Washington, DC – October 20-23, 2004 Washington, DC – October 20-23, 2004 HIT Clinical Process HIT Clinical Process and Work-Flow Change and Work-Flow Change How to Make it Work How to Make it Work Michael Zaroukian, MD, PhD Michael Zaroukian, MD, PhD EMR Medical Director EMR Medical Director Internal Medicine Clinic Director, Michigan State Internal Medicine Clinic Director, Michigan State University University President, Centricity Healthcare User Group President, Centricity Healthcare User Group
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Washington, DC – October 20-23, 2004 HIT Clinical Process and Work-Flow Change How to Make it Work Michael Zaroukian, MD, PhD EMR Medical Director Internal.
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Washington, DC – October 20-23, 2004Washington, DC – October 20-23, 2004
HIT Clinical Process and HIT Clinical Process and Work-Flow ChangeWork-Flow Change
How to Make it WorkHow to Make it Work
Michael Zaroukian, MD, PhDMichael Zaroukian, MD, PhD
EMR Medical DirectorEMR Medical DirectorInternal Medicine Clinic Director, Michigan State University Internal Medicine Clinic Director, Michigan State University
President, Centricity Healthcare User GroupPresident, Centricity Healthcare User Group
Washington, DC – October 20-23, 2004Washington, DC – October 20-23, 2004
Clinical Microsystems Approach to Clinical Microsystems Approach to Redesigning CareRedesigning Care
Small group working together regularly to provide care
Often part of a health organization
Clinical and business aims
Linked processes
Shared information environment
Produces performance outcomes
Washington, DC – October 20-23, 2004Washington, DC – October 20-23, 2004
Consumer Focus:Consumer Focus:Know Your PatientsKnow Your Patients
Number of patients in your practiceAge and gender distributionTop 10 conditions seenTop 10 "high utilizers"Measure daily demand# of patients seen/day# of patients seen last week# of NEW patients last monthOther clinical microsystems you interact with
Washington, DC – October 20-23, 2004Washington, DC – October 20-23, 2004
Know Your Patterns:Know Your Patterns:Practice Profile, Patient CyclesPractice Profile, Patient Cycles
Operating marginNote if every member meets regularlyList things you are most proud ofList successful changesHow safety/reliability are discussedOutcome measures
6. Start all visits on time7. Exploit technology8. Match capacity and demand9. Prepare for the expected10.Get all the tools you need11.Do today’s work today
HRSA Bureau of Primary Health CareHRSA Bureau of Primary Health Care
Washington, DC – October 20-23, 2004Washington, DC – October 20-23, 2004
Implications for Process and Implications for Process and Work-flow RedesignWork-flow Redesign
Physical space redesignCare team redesignTraining for cross-functionalityInstant communication toolsPM and EHR system implementationPerformance benchmarks, metricsPatient-centered process improvementFeedback and accountability
Washington, DC – October 20-23, 2004Washington, DC – October 20-23, 2004
EHR Systems and Process EHR Systems and Process ImprovementImprovement
Core HIT for process/workflow redesign
Catalyst for cultural transformation
Asset for data collection and reporting
Washington, DC – October 20-23, 2004Washington, DC – October 20-23, 2004
Viewers
Strivers
Arrivers
Basic users
System
changers
Making HIT Work: You Have to Making HIT Work: You Have to “Strive” to “Arrive”“Strive” to “Arrive”
Miller RH, Sim I, Newman J: CHCF, 2003; www.chcf.org Laggards
Innovators
Early adopters
Early majority
Late majority
Washington, DC – October 20-23, 2004Washington, DC – October 20-23, 2004