Process Engineering & Process Engineering & Health IT: Health IT: Which Comes First - Which Comes First - The Chicken or The Egg? The Chicken or The Egg?
Feb 22, 2016
Process Engineering & Process Engineering & Health IT:Health IT:Which Comes First - Which Comes First - The Chicken or The Egg?The Chicken or The Egg?
Why It Matters…Why It Matters…
Primary Care TodayPrimary Care Today
HITHIT
PCMHPCMH
““P 4 P”P 4 P”
A Caveat…A Caveat…
5
Healthcare IT is the means, but not the end, says Healthcare IT is the means, but not the end, says BlumenthalBlumenthal
September 16, 2009 | Diana Manos, Senior EditorSeptember 16, 2009 | Diana Manos, Senior Editor
I’m From The Government And I’m From The Government And I Am Here To Help You…I Am Here To Help You…
ARRA, RHITEC, &ARRA, RHITEC, &““MEANINGFUL USE”MEANINGFUL USE”
HITECH Priority Grants Program Rollout: Next HITECH Priority Grants Program Rollout: Next Steps Toward Nationwide Health Information Steps Toward Nationwide Health Information Exchange Exchange David Blumenthal, M.D., M.P.P.National Coordinator for Health Information Technology, DHHS
The White House has announced the rollout of the first two in a series of HITECH priority grant programs… Some Important Concepts:
•Meaningful UseMeaningful Use of certified EHR systems…•Health Information Technology Regional Extension Health Information Technology Regional Extension CentersCenters•Electronic information exchangeElectronic information exchange
Michigan PCMH Definition, NCQA Standard/PGIP Domain, Proposed PCMH Metrics, Michigan PCMH Definition, NCQA Standard/PGIP Domain, Proposed PCMH Metrics, Meaningful UseMeaningful Use
Health IT and Health IT and Transformed Health CareTransformed Health Care
Ultimate vision is to enable Ultimate vision is to enable significant and measurable significant and measurable improvements in population improvements in population health through a transformed health through a transformed health care delivery system.health care delivery system.*Adapted from National Priorities Partnership. National Priorities and Goals: Aligning Our Efforts to Transform America’s Healthcare. Washington, DC: National Quality Forum; 2008
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Another Caveat…Another Caveat…
HIT is NOT Part of HIT is NOT Part of “Your Father’s Medical “Your Father’s Medical
Practice”.Practice”.
.
It Can’t and Shouldn’t Be It Can’t and Shouldn’t Be Attempted Without A Change In Attempted Without A Change In Practice Culture And Practice Practice Culture And Practice
Workflow Re-EngineeringWorkflow Re-Engineering
Regional Centers must be Regional Centers must be capable of mapping and capable of mapping and redesigning work processes, redesigning work processes, updating roles and updating roles and responsibilities for clinicians responsibilities for clinicians and support staff, and leading and support staff, and leading continuous quality continuous quality improvement activities improvement activities involving rapid cycle feedback.involving rapid cycle feedback.
RHITEC Practice and RHITEC Practice and Workflow Design Workflow Design
15Go-CartGo-Cart
Practice RedesignPractice Redesign&&
Preparing for Health ITPreparing for Health IT
The The ““Magnificent Seven” Magnificent Seven”
Rules For HIT Rules For HIT Preparation...Preparation...
.
Culture Is Everything!Culture Is Everything!Re-engineer Your Practice Workflows Re-engineer Your Practice Workflows BEFOREBEFORE You ElectronifyYou ElectronifyCarefully Examine Carefully Examine ALLALL Of Your Functional Of Your Functional OptionsOptionsBe A Knowledgeable And Very Wary Be A Knowledgeable And Very Wary ConsumerConsumerTrain Like There Is No Tomorrow!Train Like There Is No Tomorrow!
Evaluate! Evaluate! Evaluate!Evaluate! Evaluate! Evaluate!
The Devil Devil Is In The Interface
Rules For HIT PreparationRules For HIT Preparation
Prep Prep WorkWork
So, What’s a Body to Do?So, What’s a Body to Do?
What is PRISM?
