Health IT Implementation

Achieve maximum ROI … Optimize clinical workflows in practice beyond IT …

MTF 2015, (by EBT)

MTF 2015, (by EBT)

The healthcare executives I am familiar with and I among them believe in maximizing returns on our organizations investments, as well as providing patient satisfaction, and delivering high quality care while increasing revenue capture. I believe the way to deliver on these is to optimize their workflow to ensure they can receive higher throughput and reduce patient waiting times. Our article is about the way executive might view clinical workflows and workflow optimization or whether we should expect this from EHR/EMRs (IT).

Often when you are looking to purchase new EMR/IT software, you may hear from the software companies that their software will "optimize" your facilities workflow, and so you automatically start thinking that this might be the magic (or some variant thereof) that will transform your inefficient work processes in your facility. I think at this point, you could be thinking you might have found the ideal system for your institution and this is how you will suddenly start seeing a grand transformation, where things in your institutions change. Moreover, you are thinking all will be fine, as after you have purchased the software and installed it, then it will do all your workflow "optimizations."

Unfortunately, this is a long way from the truth. From real experiences I have had, I am almost certain that what you will experience is after your software implementation is over and the contractors are out your doors is that you will be dealing with significantly more problems. The new software comes with their inherent issues, and (yes, new issues) they will compound others such as the older workflow problems you had prior to your initial conversations with your chosen software company that told you the problems would disappear with the new software after implementation.

The reality is the software does not optimize your organizations workflow, and if you are truly looking to institute workflow optimization, you have to do a thorough separate workflow optimization prior to your selection of any software. Only then should you adapt the software codes to match your optimal work environment that predates any software implementation.

The computer software may be able to assist you enforce/reinforce and maintain processes you have predetermined, but the software purchased for the electronic health records will not optimize your workflow for you. Unless you have already predefined the workflow, you may end with an awkward computer generated model, which your staffs are unfamiliar. The software company will have misled you.

I suggest that you employ other methods, including the old manual methods of mapping out the current state of work and developing your ideal states for your workflows, this will conform to your team/organization and will best meet your patients’ expectations. Once you have decided on the optimal workflows, then the software system should be your consideration. This is vital, as the workflows should guide the software company to conform their work to what best suits your teams optimal work efforts not the institution conforming to the computer software.

In general, the software is customizable to an institutions practice and your implementers should conform to your institution’s process. With the clinical workflows complete, provide this information to the software companies so they can build it and incorporate the mandated regulatory requirements so you achieve the incentives and value you deserve, and maximize your returns on funds invested with your decision on particular software company to support your institution.

To the software systems defense it will force your staff to document things the way you have dictated for it to act and this is good. They are also able to allow you to aggregate store and mine data; however, they are not equal in performance or features and because you might see one feature on one system does not mean that you will see the same feature on another, nor should you expect that one will behave as the other. Therefore, just as in follow-up to my last posting, you must have done all of your clinical work before you engage them. Remember, the IT people understand mostly computers and they will set up your computer software to do what you tell them. That simply means you should have a very clear idea of what you need from the system. Creating a clinical workflow in the physical patient care setting is a manual process and not software driven.

Hence, to optimize your clinical workflows so that you can eliminate non-value added steps still require physical intervention and only when workflow optimization is complete should one attempt to include it with your software discussion. I would advise that you fine-tune your workflows before you try to engage with a software company to manage your electronic medical records needs. Otherwise, you will be adding risks to your portfolio and not value.

One might agree that once you have learned a set of processes and are doing it, and then someone comes along and gives you a tool (such as the EHR/EMR) that mimics what you are doing and helps you do it better, this may be acceptable. In contrast, with someone giving you additional tasks to do while you are struggling to accomplish what you have, this creates a burden on the staffs. When you take the last approach, you are teetering on failure and possible staff revolt or even worse, as staff dissatisfaction will grow. What might start out, as an innovative idea could end in ruin and the progress that you might have gained disappear even with the most relevant software system purchase.

To prevent this, I suggest take proactive steps and exercise manual processes of creating and optimizing your patient care workflows before you engage with any software company. In addition, a suggestion is to make sure one do this across all of your patient care services, and refrain from taking short cuts by thinking you can focus only on the a few high profile areas. When you take this approach, it will end up costing you much more. Any real cost savings you realize is when the system delivers what you intend of it to deliver, as each time you make changes, you begin to add or subtract features with each that you do you are incurring additional costs.

While the thought of doing manual workflow audits and revisions may seem arduous, it is well worth the effort. Complete your patient care workflow optimizations early, as this will help you to help your teams. The care teams will be able to hardwire the workflow processes ahead of when they have to learn where what is on the new software. These steps simplify the process, enhance the teams’ performance, and put your operations in the desired state to accept learning the new software.

An item to note is that the software will do what the implementation teams instruct it, and if you as the customer did not give them their instructions, they cannot write in instructions, and in the end, the customer will not receive what they expect. To be clear, the software can help force desired behaviors, so it is best to know what desirable behaviors we need reinforced early and the patient care workflows are among them. Give yourself a chance to maximize on your EHR/EMR (IT) investments.