One hospital's experience with process improvement

January 1, 2006

Complexity still strangling efforts to automate

One hospital’s experience with process improvementby Margaret Mayer

Electronic transactions occur everyday in almost every facet of the business sector, and healthcare is no exception. Never has the demand been greater from patients, physicians, financial managers and even the government, for faster, more accurate service. Meeting these technology expectations becomes a matter of bridging a multitude of gaps between the data sources that exist behind a transaction or information request.

There are currently three major drivers healthcare organizations must address: government regulations, technology demands and business concerns. Healthcare organizations willing to address these drivers by reinventing workflow processes and adopting new technologies will thrive. Ultimately, how efficiently an organization can move data and share information will determine how well it fills both the information and process gaps these business drivers create.

Every healthcare organization already has processes in place to manage their business at any particular point. These workflows are often developed in response to an immediate demand without consideration for how the information is ultimately used or how the process might be automated. In many cases individual departments, clinics and physician practices have each developed unique workflows to handle information within their specific departments or systems, but they fail to meet the needs of organization as a whole.

For instance, a fully functioning computerized physician order entry (CPOE) system must integrate with: the clinical data repository; nursing and physician (and other caregiver) documentation systems; clinical decision support system; results reporting system; electronic medication administration system; and the pharmacy system.

That’s at least six informational gaps that need to be filled. Within each area, manual tasks may create points of inaccuracy. As the demand for CPOE rises, the demand to fill those gaps and automate tasks intensifies.

Once an organization pinpoints the information gaps, it will find that automating specific tasks through technology and enhanced workflow yields fast returns on investment. Reinventing whole processes yields beneficial and predictable outcomes with payoffs that are both tangible and intangible.

When Credit Valley Hospital in Mississauga, Ontario (Canada), began to automate its registration process, it started at the top with the corporate vision and goals. It evaluated areas that would offer the greatest benefit and developed an Information Management Plan that focused on specific areas within the hospital that could benefit from process improvement.

There were a number of reasons why Credit Valley chose to reinvent its registration process. With more than 40 registration areas (six areas off-site) and 163 registration users, it was difficult to monitor the accuracy or consistency of captured data. Inaccurate data capture leads to lost revenue; incorrect patient demographics; inaccurate abstract data sent to the Canadian Institute for Health Information (providing part of the basis for hospital and facility planning and funding, disease surveillance, public health expenditures, physician referral patterns and other community based services); incorrect contact information (needed for effective disease surveillance); and the inability to standardize for addresses, postal codes and residence codes.

Credit Valley’s IT department had two primary goals: standardize the way patients were registered and improve the quality of data being captured at the point of entry. This would create a proactive approach to information gathering. The hospital began by working with the registration clerks to develop a project definition that identified all the fields on registration screens that were misused, misinterpreted or simply ignored. To enforce standardization, it established business rules that monitor users to ensure that all fields would be properly detected and completed. To ensure data quality and recover revenue, the hospital integrated an address validation product into the registration process, providing automated address look-ups.

Since completing this project, Credit Valley has experienced an 80% drop in address inaccuracies that slow revenue recovery. Any process enhancement, including this one, requires constant improvement and upgrades, but the hospital realized that the financial and strategic rewards are well worth the work.

Proper Planning Increases Results

Evaluating the benefit of re-engineering a widespread or complex process at a large health organization involves the buy-in and support of upper management as well as users. It is important to establish clear goals that align with the overall information management plan. In addition, time should be spent to properly evaluate and select appropriate technology.

By repairing the information cracks that exist throughout the hospital environment, organizations reap fast financial rewards and are able to respond not only to tactical needs, but larger technology demands.

Margaret Mayer is director of marketing at Sherborn, Mass.-based Boston Software Systems. She may be contacted at 866-653-5105.