three medical practices win first three

consecutive HIMSS Davies Awards


Hear “Workflow”? Tweet @wareFLO


Hear “Workflow”? Tweet @wareFLO


People & Organizations FixingWorkflow with Health IT



#POWHIT



#POWHIT


Blab


The System Behind

The Smiles


“What’s needed in restaurants, car dealerships, department stores, and every place else is systems — not just smiles — that guarantee good service. Every business is composed of systems. Those systems must work together to create a process that is efficient and responsive to a customer’s wants.”


“The Systems Behind The Smiles”



40%-60%





40%-60%


The Workflow Behind

The Smiles


Patient Experience

"The sum of all interactions, shaped by an organization's culture, that influence patient perceptions across the continuum of care.”

http://www.theberylinstitute.org/?page=definingpatientexp


Patient Experience (The Smiles)



Vision Values

RecognizeUnderstand

Remember


Patient Experience (The Systems)




Interactions & Continuum (The System)

The orchestrated touch-points of people, processes, policies, communications, actions, and environment ... Before, during and after the delivery of care



Orchestration & Choreography

• Two important terms from workflow tech• Orchestration implies central workflow

conductor• Choreography implies distributed workflow

control, more like a jazz ensemble• Modern workflow systems are hybrids




Workfl

ow

Tech

nology

(Proce

ss-Aware

Info Syste

ms)


Secu

reStr

uctured

Mes

sagin

g


Interruption Statistics

• 50% of all healthcare errors are slips and lapses, such as not executing intended but interrupted actions

• 43% of interruptions affect care tasks• ~50% of pages to physicians interrupt

direct patient care• 42% of pages are non-urgent


The Workflow Prescription


What Is Workflow?

A series of steps, consuming resources, achieving a goal.


What is Workflow

• Series of steps/tasks/activities• Consuming resources/costs (HC system &

patient’s money, attention, time)• Achieving goal(s)/benefits• “Process” and “workflow” usually (not always)

synonymous


What is Workflow Technology?

• Generally? – Any technology facilitating workflow…

• Narrowly?– Executable models of work or workflow– Consultable (by computer or human)– Often visually represented• Workflow diagrams• Calendars & rules• Dynamic checklists


Workflow Tech vs Info Tech

• Info tech “affects” workflow–Influences workflow (+ or -)

• Workflow tech “effects” workflow–Drives workflow (+)

• IT “hardcodes” workflow• WT “softcodes” workflow


What Is Structured Messaging?

• Pre-build message structure• Sent securely over Internet• Structured messages occur in workflows• Repeating same structures leads to familiarity• Familiarity leads to speed & accuracy• Structured data & workflow facilitates

automation via workflow technology


Structured Messaging (Calendar)

• Forms (and therefore data, recognition faster than retrieval memory)

• Calendar (shared mental model shared with workflow engine)

• Rules (proactive intelligence re routing & escalation)


Structured Messaging (Calendar)

“softcoded” user interface & workflow

Calendar Rules Forms

Shared mental/machine model


Structured Messaging & Workflow

AutomaticWorkflow engine drives

workflows without requiring manual human intervention

(tho can be overridden)






TransparentWorkflow engine tracks task

status, which can be displayed to human users,

supervisors & administrators







status, which can be displayed to human users,


Interruptions!







status, which can be displayed to human


FlexibleWorkflow engine does whatworkflow rules tell it to do,

workflow rules are “softcoded”therefore easy to change







status, which can be displayed to human


FlexibleWorkflow engine does whatworkflow rules tell it to do,

workflow rules are “softcoded”therefore easy to change

ImprovableTime-stamped task status data can be used to find, eliminate

bottlenecks & rework, improving cycle time and consistency


Value-Add Ons…

• Multimedia (text, voice, images)• Converting between voice & text• EHR integration • HIPAA compliance (of course!)• Cross-platform (mobile, desktop)• Intelligent message routing & escalation


Thought Experiment

What if we had automated workflow first, instead of data?


How Do We Get To This?

Data(resources/costs)

Goal

s/Be

nefit

s

End

Start

@wareFLO #POWHIT

We Can Add Data To Workflow


Goal

s/Be

nefit

s

End

@wareFLO #POWHIT



Goal

s/Be

nefit

s

End

@wareFLO #POWHIT



Goal

s/Be

nefit

s

End

@wareFLO #POWHIT



Goal

s/Be

nefit

s

End

Start

@wareFLO #POWHIT

We Can Add Workflow To Data


Goal

s/Be

nefit

s

@wareFLO #POWHIT



Goal

s/Be

nefit

s

@wareFLO #POWHIT



Goal

s/Be

nefit

s

End

Start

@wareFLO #POWHIT


Which Order Makes Most Sense?

• I’d argue adding data to workflow. • We’re stuck w/adding workflow to data• Need to extremely flexible workflow

tech to existing data investments• Argument for structured messaging as a

“platform”


Experience & Engagement


Effect of Technology


Consumerization


Workflow (including Messaging)


Re-Integrating Data & Workflow

MSIE, MSIS



MSIE, MSIS

DATAWORKFLOW



MSIE, MSIS

DATAEHR

Health ITMedical

Informatics

WORKFLOWTQM

Six Sigma, LeanProcess

Improvement



MSIE, MSIS

DATAEHR

Health ITMedical

Informatics

WORKFLOWTQM


Improvement

Workflow TechnologyProcess-Aware Info Systems



MSIE, MSIS

DATAEHR

Health ITMedical

Informatics

WORKFLOWTQM


Improvement

Structured Messaging

Wellness & Workflow

• State of being in good physical and mental health

• Series of steps, consuming resources, achieving a goal

Resources/Costs

Goal

s/Be

nefit

s

Sickness

Wellness

@wareFLO #POWHIT


Blab


In Closing…

• Thank you! • Questions/Comments• Tweet me at @wareFLO using #POWHIT• [email protected]• Join Blab on Workflow & Patient Experience– Top of the hour– http://ehr.bz/blabworkflow– Chrome or Firefox browsers


About CGH Medical Center

100 Bed Acute Care Facility

140+ Physicians/1400 Staff

140+ Physicians


Structured Messaging + Workflowsat CGH

Existing Patient

New Patient

Admissions

On-Call Physician

• Over 10+ messages types that get automatically triaged

• Communication around recurring events are now highly streamlined (ex. Radiology orders)

• A more reliable system than using phones and voice messages


Message Types and Getting theRight Communications Data

The Benefits of Workflow and Structure

•Regimenting communications data

•Critical information for specific events is now required

•Communication issues such as patient handoffs are now more reliable


Making CommunicationsMore Intelligent


Q&A


Thank You for Attending

Visit www.TelmedIQ.com to learn more

Or contact us directly at:

p. 1.888.364.9305

e. [email protected]

to receive a free demo of our solutions.

Date post:	17-Jan-2017
Category:	Healthcare
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