A wide-ranging, in depth discussion on the challenges and opportunities facing the industry today.
Chuck Webster, MD, MSIE, MSIS has degrees in Accountancy, Industrial Engineering, Intelligent Systems, and Medicine (from the University of Chicago). He’s the ex-CMIO for a three-time HIMSS Davies Award-winning EHR. Dr. Webster currently serves as CMIMO (Chief Medical Informatics Marketing Officer) for workflow technology in healthcare.
Jason Harber, TeleTracking’s Vice President of Product Management is responsible for managing the direction for TeleTracking’s suite of industry-leading solutions. Jason has more than 10 years of experience in healthcare technology, data and analytics and product management. Teletracking is a HIMSS16! (booth 7410)
Q: Chuck, you are a trailblazer in the field of healthcare workflow and workflow technology. Your work is so relevant and meaningful to an organization like TeleTracking. How did you become so passionate about the subject?
Chuck Webster: For one year, during my graduate degree in industrial engineering from the University of Illinois, Champaign-Urbana, I gathered data and wrote a computer simulation of patient flow through the U of I student health center and hospital. They had a hospital with 24 beds—and they also had patient flow problems. I used old-fashioned time-stamp machines and gave every patient a green slip of paper, with the instructions that every time they saw a time stamp machine to stick the paper in it. For one week I observed people and then created a discrete event simulation. I remember thinking, what if I simply had all this time-stamped data, in real-time, all the time. Then people could actually change their workflows, and see, again, in almost real time, what the effects of the changes in workflow did to indicators like cycle time, wait-time and resource idle time.
Q: TeleTracking began as a mobile hospital bed status tracking company, but has evolved to include a wide range of services for enabling the timely delivery of care. Jason, can you elaborate on how these events unfolded and their influence on TeleTracking’s trajectory?
Jason Harber: When TeleTracking was founded in 1991, we were looking to reduce lag times in the bed turnover process with our inaugural BedTracking® product. BedTracking was so successful and that led us to realize that technology could move beyond housekeeping and have a positive impact on other departments. So in 2002, we expanded our focus to encompass the entire hospital and eventually to the development of core components like the TeleTracking’s Capacity Management Suite that centrailizes patient placement across multiple hospitals; the Patient Flow Dashboard™ and PatientTracking Portal™ to manage real-time status of enterprise operations. We went moved on from there to developing capabilities built around; and RTLS technology to advance workflows using real time location awareness. Building on on that success were products like Orchestrate™ for outpatient patient flow throughout the perioperative and ancillary care areas. The bottom line is a synergistic relationship between access and throughput—both must be in place for success.
Chuck Webster: “Workflow” is a catch-all phrase covering a wide variety of “flows.” My favorite definition is that workflow is a series of tasks, consuming resources, accomplishing goals. The biggest difference between patient flow and all the other kinds of workflow is two-fold. First, the patient can only be in one place at one time. Second, patient flow is strategically the most important of all the workflows. All the rest are in some sense subordinate and supportive.
Healthcare is moving from a provider-centric, cost-for-service system of relatively unmanaged workflow, to a more patient-centric, value-based systematic management of workflow. Given that patient flow is the most important kind of workflow—its metrics and technologies for improving them—will inevitably become an increasingly important strategic concern for healthcare enterprises.
Jason Harber: We create systems that alert healthcare workers to changing circumstances and give them the information they need to do their jobs and deliver quality patient care. And we recognize that hospitals use a range of systems to help deliver that care, which is why we have more than 80 integrations. This type of interoperability among all health IT systems liberates an incalculable amount of caregiver time, enabling a reallocation towards more purposeful care.
By managing capacity and throughput, we are examining the admitting and discharging process, as well as the workflow at a clinical and procedural level. And we will continue to build on our capabilities, as we launch our OnCall Scheduling and Behavioral Health products. Both products provide additional data to help with managing access and throughput. Our Community Access Portal suite will eventually coordinate with electronic health records, so all the data on a patient will be in one place.
Q: Consolidation seems here to stay, at least for the foreseeable future. As health systems consolidate and sub-specialize, what role can workflow play in improving patient access? Have you seen particularly innovative and/or effective examples in this?
Chuck Webster: I saw lots of innovative examples of effectively leveraging workflow within and between healthcare organizations to improve patient access and experience at the 2015 TeleTracking Annual Client Conference.
