Jumping to Solutions

HMT How many times have you seen an organization implement a solution before it completely understands the problem? It’s human nature to leap to conclusions, especially in busy and stressful environments like healthcare. The phenomenon known as "solution jumping" simply describes providing an answer before truly understanding the question. The impulse to solution-jump is especially prevalent when it comes to migrating to new IT applications. The tendency is to jump towards the new system without fully understanding the old one.

Discovery is the process of gathering, analyzing and evaluating current workflows and processes in preparation for implementing a new clinical IT system. Often times, the discovery process is overlooked or eliminated altogether. It is critical to incorporate a structured discovery process early in the project plan to maximize resource utilization, develop training strategies, identify potential workflow breakdowns and build in patient safety. Taking the time to look before you leap will pay off in a smoother implementation for the project team and the end-user. Following a structured discovery process will allow you to step up to new productivity without jumping into trouble.

The Discovery Process

Discovery offers a microscopic look at all aspects of the organization. The first discovery phase involves the discovery team working closely with end-users to gather relevant operational information. At a minimum, the discovery team should consist of a team lead, a super user and a key end-user. The discovery team lead, often a third-party consultant, must have strong expertise in the process. This individual should understand the work done by end-users, how various departments interact and be able to analyze the workflow from an objective, outside perspective. The discovery team lead will often provide pre-built templates, questionnaires, surveys, inventory sheets, structured interviews and checklists to ensure a comprehensive but standardized collection of information. Typical operational data necessary for assessment would range from rosters of clinic employees and physicians to detailed technical profiles of networked devices. This information will be helpful to your IT department for login access, security profiles, general clinic information, hardware inventory and system builds.

Paper and electronic forms such as registration and consent forms are key components of clinic workflow and each form needs to be gathered and evaluated. The discovery team can then review all forms collectively to improve efficiency and standardize practice. Outcomes would include "electronifying" paper forms, eliminating forms that do not add value and analyzing forms for error and redundancy. The review of current forms will also ensure the new application can capture all relevant patient information. Collection of this data will prove valuable when building the application dictionaries, identifying anomalies prior to go-live and incorporating error prevention into the new system.

Workflow Assessment

Workflow assessment is the next phase in discovery and is crucial for adoption of new technology. Large organizations with many clinics often have different workflows in every specialty clinic. In some cases, a different workflow is employed for physicians within the same clinic. Discovery involves uncovering all aspects of the current practice (the manual paper processes, the yellow sticky-note reminders, the flow of patient information) because if these processes are not addressed, they can lead to clunky workarounds and poor adoption.

HMT An experienced discovery team is needed to thoroughly investigate and map complex workflows. Discovery is a great opportunity to analyze the entire operation and eliminate unnecessary steps, update policies/procedures and address compliance issues. By skipping the discovery process, the inefficiencies of broken workflows, unnecessary forms and workarounds will be transferred to the new system. This will complicate the system build, frustrate the end-user and prolong the go-live. The leap of faith for most organizations is a belief that the new clinical information system will automatically capture all departmental routines and magically incorporate them into a new streamlined error-free application. Properly executed, discovery is your safety net to identify problems in the old system and offer the best solutions in the new one.

Role Assessment

During user interviews, listen carefully for other pertinent information such as previous experience with successful or unsuccessful training. Focus on the big picture message when working with the department manager, but also connect with the key end-users. These end-users know what is going on in the trenches. They are the experts in administrative processes, such as scheduling, insurance verification and billing issues. As a key patient interface, they can identify areas of weakness, points where information falls through the cracks and segments of patient dissatisfaction. These users will identify areas for improvement, but will also offer the best solution and become more engaged in the process. This user interaction helps create buy-in, ease anxiety, build rapport between end-users and the project team and ultimately enhance patient satisfaction.

When observing workflow, pay special attention to each user role. Careful mapping of current workflow quickly identifies users’ roles and their primary tasks. This allows you to customize the training for each role. Jumping to a "one-size-fits-all" training curricula typically overwhelms the user with too much information and significantly limits buy-in.

Patient Exam Process

The same discovery discipline should be applied to the patient exam process. The actual patient exam workflow can vary by physician and specialty. Interviewing physicians, nurses, physician assistants or technologists will help you eliminate workflow breakdowns and bottlenecks at go-live. A discovery team member should shadow a number of patient encounters to record each step in the process. It is important to document who does each workflow task, such as gathering vital signs, patient history, allergies and current medications. Shadowing a live encounter will often yield subtle nuances that are not uncovered during interviews or questionnaires. Exam documents, patient educational information, rare special procedures, even discussions about new treatment options should be noted as a red flag that may impact current or future workflow. In all cases, the discovery team member should carefully map how tasks are done and where the results are documented.

Transcription Assessment

Since transcription services are outsourced in many clinic environments, this assessment is often overlooked. The transcription and approval process can be complex and must be well documented, especially if you intend to migrate your outsourced transcription to your new application. This workflow often gets broken when jumping to a new solution. Again, careful documentation will pay off in cost savings and new efficiencies. Most importantly, if you plan to have your transcription service adopt the new application, you will need to provide workstation logins, access and training.

Medical Records Assessment

Most large clinics use a centralized medical record department, however, some multi-specialty organizations continue to maintain a separate chart housed within their own specialty or department. Discovery of each department’s medical record process will ensure there is a proactive plan to include historical medical records into the new application. Solutions may include document scanning of the chart or cross-referencing the medical record number in the new application for quick retrieval. Discovery should include a comprehensive review of current policies and procedures including storage and retrieval of incoming medical records, chart sign-out, and lost or overdue charts. This is the perfect time to revise policies as needed.

Discovery Results

Now the hard work begins. After gathering structured data from each clinic and department within the organization, you still need to analyze the results before jumping to the solution. An experienced discovery team lead will play a valuable role to develop templates, document operational data and map workflows. The resulting recommendations open the way to better definition of roles, new intelligent workflows and efficient system operation. It also provides a powerful guide as you work through integration and implementation processes. Cataloguing the findings by specialty allows you to pilot new solutions for each specialty workflow. Best of all, you will already have the requisite documentation for compliance, user access, system interfaces, dictionary setup and workflow re-engineering for any future IT projects.

By involving key individuals in the discovery process, you will have a built-in knowledge base of subject matter experts. Your decision-making will be based on reliable information. The end result is a more efficient use of resources, elimination of errors and redundancies, and fewer headaches for the project team and the end-user. No implementation is going to be stress free, but by incorporating a structured discovery process upfront you will have a much softer landing when you leap into your implementation.

Nanette Koch, Joe Racela and Stella Ruiz (not shown) work for Denver-based The Breakaway Group. Contact them at nkoch@thebreakawaygroup.com, jracela@thebreakawaygroup.com and sruiz@thebreakawaygroup.com, or call (303) 483-4300.