2006 EHR WfMS Tutorial Slides 80-81: Why Did Patient Volume Increase? Why Did Encounter Length Decrease?

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We already covered much of the answer to this question. However, it’s worth returning to, after examining the results of the productivity survey.

From EHR Workflow Management Systems: Essentials, History, Healthcare, TEPR Conference, May 19, 2004, Fort Lauderdale.

Productivity Survey Discussion

Why did visit volume increase? The most likely reason is that encounter length decreased, freeing up resources to see more patients. Consider this hypothetical and simplified example. If average encounter length is 30 minutes, then resources such as waiting and exam rooms, as well as staff are tied up during
this time. However, if encounter length is reduced to 15 minutes, then resources are freed up that can be used to see another patient. Shorter visits incline toward greater visit volume. However, the real question is “Why did the encounter length decrease?” Three reasons: decreased non-value-added EHR activities, increased parallelism among value-added EHR activities, and better coordination among EHR activities.

wfms-usability-ehr-039

We previous covered elimination of non-value-added EHR activities and “parallelizing” value-added EHR activities.

Better coordinated value-added coordination remains to be discussed. Key here is the degree of activity transparency made possible by workflow management systems technology. The following is what usability engineers call a “radar view” (“office view” in this system).

You may recall this slide from our discussion of the supportiveness workflow usability principle.

wfms-usability-ehr-075

The following is a bit more legible.

officescreen-web

From EHR Workflow Management Systems: Essentials, History, Healthcare, TEPR Conference, May 19, 2004, Fort Lauderdale.

Now that so much is happening so quickly and at the same time, a coordination problem potentially arises, but workflow management systems have a solution for that as well. The real-time task tracking capabilities of workflow management
comes into play.

The workflow engine, in executing process definitions, keeps track of what activity is waiting, how long, where and for who. This information can be fed not only into To-Do lists, but also onto a status screen available to all EHR users. For example, in Figure 4 we can see an office status screen. We can see rooms, tech station, nurse station, exam room one and so on. In room one is Jessica Dalwart waiting for vital signs and several other tasks. Each task pending completion is tagged with a continually updated number representing the total number of minutes that have elapsed since that task was posted to the office view. These can be used to prioritize tasks when many are competing for attention. Patients are color coded according to physician; tasks are color coded according to who or what role is responsible for completing the task. So, at a glance, a nurse can see all pending nursing tasks or a physician can see all his or her patients.

wfms-usability-ehr-040

This animation requires some imagination on your part. Imagine the Begin Encounter bar in the upper right slowly moving downward toward the End Encounter bar. This represents patient encounter length getting shorter. At first non-valued EHR activities are eliminated (that’s the arrows in the upper left disappearing, in your mind’s eye). But then there are a bunch of EHR screens in the lower left (partially obscured by the radar view). This need to clump up, so to speak, parallel with each other. You can see this in the earlier representation of this animation from the 2004 tutorial. Thirdly we see the “radar view” to provides supportive transparency so all the member of the team can see what tasks have been waiting where for who and for how long.

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