Transcript Wendy Clark - Presentation (2Mb)

EDM Workflow and Change
Management
Wendy Clark, 13th March 2008
Outline

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
The Portsmouth brief
Our approach
Methods and tools – overview
Learning points
The Portsmouth brief
 Review of processes involving health records
 Identify how records are managed, accessed, referenced
and amended
 Provide input into the following activities:
 The configuration of the EDM solution
 The development of appropriate workflows and working practices
for the deployed system
 Identification of potential cost savings that could be realised
through the rationalisation of clerical staff involved in the
processing of paper-based records.
The approach
 Generic patient journeys:
 Outpatients
 Planned
 Unplanned
 Then variations by specialty
Current Records Process Interaction
with the Patient Journey
Patient
History
Records
Process
Effort and delay of
pulling, tidying,
preparing and filing
Pull
Updated History
Where is it? –
Tracking and
searching…
File
Patient Journey
Urgent cases are
seen without history
2000+ forms in use!
Updates
Everyone wants it,
only one person
has it
The approach
 Tribal model for workflow analysis
 Walking the process
 Using Visio to create swimlane diagrams and process
documents
 Creating ‘storyboards’ to engage with and involve users
Method and deliverables
Current State
Top level “map”
o/p i/p A+E emerg
Speciality
code
pull prep move file
Process models
1
2
3
4
1
Doc
Schedule
2
Story-boards
Dr.
Clerk
File
Method and deliverables
Current State
Future State
Impacts
To-be process models
Impacts, Issues
by dept.
speciality, role.
Metrics
Top level “map”
o/p i/p A+E emerg
Speciality
code
pull prep move file
1
2
Process models
3
Benefits
Dependency
Network
(Visio)
4
1
1
2
2
3
4
1
Doc
Schedule
2
Story-boards
Top20
Docs &
Architecture
Dr.
File
• Exec. summary
• Intro & Background
• Context
• EDM Architecture,
P.A.C.
• Current state
• Future state vision
• Future state
processes
• Impacts, variances
and migration
issues
• Benefits realisation
To-Be Stories
EDM
Clerk
Stakeholder
Map
Final Report
Clerk
Dr.
Operational
Guidelines
(MS-Word)
• Conclusions and
recommendations
• Appendices…
Method and deliverables
Current State
Future State
Impacts
To-be process models
Impacts, Issues
by dept.
speciality, role.
Metrics
Top level “map”
o/p i/p A+E emerg
Speciality
code
pull prep move file
1
2
Process models
3
Benefits
Dependency
Network
(Visio)
4
1
1
2
2
3
4
1
Doc
Schedule
2
Story-boards
Top20
Docs &
Architecture
Dr.
File
• Exec. summary
• Intro & Background
• Context
• EDM Architecture,
P.A.C.
• Current state
• Future state vision
• Future state
processes
• Impacts, variances
and migration
issues
• Benefits realisation
To-Be Stories
EDM
Clerk
Stakeholder
Map
Final Report
Clerk
Dr.
Operational
Guidelines
(MS-Word)
• Conclusions and
recommendations
• Appendices…
Method and deliverables
Current State
Future State
Impacts
To-be process models
Impacts, Issues
by dept.
speciality, role.
Metrics
Top level “map”
o/p i/p A+E emerg
Speciality
code
pull prep move file
1
2
Process models
3
Benefits
Dependency
Network
(Visio)
4
1
1
2
2
3
4
1
Doc
Schedule
2
Story-boards
Top20
Docs &
Architecture
Dr.
File
• Exec. summary
• Intro & Background
• Context
• EDM Architecture,
P.A.C.
• Current state
• Future state vision
• Future state
processes
• Impacts, variances
and migration
issues
• Benefits realisation
To-Be Stories
EDM
Clerk
Stakeholder
Map
Final Report
Clerk
Dr.
Operational
Guidelines
(MS-Word)
• Conclusions and
recommendations
• Appendices…
Features
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Rapid start-up
Maximum staff engagement
Minimum impact on departments and staff
Live walkthrough environment captures “rich picture”
Time to book events in busy diaries
Maximum value from workshops from dynamic
storyboards
 “Best of both worlds” – detailed swimlanes and process
documents, plus visual storyboards
Swimlanes
AE L1:
CAS
ready
AE B07: Collect
CAS card from
box at reception
and call patient
minor injury?
Majors
Reception
Clerk
Minor Injuries
Nurse/Doctor
Streaming Nurse
Accident and Emergency – patient assessment
Yes
AE B08: Deliver
CAS card to
minors and place
in box in order
No
AE B09: Record
patient treatment
on CAS card
80% of majors arrive
this route
AE I4: Patient
arrives via
ambulance
AE B11: Create
medical/surgical
admission record
Follow-up
required?
AE B10:
Photocopy CAS
Yes card, place copy in
pigeon hole for
clinic and log appt
AE B12:
Photocopy
completed Majors
CAS card
Transfer Nurse
Reception
Clerk
No
AE B14: Code
completed cards
directly onto
system
AE B13: Majors
CAS card is
transferred to
MAU/SAU
AE O1: Patient
transfered to
MAU/SAU
AE L4: A&E AE L5: A&E
to MAU
to SAU
AE L3:
On
system
Storyboards
UNPLANNED INPATIENTS FUTURE - Stage: A&E Treatment
E
D
M
Possible move to electronic
booking in the future
Consult
EDM
MINORS
Allocate
patient to
stream
Minor cards
in order
YES
Record details
on CAS card.
Make out script.
Log into
clinic book
If next day F/up,
then retain paper
Copy card
Follow
up?
NO
Code
completed
cards
NO
MAJORS
Put card into
pigeon hole
Admit?
E
D
M
Consult Record treatment
details on CAS
EDM /
card
Graphnet
Opportunity / benefit:
Early consultation of patient
record=> admission avoidance
»
YES
lllllllllllll
lll
20
Create admission
record. Copy CAS
card. Orig. may be
passed on
UP TO 4 HOURS
Patient transferred to
assessment unit/ward or
theatre. May request
Xrays / notes for out-of
area patients
To scanning, or:
MAU,
SAU,
other wards.
01:00
Workshop approach
Describe EDM software
Present storyboards slides
(current => future)
Q&A
Work with small groups
around A1 posters + post-its
Update future state
storyboards and log risks,
issues, benefits, FAQs
Some EDM issues and challenges
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Stakeholder engagement is vital
Agreeing a standard EDM record structure
Workflows are complex and inconsistent
Variety of paper documents and ways of working
How and when to scan
Management of temporary notes, including tracking
Significant information governance issues
Contact details – Wendy Clark
 Email:
[email protected]
 Mobile: 07786 510490
 Tribal Consulting, First Floor, 154
Great Charles Street,
Queensway, Birmingham, B3 3HN