Tactical decisions

More than ever, healthcare organizations of all types and sizes are feeling the pressure to implement specific business and clinical initiatives to meet government regulations and increase operational efficiency. Whether it is complying with quality standards or expanding the use of an electronic health record, adopting a major strategic initiative requires thoughtful analysis of the tactics it takes to get there.

Integration and automation technologies are almost always required to develop a process that provides successful implementation and improves productivity. By integrating systems and automating time-consuming manual work, not only does valuable data become easier to access, but organizations also save hundreds of hours and tens of thousands of dollars. Often, commercial applications, such as EHRs, do not precisely match the business practices of an organization.

I am the chief information officer of the Little Clinic, a chain of retail health clinics that are located in grocery stores. Here are three initiatives that we have taken on, and the kinds of tools and tactics we used to accomplish them.

Registration kiosks: We made the strategic decision to use patient self-registration kiosks to expedite the registration process for patients and clinicians. Integrating the kiosk with the EHR eliminates the need to manually enter registration data (such as patient demographic information) into the EHR. We developed a Web-based patient registration kiosk application to collect the information that we need from each patient.

We then used a workflow automation tool to develop an integration that pushes the patient data from the kiosk database into the EHR. Automating the registration and data transfer process saves us about one hour a day per clinic. Given that the clinics are open up to 72 hours a week, this easily translates to a savings of hundreds of hours and thousands of dollars a month.

Chart review: State regulations and the Little Clinic's policies require the review of patient charts by someone other than the healthcare provider who administered the care and initially documented the encounter. the Little Clinic administers two types of chart reviews. One is a peer review carried out by one nurse practitioner on a chart that another nurse practitioner created. The other type of chart review is a collaborating physician review carried out by the physician who is in a collaborative relationship with the nurse practitioner who created the chart.

This chart review function is somewhat specific to the nurse practitioner-based healthcare environment and, as such, is not a feature that is typically present in EHRs. So we built a Web-based electronic chart review application to automate the process for both types of reviews. This system will display progress notes from the EHR and then prompt the reviewer for scoring the charts based on standard criteria. The scoring is saved in a database for later summary reporting.

Tracking quality: The Little Clinic has been accredited by the Joint Commission. A significant requirement of Joint Commission accreditation is looking for key performance indicators of clinical quality and tracking those indicators over time. We needed to implement a solid quality program working quarter by quarter to track progress. We designed and developed a set of reports, on top of the EHR, to demonstrate ongoing compliance with specific quality standards.

These reports were designed with input from the Little Clinic's chief medical officer and numerous nurse practitioners within our organization. The Little Clinic's quality reporting was a part of reaching the goal of accreditation by the Joint Commission and prepares the Little Clinic for upcoming requirements for meaningful use of electronic health records.

Healthcare organizations can maximize the overall benefits of technology initiatives through automated processes and increased efficiency throughout the organization. As shown in the examples above, integration and automation in the back office and for customer-facing areas play an indispensable tactical role in a healthcare organization's larger strategic initiatives.

Mat Waites is chief information officer of the Little Clinic, Brentwood, Tenn.