It Went Away When the EHR Came. Dr. Paul Richardson Marina Moore Ramon Enachescu

Transcription

1 It Went Away When the EHR Came Dr. Paul Richardson Marina Moore Ramon Enachescu

2 Process changing to EHR Paper referral process Assessing and managing projects EHR referral issues Data collection and design of the referral process All about forms Information systems interface Closing

3 Committee Collect data about usage Interviews Focus groups Collect all forms and documents Create process flow diagrams Post doc Pre-doc Faculty Practice Create form flow diagrams Post doc Pre-Doc Faculty Practice Understand ownership of process Understand ownership of forms Understand fee structure Understand business office issues Cash Insurance Payment Plans State/ Federal aid Understand dreams for system Create an integrated action plan

4 Juran Demming Sigma 6 LEAN What do these processes look like?

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7 BEFORE AFTER

8 AFTER AFTER

9 AFTER START OF PROJECT

10 Had multiple forms Most forms lost their way Patients lost their way in the process Information provided usually incomplete Information from referral provider to treating provider almost never happened Took a lot of time to prepare correctly Faculty, care provider many times unaware of referral completion Referring provider changed treatment plan without consultation

11 Required a very different path Must have notification at both ends of process, nothing physical to pass Needs confirmation to hand to patient All forms/ process require design and testing Must be time aware Must be easy to understand Assessment of present referral issues Obtaining input to referral process Referring provider changed treatment plan without consultation

12 Evaluate present paper forms Analyze referral loops Gap analysis Design EHR form Design referral loop Decide who to include in referral track Specify duties of each person in referral track Design/ incorporate notification of referral for persons responsible for process Integrated Action Plan (IAP) Evaluate forms and process for future data collection

13 Improves patient care services and provider satisfaction Simplify referral process in time and communication Save time in follow-up referrals and track missed and overdue referral recalls Inform present provider of past care and future planned care Inform a care provider outside the system of the patient s care needs Comply with government and industry regulations

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16 Auto populated data and reduce re-keying of information Does not prescribe treatment that may not be appropriate Few if any open ended questions, comments Ease of flow and user friendly Has data elements that can be retrieved for data analysis

17 Available skills Standardize form format Validation and controls What does the referral form look like? Management life cycle Test and train

18 Time and skills to implement electronic forms Installation of software and database Identify and understand business workflows Field lengths and validations Understanding how troubleshoot user errors on forms

19 INTERNAL FACTORS Management Manpower-available skilled resource Machine-Computers Money EXTERNAL FACTORS Government Environment Technological Ecological Legal

20 Database Software Tools Structure Process Defined work flow Protocols Reports Outcome indicators Outcome

21 Plan Evaluate and Repeat Cycle Execute Course-Correct Analyze analyze data report

22 Ideal data storage and interface Messaging and notification systems Report creation and process improvement Future integration

23 PAPER FORM ELECTRONIC FORM

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26 Use standard data entry elements: Drop down lists Checkboxes Number fields with specific ranges Date fields Keep free text entry to a minimum

27 Eliminate all duplicate information already available in the EHR: Patient Demographics Medical alerts (i.e. allergies) Patient History Prescriptions Keep track of changes Make sure form is secure Enforce required answers Enforce process flow through statuses

28 Create initial form request Request Referral Schedule Patient Referral Assigned Referring Provider Supervisor Referring Provider Specialty Care Provider Complete restoration Tx Complete Perform the work Endo Tx Complete

29 Create initial form request Request Referral Supervisor Schedule Patient Referral Assigned Referring Provider Supervisor -Supervisor -Specialty Care -Referring Prov - Specialty Care Referring Provider Specialty Care Provider Complete restoration Tx Complete Referring Prov Perform the work Endo Tx Complete

30 Notifications should be triggered automatically Types of notifications Notification in the User Interface of the Patient Management System Internal messages /Text messages Management Reports

31 Report on several metrics: Form turnaround time by referral types Referral back and forth s Catch idle forms before they get lost in the system. Count number of referrals by facility/specialist Count referral types following certain procedures Reports help improve the overall referral process.

32 Send data electronically to other providers Accept referral responses back through the same channels The electronic data exchange (EDI) could rely on the existing health messaging standard (HL7)

33 Loma Linda University School of Dentistry Dr. Paul Richardson - plrichardson@llu.edu Marina Moore - mmoore@llu.edu Ramon Enachescu - renachescu@llu.edu