CNEA Question #4.

4. If you are a network, do you support your clinics in workflow redesign? If you are a clinic organization, how did workflow redesign play a part in your implementation?
a. What tools or techniques did you use?
Golden Valley has 25 medical locations in which we are implementing our EHR. Our first step before we could even attempt to implement any piece of EHR was to review the current processes for the workflow for our Back Office, Front Office, Medical Records, Providers, and other support staff. We worked with our HealthPort EHR trainers and support staff to gather information on ways to convert a paper workflow to an EHR workflow. Our IS Application Support Trainers were tasked with the role of working with the staff to modify the workflows.
After working with various supervisors and providers in the workflow modifications, it was determined that an EHR committee would be needed to assist in modifying and enforcing the changes. We created a committee which is comprised of our CMO, CIO, Deputy CEO, Chief Site Administrator, Associate Medical Directors, Nursing Site Administrator, Director of Nursing, and our IS Application Support/Trainers. This committee meets monthly to review new EHR processes and assist in identifying issues with our current processes and the development of new processes and software enhancements.
b. What were the most challenging aspects of workflow redesign?
We have actually had a few challenges in implementing our EHR workflow redesign. Since our organization has so many locations and is spread between 2 counties, we found that the current paper workflows weren’t always consistent between the sites in the various counties. In dealing with this problem we had to work harder at gaining the staff and site level managements cooperation.
Another issue that we found to be quite difficult to overcome was getting site level management to set in and take charge of the EHR deployment and own the processes after we had finished training and shadowing at the site. This is a problem that we are still in some ways struggling with. By having full top level leadership cooperation during the process redesign and throughout the implementing the EHR we didn’t anticipate this problem. We have actually had to develop processes to insure the site level supervisors are aware of the audits and responsibilities they need to do to insure their staff continues to work successfully and correctly in the EHR.
c. How did this effort positively or negatively impact you’re EHR implementation?
There has been both positive and negative impact on the EHR implementation by taking the time to examine the existing workflow processes and modify them to work within the EHR environment. By having written workflow processes to refer to and pass along during training, many staff felt at ease. The processes made it easier for our trainers to understand the various tasks and responsibilities of the staff to be trained. The staff being trained knew what was expected of them and had a resource they could turn to for assistance; that is other than their EMR trainers. While many staff members felt at ease with the new processes and were able to adapt without any problem. There were several that felt that by changing what they had always done, we were adding additional work to their day. I have to say that whether there was some reluctance in the beginning to adapt to the new processes or not, we have had a successful implementation at the site we have moved to EHR. Once the staff adapted to the new processes it is difficult for them to go to one of our medical sites that haven’t had the EHR implemented yet. There will always be those who have more difficulty adapting to new processes than others.
Many times a new workflow process meant introducing new hardware into the current flow. This sometimes means training staff on equipment they have never used before. There is always a learning curve and some anticipation whenever you introduce new equipment; i.e., laptops and scanners.

d. Are there any tools, templates or approaches to this activity that you can share or recommend?
When trying to develop the new EHR processes we found that it helped to write down exactly what the existing responsibilities of each staff member were. By taking the existing process and looking at the expectations of the new EHR environment it made it easier to see where the changes needed to be. As with any process redesign there were many of the processes that had to be redesigned again after they were implemented. By developing an EHR committee we can continually reevaluate the working EHR processes and rework them as needed.