Andrea Morgan, AndreaKnowsEMR.com
Most providers will agree that they want to care for patients, document appropriately, bill confidently and have a smooth transition from paper to electronic medical records. Having a plan in mind, such as the one outlined here, will go along way toward meeting your objectives.
- Practice overview
- Role definition
- Current state workflow defined
- Future state workflow
- Design,build, validate
- User acceptance testing
- Build for production
- Go-live support
- Post go-live support can be provided by:
○ Newsletter/tips and tricks
- Refresher training
- On-going needs for training:
○ New hire training
○ Software updates
In an ongoing series, each of these steps will be discussed in turn. Let's take a look at Steps 3 and 4, Current State Workflow Definition and Validation.
A suggestion: write down the basic workflow, each step for a typical office visit. Think about where time can be saved in the process as well as what may take longer during the learning phase of implementation.
What is workflow? Originating in the manufacturing arena, it has come to be an integral part of planning and managing implementations. Fundamentally, workflow delineates and defines the discrete steps involved in completing tasks.
Details may vary but the basic components of an office visit are the same: patient arrival, examination, billing. Many individual tasks are contained within each of those very broad categories. Very often tasks are completed out of habit and those are things that get overlooked and subsequently cause consternation upon implementation because the EMR is not aware of/programmed to take into account human habits. It can be, but only if those things are recognized and requested.
For example, in placing lab orders for a diabetic patient, an endocrinologist may say to a nurse (or medical assistant), please order the usual tests for Mrs. Johnson. The nurse/MA knows that Mrs. Johnson is an established patient, has been seen several times in the practice. The doctor always orders Hemoglobin A1c, a lipid panel and fasting glucose for patients like Mrs. Johnson. This is called the current state workflow; the steps for this can be defined as follows:
- Review labs for Mrs. Johnson
- Fill out lab order form (specifying which tests are to be performed)
- Sign order form (provider)
- Give lab slip to Mrs. Johnson
- In some offices, blood will be drawn and sent to the lab; in others, patient will need to go to a different location
- Wait for lab results to be faxed to practice
- File results in Mrs. Johnson’s chart
From one verbal request we’ve come up with seven distinct steps. Defining the current workflow in this manner should occur for each of the most common tasks in your practice. This is necessary so that the current practices can them be mapped to future practices that will be required once the electronic medical record is implemented. The more specific the current state workflows are, the more effective the future state workflows can be.
Validation is an integral part of this process because it helps to insure that the workflow as documented is what actually happens. As the saying goes, "two heads are better than one." It is helpful to have another set of eyes to confirm that the standard in the office is the same for all providers and that staff members understand what is meant when requests are made. It is amazing how people can hear the same words but have very different understanding.
In a specialty practice that I worked with, providers were told that after implementation they would be able to continue dictating progress notes. The providers understood this to mean that they could continue to speak into pocket recorders and have those recordings transcribed. The implementation team understood dictation to mean that providers would speak into a microphone attached to a computer. For weeks providers were frustrated because they kept asking why their dictations were not showing up in the patients charts, and the implementation team couldn't understand why they couldn’t find any .wav files. Same word, very different understanding. No validation of that workflow had taken place and the result was painful.