Workflow Redesign The Challenge in Implementing an Electronic Medical Record

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Workflow RedesignThe Challenge in Implementing
an Electronic Medical Record

• Patient Safety and Health Information Technology

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CCHS East Region Hospitals
South Pointe Hospital
Euclid Hospital
Huron Hospital
Hillcrest Hospital
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About Our Project
Order Entry
Remote Access
Results
EMR
Clinician Adoption
Rules Alerts
Strong Authentication
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Why Workflow Redesign?
If you do what youve always done, youll get
what youve always gotten.
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Our Project Org Structure
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Purpose, Goals Objectives
Process Redesign
To diagram existing processes, identify new
processes and revise workflow to maximize the
benefit of new technology
Physician Workflow
Business Processes
Nursing Workflow
Pharmacy Workflow
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Physician Workflow

• Mechanisms
• Physician Advisors
• Physician Advisory Committees
• Clinical Informatics Council
• Connectors
• Outcomes
• Regional formulary consolidation
• Regional best practice order sets
• Physician-friendly system design
• Revisions to Medical Staff by-laws

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Nursing Ancillary Workflow

• Mechanisms
• Patient Care Advisory Committee
• Clinical Informatics Council
• Unit-Specific Workflow Design Teams
• Outcomes
• Detailed flowcharts of every workflow
• Identification of new processes related to EMR /
  CPOE
• Revisions of all affected existing processes
• EMR version policies and procedures

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Pharmacy Workflow

• Mechanisms
• Patient Care Advisory Council
• External Consulting Services
• Outcomes
• Pharmacy Workflow Assessment Report
• Problem Definition
• Detailed Workflow Analysis
• Recommendations

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Pharmacy Workflow Problem Definition

• Reduced physician confidence in the safety of the
  EMR and the delay in entry of medication orders
  in the EMR
• Pharmacists work environment is hectic and
  disruptive and impedes accurate order entry
• Replacement dose requests are documented and
  processed in an inefficient manner
• Orders written at night are queued for EMR entry
  in the morning, putting the pharmacy behind at
  the start of each day
• Illegible physician names on order sheets

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Existing Replace Dose Process
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Proposed Replace Dose Process
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Pharmacy Workflow Recommendations

• Remodel space to create less disruptive
  environment
• Modify replace dose processing
• Implement EMR generated paper Medication
  Administration Record (MAR)
• Implement electronic MAR following software
  upgrade
• Perform time studies to measure workload,
  identify additional resources and project when to
  reactivate CPOE
• Implement integrated pharmacy module to eliminate
  duplicate order entry in pharmacy

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QUESTIONS?Sue Kraus skraus_at_cchseast.org

• Patient Safety and Health Information Technology