BUSINESS PROCESS IMPROVEMENT PROPOSAL FOR MEDICAL CENTER ‘X’

CONVERTING INPATIENT SURGICAL MEDICAL RECORDS:

From Patient Admissions To Patient Discharge & Prescription

Keith Wymetalek

Seattle University, ECIS 560

US Healthcare Background:

• US Healthcare in 2001 = $1.4 Trillion (14% GDP)• US Hospitals: Perfect example of ‘Job Shop’

– Bottlenecks, inefficient processes/workflow, poor information

• Estimated 44,000 to 98,000 people die each year due to medical mistakes (surgical errors, wrong medication, incorrect patient data, etc.)

• Medical Malpractice Insurance skyrocketing (putting some hospitals and doctors out of business)

• HIPPA - Strict security rules on patient data– Health Insurance Portability & Accountability Act

• California Law: Requires hospitals to use implement order-entry systems by 2005

“As Is” Business Process

2.0Inpa

tient Bed

(Pre-O

p)

5.0Sur

gery4.0

Radiolo

gy

3.0Lab

oratory

Hospita

lRec

ords

Creates

patient

’s Lab

oratory

records

Creates

patient

’s Radio

logy

record w

ith X-R

ay or MR

I ima

ges

Creates

patient

’s Surgi

cal reco

rd

Laborat

ory Res

ults

7.0Pat

ientDis

charge

6.0Sur

gery

Succes

sful?

Radiolo

gy Resu

ltsNo

-mor

e tests

required

(6.2)

Patient’

s medic

al record

s sent

back to

Hospit

al’s reco

rd room

7.2Pati

ent RX

(handwr

itten)

7.1

Surgeo

n’s note

s and

vital inf

oPhy

sician no

tes, vita

ls, lab an

d radi

ology re

ports

= Paper

Medical

Records

NewPat

ient?

1.0Adm

issions

YesNo

1.1:Adm

issions c

reates

newpati

ent med

ical &

billing re

cord

1.2:

Admissio

ns retrie

ves

existing

patient

medical

record a

nd send

to Phy

sician

1.2

Yes

3.1 4.1 5.1

= Paper

Reports

5.2

4.2

3.2

6.1

BPI Solution: EMR and CPOE

• Information is critical, especially in medicine:– Electronic Medical Records (EMR)– Computerized Physician Order Entry (CPOE)

• Benefits: Real-time Information– Timely access to patient history, lab test, radiology, drug

interaction warnings, etc.

• Net Results from Technology:– Greater efficiency: Improved workflow and information access– Shorter patient stays: Better, faster care for patients, greater

capacity and revenue for hospitals– Decreased costs: Decreasing paper files (reduced storage and

staff)and fewer medical errors (lower malpractice insurance)– HIPAA Compliance

“As Proposed” Business Process

Data

Wareho

use(Har

dware, S

oftware,

& R

eporting

Tools)

2.0Inpa

tient Bed

(Pre-Op

)New

Patient?

5.0Surg

ery4.0

Radiolo

gy3.0

Laborat

ory

7.0Pati

entDisc

harge

6.0Surg

erySuc

cessful?

10.0Refe

rring

Physicia

n9.0

Billing

8.0 RxHos

pital

Pharma

cy

Patient Fl

owEMR

Data Flo

wMed

ication F

lowUniq

ue Patien

tBar

Code (lin

ksto E

MR)1.0

Adm

issions

1.2 Admis

sions

retrieves

existing

patient

individua

l bar cod

e.1.1 N

ewpatie

nt file

& unique

barcode.

No

Yes

Patient

wristban

dbarc

ode

NoYes

Potential Barriers to Success

• Physicians– Changing the way Physicians practice medicine (Physicians

killed $20M CPOE system at Cedars-Sinai Medical Center)– Resistance to process improvements and workflow changes

• Data Security concerns – HIPAA and Sarbanes-Oxley Acts

• Expensive to implement– Maimonides Medical Center (Brooklyn, NY) spent $44

million (over 7 years) to implement system• Net Gain: $50 million in increased revenue (32,000 additional

patients) and reduced costs