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DEPARTMENTS: Practice Points

The Value of Smart Workflows in a Specialty Electronic Medical Record

Hess, Cathy Thomas BSN, RN, CWOCN

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Advances in Skin & Wound Care: December 2014 - Volume 27 - Issue 12 - p 576
doi: 10.1097/01.ASW.0000457185.30748.ff

Applying processes and workflows are vital for a successful business. In healthcare, these needs are more apparent than ever as providers are automating a traditional manual process by adopting electronic medical records (EMRs). The goals when using the EMR are to drive accountability of care to leverage clinical tasks from the physician to the clinician; improve care coordination through smart, efficient workflows and compliant documentation; impart care coordination through evidence-based care models; and maximize reports to drive compliance. Compounding the shifts to process and efficiency change is the adaptation to regulations and evidence-based clinical practice guidelines, as well as the introduction of improved devices/technology.

The value of using smart workflows is to manage and optimize critical Clinical, Operational, Regulatory, Economic (CORE [CORE, a proprietary process developed by Cathy Thomas Hess, chief clinical officer and vice president, Professional Services, Net Health, Pittsburgh, Pennsylvania]) functions, thereby streamlining documentation; improving quality care, patient safety, and satisfaction; and increasing process efficiencies.

Process is defined as a series of actions, changes, or functions bringing about a result.1 Along with every process come defined targeted actions and goals. All of the actions taken need to be clearly defined through your healthcare processes. Workflow, as defined by the Agency on Healthcare Quality and Research, is a series of steps, frequently performed by different staff members and often dependent on related workflows, which accomplish a particular task. Workflows represent how work actually gets done, not the protocols that have been established to do the work.2

Designing clinical and operational workflow requires review and customization of current clinical and documentation practices for an efficient outcome. Current practices include the operational processes for registration, coding, and billing and also the cognitive workflow by the clinicians. Producing the right mix of operational oversight and clinical experience, grounded with a solid documentation system, will produce efficient business practices within your EMR workflow and optimal patient flow and care.

Investing time and expertise in developing appropriate workflows is imperative. This investment yields patient satisfaction, improved department processes to increase efficiency, reduction of errors, and improved outcomes, as well as patient and staff safety.

For example, when a patient arrives for a visit in an outpatient wound care department, the patient interacts with administrative staff, clinicians, and physicians. From the point of time the patient enters the department, the patient has expectations to be met for the visit, hence patient workflow. In order to effectively evaluate and manage the patient’s flow, the department must operate from best practice clinical pathways and documentation standards, hence clinical workflow. Organizing the processes and workflow will improve organizational and clinical efficiencies, optimize the patient’s experience, and improve clinical outcomes.

Education is the cornerstone for each clinician and physician providing care within an organization. Invest time to educate your staff on the proper process and workflow. Mentor your staff. Discuss realistic goals to achieve after the educational process is complete. Education, clinical leadership, and management oversight are key steps to paving the way for a successful program’s process and EMR workflow.

Developing smart workflows within a practice takes time and patience. It is important to choose a specialty EMR that is customizable, flexible, and adaptable to your practice as you manage CORE changes along the way. Ultimately, the smart workflow process will lead to maximized efficiencies, enhanced clinical and operational quality, patient safety, streamlined documentation, and improved care coordination.

Let’s look at the most recent healthcare event that impacted workflows everywhere, namely, the Ebola crisis. The EMR workflows must be flexible enough to handle the onset of a significant need that requires quick change. Overnight, we needed to understand the implications of the disease, import new guidelines for healthcare workers, and modify existing forms and workflows to guide policy, procedure, and documentation processes. These steps were mandated and methodically conveyed for the safety of the patient and healthcare workers. Workflows within the EMR can be adapted to the following:

  • insert pertinent questions upon the patient’s arrival for the encounter;
  • methodically choose the appropriate form to insert these questions;
  • prompt actions or tasks when certain answers were chosen;
  • streamline workflows for the staff and physician, ensuring review of all pertinent documentation and maximizing the scope of practice(s); and
  • customize questions within existing documentation forms to meet the facility’s requirements of the mandate.

The healthcare industry is constantly evolving and becoming more accustomed to the EMR guiding process. Examine your process as this is the key to a successful implementation. Look closely at changes required to adapt to new technology, regulations, processes, and procedures. Clinical and operational intelligence lie within your smart EMR workflow.

References

1. Hess CT. Process + workflow = strategy. Adv Skin Wound Care 2010;23:144.
2. Agency for Healthcare Research and Quality. Module 5. Mapping and Redesigning Workflow. http://www.ahrq.gov/professionals/prevention-chronic-care/improve/system/pfhandbook/mod5.html. Last accessed October 27, 2014.
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