• A physician driven, non-profit corporation formed A physician driven, non-profit corporation formed in cooperation with nine Michigan PO’s and PHO’sin cooperation with nine Michigan PO’s and PHO’s
• Providing comprehensive practice and culture Providing comprehensive practice and culture transformation services in Michigan and beyond transformation services in Michigan and beyond on a “no-lose”, gain-share basison a “no-lose”, gain-share basis
• Able and willing to assist the Michigan RHITEC Able and willing to assist the Michigan RHITEC (and others) in preparing primary care practices (and others) in preparing primary care practices to becoming “meaningful users” in the context of to becoming “meaningful users” in the context of helping them undergo transformation helping them undergo transformation
EVIDENCE-BASED MEDICINE
EVIDENCE-BASED MEDICINE
LEAN THINKING
LEAN THINKING
INFORMATION TECHNOLOGY
INFORMATION TECHNOLOGYCULTURE CHANGE
CULTURE CHANGE
PROFITABILITYPROFITABILITY
CUSTOMER SATISFACTION
CUSTOMER SATISFACTION
CURRENT STATE
CURRENT STATE
ANTICIPATED ANTICIPATED OUTCOMESOUTCOMES
Strategy For Sustainability & Spread Strategy For Sustainability & Spread of Practice Transformation in of Practice Transformation in Michigan & BeyondMichigan & Beyond
PRISMPRISM
PCPCPP
PCPCPP
PCPCPP
PCPCPP
PCPCPP
PCPCPP
PCPCPP
PCPCPP
PCPCPP
PCPCPP
PCPCPP
PCPCPP
PCPCPP
PCPCPP
PCPCPP
PCPCPP
PCPCPP
PCPCPP
PCPCPP
# of PCP’s Not LimitedBy Grant Resources
Sustainability & Spread Assured
• No Risk To PCPNo Risk To PCP•Funded from Funded from Waste RemovedWaste Removed•Physician Physician DirectedDirected• Staffed by FT Staffed by FT ProsPros• Consistency Consistency
PO PO #1#1PO PO #3#3PO PO #5#5
PO PO #6#6
PO PO #2#2PO PO #4#4
PO PO #7#7PO PO #9#9
PO PO #8#8
The ASQ The ASQ Marshall Marshall
PlanPlanakaaka
PRISM-litePRISM-lite
Would Like To Partner with Communities, Medical Associations, and Medical Groups To Assist In The Redesign
of Their Practices
A Modern-Day A Modern-Day “Marshall Plan For “Marshall Plan For Healthcare”Healthcare”
A Fishing Pole, A Fishing Pole, Not A FishNot A Fish
Getting to Sustainability and Spread…
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Communities Considering This ApproachCommunities Considering This Approach
Community Sponsor(s) Anticipated Start Date
Akron, OH Employer Health Coalition 1st QTR, 2010
York, PA Local Health Care System 1st QTR, 2010
Milwaukee, WIMedical Society & Employer Health
Coalition1st QTR, 2010
Findlay, OH Employer & Local Hospital 1st QTR, 2010
Erie, PA Local Health Care System
2d QTR, 2010
One Example Of One Example Of Process Re-Process Re-
Engineering At Work Engineering At Work In A Medical In A Medical Practice…Practice…
31
Meet SJ Family Meet SJ Family Medical CenterMedical Center
I Call I Call Them The Them The
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Their StoryTheir Story
Current StateCurrent StateManagement Of Patient Medical FormsManagement Of Patient Medical Forms
Receive Form When
Patient Presents
Receive Form From
Patient in Room
Inquire Re:
DX Codes
In Box Message:Is Form
Completed?
Receive Patient Phone Call: Is Form
Ready?
MA Distributes
Form To Doctor Box
Receive Form By
Mail / Fax
Form Is Placed In MA Box
In Box Message:
Is Form
Completed?
DoctorCompletes
Form
Receive Call
About Form Error
Receive Form From
Patient in Room
FormError
Receive Call:
Is FormReady?
FileForm
At FrontDesk
Give Form
ToPatient
Inbox Message
To Doctor re:
Error
Is Form
Ready?
InquireAboutForm
InquireAboutForm
Correction Done / Form
Completed
PatientCalls Re: :
FormStatus
ReceiveCall
ComplaintRe:
Form Status
Practice Performance In The Current StatePractice Performance In The Current State
First Time Quality (FTQ)First Time Quality (FTQ) = 1% !!!!!= 1% !!!!!Value/Cost of Total Practice Time Spent / Yr In Process Value/Cost of Total Practice Time Spent / Yr In Process = = $ 169,780$ 169,780
Receives Finished Form
FromDoctor
Contact Patient to Pick
up Form
Management Of Patient Medical FormsManagement Of Patient Medical FormsFuture StateFuture State
END
Practice Performance In The Future StatePractice Performance In The Future State
First Time Quality (FTQ)First Time Quality (FTQ) = = 72% !!!72% !!!Value/Cost of Total Practice Time Spent / Yr In Process Value/Cost of Total Practice Time Spent / Yr In Process = = $ $ 80,44880,448PLUS: Process Throughput Time For Forms Cut in Half!!!PLUS: Process Throughput Time For Forms Cut in Half!!!
The COCQ Applied In One The COCQ Applied In One Family PracticeFamily Practice
•Hard Dollar Annual Savings of Hard Dollar Annual Savings of $90,000$90,000 In In Only One ProcessOnly One Process
•Energized staff and physicians eager for Energized staff and physicians eager for more improvementmore improvement
•Dramatically Improved First Time QualityDramatically Improved First Time Quality•Once learned, can be done by practice Once learned, can be done by practice
itself without outside helpitself without outside help
In Closing, I’d Like to In Closing, I’d Like to Leave You with A Song Leave You with A Song
About Health IT…About Health IT…
Dr. Sam Bierstock is an ophthalmologist, an electrical engineer, and a consultant for medical information systems management and design. He has published more than 50 articles on medical information systems, and written a book about medical office computerization.
The EMR Blues: “Paper Won’t Be The EMR Blues: “Paper Won’t Be Here Long…“Here Long…“Dr. Sam & the Managed Care Blues Dr. Sam & the Managed Care Blues BandBand
“…“…Too many tests Too many tests A thick chart - for you to read A thick chart - for you to read An EMR - is what you need An EMR - is what you need
You like to think that you're You like to think that you're immune to the stuff, oh yeah immune to the stuff, oh yeah
It's closer to the truth, you know - It's closer to the truth, you know - Like it or not you knowLike it or not you know
You're gonna have to face it – You're gonna have to face it – PAPER WON'T BE HERE LONGPAPER WON'T BE HERE LONG…” …”