Question #4: Support of clinics in workflow redesign

NGHN strongly encourages its customers to conduct workflow analyses to plan for and train on new processes in seeing patients using an EMR and to ensure that the EMR system is implemented in a way that maximizes functionality. NGHN supports its customers in workflow redesign through the development and availability of relevant tools and resources. NGHN developed a Workflow Assessment Tool this year that provides a customized methodology in conducting the workflow analyses. This guide provides a standardized process to evaluate work flows and identify opportunities for change. The work flow analysis process includes: 1) collecting and analyzing baseline information; 2) comparing current work flows to ideal EMR use; and 3) developing future work flows and confirming hardware selection and placement within the constraints of each clinic.

The tool that was developed comprises the following documents:
· A process overview diagram that describes each work flow analysis step.
· A current-practice work flow analysis questionnaire that details specific information that should be captured for each common process and associated questions to ask during the observation periods.
· Templates to identify opportunities for change and design future processes to address each opportunity.
· A template to understand and analyze current documentation processes, as well as determine future hardware requirements and work flows to support clinical documentation.
· Example future-state diagrams and recommendations from two Planned Parenthood affiliates.

The end result of the work flow analysis is a vision for how the clinic will operate once the EMR is implemented, as well as specific and executable plans to support that vision. The final product is a series of process flow diagrams, using Microsoft Visio or a similar drawing program, outlining each of the major steps and decision points for each work flow in its current state.

In addition to the Workflow Analysis Toolkit, NGHN also maintains a sample library where customers that have already completed their workflow redesign work can share their processes and tools with others.

These efforts in conducting workflows have positively impacted their EMR implementation. It has required clinic staff to think through how they are going to transfer documentation and processes from paper to an electronic health record. The clinic staff is better prepared as a result for the transition to EMR.

There are several challenges that have been faced in conducting this work. Some customers have found a lack of standardization among existing processes at clinics within an affiliate when documenting current state. Also, it can be difficult to imagine the future state in EMR if you have not received adequate training on the use of EMR, so this is something that must occur prior to completing the workflow analysis.