Using advanced process re-engineering methodologies is an important prerequisite for EHR success. Every C-level executive should consider this when choreographing patient flow and maximizing throughput. Operational methodologies most often associated with manufacturing processes, such as Lean, Six Sigma and Toyota Production System, are rapidly gaining favor as the best means to increase efficiency. Besides lower resource utilization, increased capacity, improved profitability and greater quality, synchronized patient flow will remove many of the logistical problems that reduce the time clinicians have to spend with patients.
Too often, front-line caregivers are burdened with non-clinical activities that involve boarding, scheduling and transport instead of providing care. These activities create waste in a process for which efficiency is critically important. Adding an EHR to this dynamic will not improve care; instead it may paralyze already overburdened caregivers. By improving patient flow and logistics across the entire hospital, nurses and doctors will be freed to spend more time with patients.
Clinicians can use this additional time to achieve an optimal balance of patient care and documentation. Incorporating an EHR in a hectic environment buffeted by inconsistent patient flow and demands will not establish a solid foundation for success. The effects of having more time at the bedside for clinicians will be enhanced by the EHR's inclusion of decision-support protocols, computerized physician order entry, test results and other functionalities that are anticipated to transform care.
Increasing efficiency through advanced-care coordination methodologies begins with developing a consensus that the hospital is committed to transforming its operations. Once that mindset is accepted, it is important to understand how processes are completed. This can be done through mapping workflow to accomplish key patient flow tasks. A review of the workflows will identify opportunities for improvement (such as waste, no value added and rework).
Once the opportunities are identified, an optimal future-state process design leads to the elimination of unnecessary steps in the workflow process. Upon implementation, processes are standardized and key metrics and milestones are established, resulting in: optimized patient flow for all patients; reduced non-value-added activities and waits; and increased hospital efficiency.
The final component to maximizing efficiency and realizing the attendant gains is using adaptive systems software and technology that automates the process, provides visibility to and management of key metrics and milestones, and ensures optimal patient flow. By using a software platform that maps to the new care model and integrates with other related hospital systems such as EHRs, real-time performance information is available for the entire hospital as well as specific patients. Not only will this ensure on-time, complete and correct actions regarding hospital operations, but it also will provide clinical leaders with valuable data about patient care, treatment and outcomes.
EHRs are an important piece in developing a high-quality, low-cost health system. If the foundation upon which they are built is disorganized, inefficient and overburdened, however, they will fail to live up to their potential. The country is spending too much money on EHR implementations to ignore the need to first commit to greater hospital efficiency. Designing processes focused on value-added patient care will radically change the care environment for clinicians and provide an ideal environment for integrating EHRs.
Dr. Tim Jahn is chief quality officer of the eastern Wisconsin division of Hospital Sisters Health System, Springfield, Ill.