Lost Productivity: Symptoms of Weak Workflow Analysis Pre-EHR

by Carolyn P. Hartley, President & CEO Physicians EHR

A workflow analysis and redesign plan is the apex of data migration from paper charts to an EHR system. During the data abstraction and training stages, health care professionals are just trying to get patient health information into the system while keeping up with patient schedules.

A workflow redesign strategy begins by analyzing how information moves between departments to ensure operational and clinical tasks are completed and documented. Nearly everyone’s role is important on both the paper and EHR side. A workflow analysis ensures that key information will be transferred into the EHR and available to the professional in a secure and manageable format.

In a paper-based setting, people know what to do next when paper “triggers” an activity.  For example, the chart on the back of an exam room triggers the provider that the nurse has completed the intake and the patient is ready for the physician. Frequently, we identify up to 18 administrative steps to find a lost chart and 14 steps to refill a prescription.

The real effectiveness of the study is not to find fault with the paper steps, but to redesign the workflow by automating repetitive work into the EHR without losing key information and keep the clinic in business.

In our analyses, we study and map 20 to 30 operational and clinical workflows into diagrams that show how data enter the clinic and then are handed off between departments. This helps demonstrate cause and effect. For example, what happens to cash flow when subscriber information is missing and the payer denies the claim?

For clinical redesign, we evaluate the EHR vendor’s online training modules; for examples on how to complete nursing intake, capture the problem list, order a prescription or a lab test. To redesign the workflow, we analyze, “What data need to be embedded in the system for the physician to complete the note on this patient visit?”

To help people accept the new redesign, I recommend using Deming’s “Plan Do Study Act” (PDSA) or Six Sigma’s Project Management Body of Knowledge (PMBOK).

Symptoms of post EHR go-live redesign issues include (a) physician complaints that it takes 15 minutes to complete a patient encounter; (b) accounts receivable reports upwards of $1 million lost somewhere in the system; (c) abundance of templates without any clear clinical customization strategy; (d) productivity has not exceeded 80% of pre-EHR patient volume.

A workflow analysis and redesign is most effective when completed prior to Go-Live. An analysis after the fact slows productivity even more when staff has to unlearn and re-build efficiency into their daily routines.

Carolyn P. Hartley, President & CEO, Physicians EHR, serves as provider/clinic advocate, managing the EHR implementation process. She and her EHR project management team oversee the complex paper to paperless migration for clinics in 17 states, and also serve as EHR technical advisor to national and state medical societies and quality improvement organizations. She also served on the Technical Advisory Panel for the Health Information Security and Privacy Collaborative (HISPC), funded by the Office of the National Coordinator (ONC).She is co-author of 15 textbooks published by the American Medical Association, the American Dental Association, the American Society of Clinical Oncology, and the American Gastroenterological Association on HIPAA Privacy, Security, and EHR Implementation. She is a recipient of the distinguished Silver Anvil award for communications and Leadership award from the Points of Light Foundation.