During the TeleTracking conference I tweeted: “Remarkable scale of event-driven propagation of patient & task state across HC enterprises 2 apps & users”
- By “event-driven propagation” I mean when something happens, information is immediately sent somewhere useful.
- By “patient & task state” I mean tracking not just the location of people and objects, but also tracking patient status changes
- By “across HC enterprises 2 apps & users” I mean workflows inside of one healthcare organization, such as a hospital, can be enormously important to workflows inside another healthcare organization
All three of these ingredients—events triggering workflows, tracking and influencing patient states, and doing so within and across healthcare organizations—are incredibly important to freeing and mobilizing staff to improve patient access and experience.
Jason Harber: Orchestrate is an application that provides the technical and process management tools to improve patient flow throughout perioperative and ancillary care areas, and helps ensure a hospital maximizes its most valuable resources to full capacity. It also helps staff maximize the amount of time a patient is receiving clinical care, versus dealing with administrative tasks. With Orchestrate, unique workflows are possible because we’re aware that one size doesn’t fit all. The current market is operating rooms and cancer centers, with a growing installation base in other clinical specialty areas.
Q: Continuing with the idea of Orchestrate. Two important workflow terms are Orchestration and Choreography. Orchestration implies a workflow “conductor” in analogy to the conductor of an orchestra. In contrast, choreography is about distributed workflow control. It’s like a jazz ensemble in which all the musicians have workflow rules in their heads and watch each other and react constructively to each other. The musical workflow emerges out of this synergy. Comments?
Jason Harber: With our primary applications, there is no true conductor. We are acting as choreographers across stakeholders. Our TransferCenter product – with a referral network from patient placement to nursing – works because all of the parties are engaged and on board. There are set boundaries and defined responsibilities. With Orchestrate there are multiple roles, but at the same time, people have the autonomy to make informed decisions based on the current conditions.
There is always a base process that helps establish a base workflow and measurable outcomes. However we also build in the appropriate degree of flexibility that allows people do their jobs and respond to changing situations.
Jason Harber: The introduction of TeleTracking IQ demonstrates TeleTracking’s continued focus on enabling timely and purposeful patient services across the healthcare continuum by providing a streamlined user experience. The TeleTracking IQ platform also augments the investment that hundreds of hospitals and health systems have already made in TeleTracking’s industry leading patient flow solutions. Our users are empowered to take their capabilities to the next level.
TeleTracking IQ offers significant advancements in user experience. Solutions will share common information and workflows, so users will not have to navigate among multiple products unnecessarily. For example, health systems that use TeleTracking to manage transfers, referrals and direct admits will have one comprehensive view of access management that incorporates other tools that support their workflows, such as a view of the physician on-call schedule and a Community Access™ Portal for referring physicians.
Jason Harber: TeleTracking delivers an operational platform and proprietary set of capabilities backed by 25 years of expertise in patient flow. Frequently observed outcomes include a 10% – 20% increase in patient volumes while reducing length of stay, improving utilization of health system capacity & resources, and reducing wait times and call volumes. This means hospital workers can deliver the right care, from the right provider, to the right patient at the right time.
Q: The teams at TeleTracking spend a lot of time thinking about the notion of “timely and frictionless” patient and caregiver experience. And we do that, among other things, by examining the proportion of time spent on non-purposeful activities. Patient boarding, diversions, late starts, manual data search / entry, countless phone calls and poor care coordination are things we hear about. How big is that impact and what are healthcare leaders failing to take into account as we try to solve for it?
Chuck Webster: Ten years ago everyone was trying to figure out how to implement EHRs without decreasing productivity. Today, everyone is trying to figure out how to leverage EHRs to increase productivity, a subject smack dab in the middle of your question.
Value-added activities (your purposeful-activities) are typically those that someone will pay for. Hospital patient stays and encounter lengths are determined by a combination of value-added and non-value-added activities. Value-added activities include collecting data that may be used in a future decision or making a decision that affects the welfare of the patient. Non-value-added activities include navigation from screen to screen and searching for the next person to handover the next activity in the encounter. If these non-value-added activities, and the time required to accomplish them, can be eliminated, both hospital stay and encounter length can be reduced.
I think almost everyone, including myself, suspects the impact of these non-purposeful, non-value added activities is enormous. The crucial ingredient has always been, and will continue to be, time-stamped clinical and administrative workflow data, such as what TeleTracking collects and leverages, since this is the data from which cost of labor and tied up physical resources can be most accurately estimated.