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Workflow Management Systems in Healthcare: Focus on Quality and ThroughputJune 23, 2005
Harm Scherpbier MDProduct Manager, Clinical Decision SupportSiemens Health Services
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©2001 Siemens Medical Solutions Health Services Corporation. All rights reserved
Topics
What is a Workflow Management System?
How to apply Workflow Management to Disease Management processes?
Drivers: Safety, Quality and Throughput
The parallel objectives of Disease Management and Workflow Management: “More health for less $$$”, or “Do more with Less”
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©2001 Siemens Medical Solutions Health Services Corporation. All rights reserved
What is a Workflow Management System?
Process Management ToolB Industry: BPM, Business Process Management
Consisting of:B Predefined steps, sequential and parallel,
B Spanning a period of time,
B Involving all players on the team.
“Orchestration”
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©2001 Siemens Medical Solutions Health Services Corporation. All rights reserved
What’s Wrong With the Status Quo?
1HospitalDischargeOrder
2Nursenotified
14House-keepingadvised
17Roomqueued
Roomrefresh
Roomassignment
3Nurserevieworders
11Patienteducation
5Familynotified
6Pharmfills d/cRx's
10Familyarrives
12Transportnotified
13Pt out ofroom
4Nurse d/cprocess
8Dietarynotified
9Respnotified
7Pharmnotified
15House-keepingnotified
16Roomcleaned
18Nursingsupervisornotified
19Nurseasigned
20Notifyadmitting
21Notify ER
Bed turnaroundHandoffs
PatientDischarge
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©2001 Siemens Medical Solutions Health Services Corporation. All rights reserved
Sheridan’s “Degrees of Computerization”
U.S. Medicine today mostly at level 1
Clinical Decision Support most effective at approx level 5
1 5 10
No assistance Computer suggests one option and executes if human approves
Computer decides everything
Bates DW et al, Ten Commandments for Effective Decision Support, JAMIA 2003;10:523-530Sheridan TB, Thompson JM, People versus Computers in Medicine, Human Error in Medicine, 1994, 141-59
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©2001 Siemens Medical Solutions Health Services Corporation. All rights reserved
Workflow Management System
Optimize Workflow
Manage Tasks
Prioritize
Coordinate
Delegate
Escalate
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©2001 Siemens Medical Solutions Health Services Corporation. All rights reserved
Workflow Management Strategy
Workflow-enable all processesB Intra
B Inter
B Extra
Focus on: Team, Time, and Configurability
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©2001 Siemens Medical Solutions Health Services Corporation. All rights reserved
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©2001 Siemens Medical Solutions Health Services Corporation. All rights reserved
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©2001 Siemens Medical Solutions Health Services Corporation. All rights reserved
Example 1: DVT Prophylaxis
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©2001 Siemens Medical Solutions Health Services Corporation. All rights reserved
Example 2: Infection Control
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©2001 Siemens Medical Solutions Health Services Corporation. All rights reserved
Example 3: Bed Management
Objective: Reduce Turn Around Time from Discharge to Bed Availability
Notification via beeper, telephone, worklist
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©2001 Siemens Medical Solutions Health Services Corporation. All rights reserved
Next Workflow Management Scenarios
Discharge Management
Case Management
JCAHO / CMS Metrics
Clinical Practice Guidelines
Progressively more complex, involving more members of the healthcare team
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©2001 Siemens Medical Solutions Health Services Corporation. All rights reserved
Extend into DM Processes
DM processes are ideally suited for Workflow ManagementChallenges:B Span longer periods of timeB Span organizations – payor, providerB Includes patient as participant in the processB Partly predictable, partly unpredictableB Target: both individual patient as well as population
Opportunities:B Increase candidate identificationB Improve process definition, yet easier to changeB Reduce manual transactions
Goal: deliver more DM within same team
Key challenge – particularly in management of chronic diseases in primary care!
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©2001 Siemens Medical Solutions Health Services Corporation. All rights reserved
Challenges of clinical guidelines for chronic diseases in primary care
Targets: Hypertension, Angina, Asthma
Challenges:B Timing of triggers
B Ease of use
B Helpfulness of content
Bates: “biggest challenge is identifying accurately where the patient is in their care, so that helpful suggestions can be made.”
Montgomery AA et al, BMJ 2000; 320:686-90Eccles M et al, BMJ 2002; 325:941Roussau N et al, BMJ 2003; 326:314-8Bates DW et al, JAMIA 2003;10:523-530
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©2001 Siemens Medical Solutions Health Services Corporation. All rights reserved
Eliyahu M. Goldratt: “The Goal”
North River Press 1984
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©2001 Siemens Medical Solutions Health Services Corporation. All rights reserved
The Process Improvement Dilemma
What to Change?
What to Change it to?
How to Change it?
??
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©2001 Siemens Medical Solutions Health Services Corporation. All rights reserved
What is Your Organizational Goal?
Improve qualityIncrease efficiencyIncrease profitsReduce cost of careImprove market shareImprove patient satisfactionImprove health of the communityProvide efficient, high-quality careImprove workflowImprove performance….. Other suggestions?
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©2001 Siemens Medical Solutions Health Services Corporation. All rights reserved
Goldratt’s Goal
Manufacturing: “Make Money”
But: how does that apply to healthcare organizations???
Increase Throughput
Decrease Inventory
Decrease Operational Expenses
In other words: Do More With Less….
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©2001 Siemens Medical Solutions Health Services Corporation. All rights reserved
Drivers of Workflow Management Technology in Healthcare
Today: B Patient Safety
B Quality Improvement
Tomorrow: BThroughput
B…realizing that quality and safety are necessary preconditions to high throughput
Do More With Less….
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©2001 Siemens Medical Solutions Health Services Corporation. All rights reserved
Conclusions
Workflow Management Systems as emerging technology in healthcareB Starting in inpatient settings, expanding from there into
continuum of care
B Clinical and operational
Parallel Goals of DM and WFMB Optimize health (patient and population) at minimal expense
B Do more with less – increase throughput for the healthcare system as a whole
Seeking application areas