1. 1. Using Technology to Modify Clinic Workflows Promoting Patient Engagement and Restoring Fun in Clinic Exam Rooms
2. 2. More Accurately . A story of failure How Ive been totally unable to convince colleagues and health care systems to put more technology in primary care clinics .
3. 3. Or the power of the second screen Photograph: Colin Anderson
4. 4. Objectives and Goals Objectives Define and identify clinic workflows and designs Discuss variations that promote patient engagement Review technologies and techniques that can restore creativity and fun to the clinic experience Goal Show and outline current states Illustrate and map out variations that reduce work for everyone Demonstrate tools that add spark and help create aha moments in our exam rooms
5. 5. Form follows Function It is the pervading law of all things organic and inorganic, of all things physical and metaphysical, of all things human and all things superhuman, of all true manifestations of the head, of the heart, of the soul, that the life is recognizable in its expression, that form ever follows function. This is the law. Louis Sullivan, The Tall Office Building Artistically Considered 1986
6. 6. First, a personal story All of us are somewhere along a personal trip that defines who we are and helps understand where we are today. This will help you understand this presentation and help you evaluate the relevance of this session to your own situation.
7. 7. Proposed Modular Design
8. 8. Multiple modules in a Clinic
9. 9. Expanded Design
10. 10. Became Reality
11. 11. Trouble in paradise Management outsourced to outside group No experience with novel clinic settings Continued traditional visits Form incompatible with function Very little interactivity with technology at the point of care Only minimal amount of patient engagement Has gradually changed over time but basic design of the suite remains
12. 12. Observations Changing World Decreasing autonomy Increasing regulation Meaningful Use Issues Volume to Value migration Lifestyle diseases Population Health Increasing transparency Here to stay and growing EMRs, EHRs, PMRs, PHRs Imaging & Photography Patient satisfaction and engagement Patient originated information Telemedicine & virtual visits License expansion High cost of physical space
13. 13. Change, change and more change Rapid adaption key to survival Industry responses Move transaction processing as close to customer as possible Decreasing costs Increasing value Changing who does what, where and how things are viewed Medically allowing patients to participate in the process Medical inertia drags down required adaptation
14. 14. What can be changed? Element Cost Workflow Who does what Who does where Low Technology Whats in the room Tools to help Medium Design Architectural design Bricks and mortar High
15. 15. Secret fact: Computer is More for the patient than the physician
16. 16. A closer look at workflow
17. 17. Typical Office workflows 1 2 3 4 5 8 6 9 10 11 7 12 13 14 1 2 3 4 5 8 6 9 10 11 7 12 13 1 2 3 4 5 8 6 9 10 11 7 12 13 14 15 16 17 18 19 20 212223 24 26 27 28 29 30 31323334 1 2 3 4 5 6 78 8b 9 10 11 1112 131415 12
18. 18. Technology Enabled Simplified Work Flows 1 2 3 4 5 6 7 7 8 8 9 10 11 12 13 14 1516 1 5 9 6 9 7
19. 19. Second attempt: Heartland Health Suburban ambulatory clinic Community hospital 60 clinics spread out over a 22 county area in NW Missouri and NE Kansas Engaged staff open to experiments
20. 20. Existing Building: Architectural Layout Patterned after Greg Korneluk International Council for Quality Care No planning for information technology Brought in to take offices into a paperless environment Carved out pilot to allow for rapid expirimentation Providers Rooms Providers Rooms Providers Rooms Providers Rooms Providers Rooms Providers Rooms Functional Unit Functional Unit Functional Unit Functional Unit
21. 21. Each provider had own workflow Exam Room In Drs Office Rooms Pt Takes Vitals Rooms Pt Review Meds, Allergies & Problems Documents HPI & ROS Rooms Pt Review Meds, Allergies & Problems Documents HPI & ROS Rooms Pt Review Meds, Allergies & Problems Documents HPI & ROS Prints Sheet for Physician Nurse Area Exam Room Physician Sees/Exams Using Paper Dictates Note Physician Sees/Exams Using Paper Physician Sees/Exams Uses Computer & Nurse Note Dictates Note In Drs Office Reviews and Signs Note Reviews and Signs Note Documents Note in Comptuer Documents Note in Computer Using Nursing Note Prints Sheet for Physician Traditional paper based with role stratification Traditional paper based with role expansion Collaborative, computer based with role expansion Collaborative, computer based, role expansion and at point- of-care Work Flows
22. 22. Variable contributions and Trade Offs 0 1 2 3 4 5 6 7 8 9 10 Paper No Chart Same Tool 0 1 2 3 4 5 6 7 8 9 10 Paper Paper + Comp Comp + Dict Comp Nurses Time Documenting Physicians Time Documenting
23. 23. Time spent in exam room
24. 24. Exam Room Technology My own experience
25. 25. Evolution of in-room technology
26. 26. Enabling point of care interactivity
27. 27. Second Screen Concept Primarily for the patient Doesnt have to be a computer screen Smart Phone Attached device Procedure instrument screen Examples Dentist office Accountant Grocery Store
28. 28. Current State
29. 29. Web tools
30. 30. Point of Care Diagnostic Devices Proscope HR Proscope Micro Earscope Firefly Dino-Lite Cellscope Camera(s) Spirometers
31. 31. Design Revisited Whats out there now
32. 32. Typical designs
33. 33. Few designed with computer in mind
34. 34. A good design
35. 35. Summary
36. 36. Change is Inevitable .adaptation is the key to survival Workflows are the least expensive approach to change Internal policies and procedures (based on paper workflows) may be the hardest obstacle next to Reimbursement rule interpretations Exam room technology is the next least costly approach Computer(s) in room are for everyone in the room Use them to work in parallel Think outside the exam room Architecture is the most expensive Biggest enabler but requires 10-15 year foresight