Readiness Assessment – 1.5 – Workflow

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Category: Educational
Date: February 25, 2010
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Eric Fishman: Before choosing an EHR, you will need to determine what functionalities you need. Examining your workflow will help you identify the ways in which an EHR could help you improve it to increase your efficiency. This module will help you to fully understand your existing workflow, and help your practice to create a consensus of opinion about its desired workflow with an EHR.
Nicole Laws: The Workflow Management Coalition defines ‘workflow’ as: ‘the automation of a business process, in whole or in part, during which documents, information or work items are passed from one participant to another for action, according to a set of procedural rules’. Now, let's look at a conceptual model for workflow.
Conceptual models can provide support for structured and comprehensive analysis of the workflow in its 3 major aspects: processes, information, and organization. This will help document knowledge of the processes; and describe process bottlenecks, information flows, system integration, work organization, process improvement and process monitoring.

With knowledge of where improvements can be made, you will be able to define your desired future operations. The effects of re-designing the work processes and of introducing various IT solutions can then be examined in detail before the system is implemented. One way of modeling workflow is to think about your operations in 3 categories: Process, Information, and Organization.
Process refers to activities, sub-processes, buffers, triggers, and status.
Information refers to documents, folders, data, and applications
Organization refers to roles, groups, terms, and distribution.
When looking at your processes, information, and organization, consider how long it takes to complete specific tasks and how this could be expedited
Here is an example of how to model your current workflow and then consider changes for your desired workflow. As you will notice, each aspect of the model is coded based on the three categories of workflow: process, information, and organization.
Lindsay Pine: Now, let’s talk to an expert who can tell us about why documenting workflows is an important step in the readiness assessment
Andrew Carricarte testemonial
Voice Over: A workflow analysis should be completed for every process in your practice. While this will differ depending on your type of practice, it is likely to include examining each of the following:
• Phone calls/messages
• Interoffice messaging
• Scheduling/confirming
• Patient check-in
• Prescribing
• Transcription
• Coding/billing
• Physician exam
• Informed consent
• Specific procedures
• Etc.
Identifying workflow issues that you would like to change will lead you to develop a list of functionalities or ‘tools’ that you would like an EHR to have. These tools can have a clinical, administrative/ financial, or patient focus.
If you are a specialist, you will have unique needs that an EHR will have to meet. For example, if you’re an allergist, you may need to time your patients after they have their allergy injection, and a plastic surgeon may want to upload before/after images and attach these to the patient’s record.
Please see the specialty-specific guide in the resources section for more information on EHR considerations, or visit and review the specialty articles there.
The list of your desired EHR tools will be helpful when you begin evaluating EHR products and narrowing your focus onto only a few EHR vendors that can meet at least your basic functional needs.
You should also consider doing a time-motion analysis to identify what workflow tasks are taking up valuable time, and consider how an EHR or other technology could help make you more efficient in these areas. For example, administrative tasks should take little to no time, and physicians should not even be thinking about this; they should be increasing patient volume and providing better patient care.
Billing is another time consuming task in a practice. Physicians still using paper claims often have to wait longer to receive payments and resolve denied claims.
The billing process should all be automated whether you have in-house administrative staff working on this using the Practice Management portion of the integrated suite or if you are using a third party outsourced billing company.
Another way to increase efficiency is to consider mobile devices, such as a blackberry, iphone, or PDA. This technology can integrate into an EHR and make medical information accessible to a physician anywhere.
Speech Recognition software can also increase efficiency and eliminate transcription costs. This is especially useful for physicians who dictate extensive notes.
If you would like to use additional technologies, make sure that you seek an EHR that can integrate with the technologies you wish to use.
You have now completed Chapter 1.5, please continue to the last step in ‘Readiness Assessment:’ Identify Resources

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