Phil ColpasWorkflow: We hear it now all the time, in almost every imaginable context. And as hospitals and physician practices continue to try and do more with less, workflow can easily transform itself into an all-pervasive, omnipotent bane of their existence. For if workflow is significantly impeded, it likely supersedes everything else, including implementing an electronic health record (EHR), meeting meaningful use and jumping through all the hoops required to be considered for incentive payments.

The great American writer Ernest Hemingway understood workflow. He knew the importance of putting in the extra time up front to give his readers a smoother, more efficient experience down the line.

“The dignity of movement of an iceberg is due to only one-eighth of it being above water,” Hemingway famously said.

The above-the-surface part of the iceberg, for our purposes, is the front-of-the-house aspect of workflow – readily apparent to patients, while most of what’s really important takes place behind the scenes, below the surface.

Here, we will examine three scenarios and their effects on productivity; specifically, how medical device integration, mobile technology and virtual card payments impact workflow.


1. Restore clinical efficiency with MDI

Mary Carr
Mary Carr is CNO of iSirona. For more on iSirona:
click here.

How can hospitals resuscitate clinical efficiency after an EMR change? Consider medical device integration (MDI), which automates device data collection by sending patient data directly to the EMR – reducing clinician documentation duties.

“The clinical improvements promised to the hospital that becomes a ‘meaningful’ user of EMRs are great: better patient outcomes, increased efficiency,” says Mary Carr, chief nursing officer of iSirona, which specializes in medical device connectivity. “But the truth is that implementing an EMR represents an enormous change in clinical workflow. And this change can hurt … a lot.”

Carr cites a recent UC Davis study, which estimates that EMR implementations result in an initial reduction in productivity of 25-33 percent. “Naturally, productivity inches back up through clinician training and adjustment,” she says. “Still, the change hits the hospital’s bottom line awfully hard.”

Field studies indicate that MDI not only alleviates the initial negative impact of implementing an EMR, it takes clinician efficiency to levels surpassing those experienced before the implementation. According to MindGent Service Center, which specializes in business workflow solutions, MDI can save a 150-bed hospital more than 2,000 nursing hours a year. Another study projects a reduction in charting time up to 50 percent for support staff and 20 percent for physicians.

“These improvements in clinical efficiency through MDI keep clinicians happy; the less frustrated the caregivers in your facility, the less likely they are to leave,” Carr says. “Perhaps more important, though, is what clinicians consistently do with the hours that MDI frees up: deliver direct care.”


2. Assess mobile technology’s changing impact

Robert Hitchcock
Robert Hitchcock, M.D., FACEP, is VP and CMIO of T-System. For more on T-System: 
click here

In today’s high-tech age, medical apps and mobile devices have become almost ubiquitous. But an extended array of choices also means more diligence is required during the selection process.

“A word of caution is advised when embracing the influx of apps and medical devices,” warns Robert Hitchcock, M.D., FACEP, vice president and CMIO of T-System, which produces emergency-department solutions to facilitate better patient care, boost workflow and maximize revenue. “We must use them for what they are intended – augmenting care, not replacing clinical judgment.”

There is no doubt that the right mobile tool in the right situation can increase quality of care and change outcomes for the better. But the novelty of first impressions often diminishes with time.

“Once the euphoria fades, step back and take into account workflow implications, balancing the usefulness and productivity impact,” Hitchcock says. “The tools can be designed to help solve complex problems, but should not supplant good, solid clinical training and decision making.”

Hitchcock suggests questioning the methodology and information the app uses to arrive at a conclusion, estimating the ramp time necessary for adjusting to your new workflow and inquiring if your hospital has proper mobile security controls in place to safeguard patient health information against breaches.

“Enjoy the new era of mobile computing,” Hitchcock says. “At the same time, adopt a new mindset to use the tools to their full potential to support, not hinder, patient care.”


3. Prepare for the virtual card payment wave

Kevin Arner
Kevin Arner is president and CEO of PaySpan. For more on PaySpan:
click here.

Seeking to improve payment processing efficiency, reduce administrative costs and enhance provider relationships, insurers are increasingly deploying “virtual card” payments, says Kevin Arner, president and CEO of PaySpan, which specializes in healthcare payments automation. With virtual card reimbursement, payers provide virtual card numbers and authorization codes that enable hospitals and physicians to retrieve payments from merchant terminals.

According to Arner, more than 25 payers have adopted virtual card payments, with hundreds more in the planning stages. “Providers need to take steps now to prepare for and take advantage of virtual card benefits,” he says. “When properly managed, virtual card reimbursement minimizes fraud and expedites reimbursement, enabling providers to access funds quickly.”

To take advantage of these benefits, Arner says, providers must adapt their workflows and ensure certain safeguards are in place:


  • Assure virtual card numbers and security codes for payments and reconciliation data are delivered over a secure electronic payment network instead of receiving complete card information in printed form, which creates a significant security risk and is much less efficient.
  • Choose a merchant terminal solution that is both secure and optimized for healthcare.
  • Avoid merchant solutions that charge excessive rates, limit redemptions and charge fees that reduce overall reimbursement income.
  • Seek out proven healthcare payments solutions and services to secure the best rates, rebates and other value-added services.

“Virtual cards automate many steps in processing reimbursement payments,” Arner says. “This new workflow process can reduce paper and decrease errors, while improving efficiency, the accuracy of claims reconciliation and cash management – and it does so with fewer administrative resources.”