2006 EHR WfMS Tutorial Slides 90-97: Hospital EMR/EHR BPM: A Case Study

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This portion of my three-hour tutorial EHR Workflow Management Systems: Key to Usability draws from a presentation I attended at the 2005 HIMSS conference in Dallas: What a Concept! Automate Manual Processes Using a Workflow Management Engine. By the way, I presented a 50 minute version of my three hour tutorial at this HIMSS: EHR Workflow Management Systems in Ambulatory Care

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[Typo! “Staphyloccus” should be “Staphylococcus” :)]

Combating MRSA Infections with Workflow Management

  • Methicillin Resistant Staphylococcus Aureus
  • 3% of admissions, 7% of patient days
  • Strict regulatory guidelines
  • High cost per patient/day
  • Traditional approach (flowcharting, improving a manual process)
  • Workflow Management System approach…

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Characterizing the Problem

  • Many time consuming manual steps
  • Steps were missed
  • Haphazard inconsistent documentation
  • Some patients should be removed form isolation weren’t
  • Some patients who should be removed from isolation weren’t

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Workflow Management System Approach

  • Document existing process
  • Optimize desired process
  • Diagram desired process in process definition editor
  • Test sub processes
  • Test whole process for possible inputs (testers execute steps, alerts to reviewers)

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Here is Soarian’s graphical workflow editor. You can see that it resembled MS Visio, but with a major difference. Diagramed workflows are executable. This is what I mean when I refer to executable process model elsewhere. Instead of a Java or C# programming writing code that is incomprehensible to users who best know their workflows, the “code” is this is based on this diagram, which is comprehensible to users who best understand their workflows. The workflow is constructed from clinical workflow domain-specific terminology:

  • Admission Kickoff
  • Lab Kickoff
  • Manual Kickoff
  • Check Results Last 6 Weeks
  • Order MSRA Screen
  • Call RN Supervisor
  • Write to MRSA Db
  • Send Alerts Procedure
  • Etc….

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Triggering MRSA Workflow

  • Does patient have MRSA history (in system)
    • Do they have any lab results in last six weeks?
  • Does patient have MRSA history (not in system -> manually triggered)
  • Generates alert for MRSA screen

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Forward Items on to To Do Lists

  • Infection Control
  • Central supply (isolation kit)
  • Laundry (extra gowns)
  • Dietary (disposable protocol)
  • Housekeeping (resource allocation)

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Dischare/Removal from Isolation

  • Bed manager (bed availability)
  • Nurse (documentation)
  • Laundry (stop extra gowns)
  • Housekeeping (clean bed, trigger discharge workflow)

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Results

  • Improved ability to verify proper isolation status
  • Eliminated 12 manual steps by automating them
  • Execution is consistent and complete
  • Documentation better demonstrates compliance with regulation

Just as was the case in the results to the previous survey of twenty practices implementing an EHR workflow management system, good things increased and bad things decreased.

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