NURS 6420 - Supporting Workflow in Healthcare Systems Case Study Paper

• What is workflow?Workflow is the sequence of physical and mental tasks performed by various people within and between work environments. It can occur at several levels (one person, between people, across organizations) and can occur sequentially or simultaneously. NURS 6420 - Supporting Workflow in Healthcare Systems Case Study Paper

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  For example, the workflow of ordering a medication includes communication between the provider and the patient, the provider's thought process, the physical action by the provider of writing a paper prescription or entering an electronic prescription into an electronic health record and transmitting the order electronically or having the patient take the prescription to the pharmacy to have the prescription filled.NURS 6420 - Supporting Workflow in Healthcare Systems Case Study Paper

• What must I consider when I think about workflow?Always keep in mind that workflow occurs between organizations; between people at a clinic; in one's head; and before, during, or after a patient visit.
• Why is it important to assess workflow?Anytime you make a change to your practice, especially when implementing health IT, the workflow associated with clinical and practice management processes will change.NURS 6420 - Supporting Workflow in Healthcare Systems Case Study Paper
• What are consequences of not analyzing workflow?Research assessing health IT implementations demonstrates that delays in patient care, billing, and communication are likely to occur if workflow is not taken into account. This is generally due to the fact that clinical and practice management requirements are overlooked or oversimplified.
• How do I analyze workflow? This toolkit provides a number of resources to help you get started. Depending on your needs, you may wish to:NURS 6420 - Supporting Workflow in Healthcare Systems Case Study Paper
  • see examples of how to analyze workflow (Workflow Tool Examples)
  • read about other clinics like yours that have implemented health IT (Others' Experiences)
  • select educational presentations to use in your clinic (Educational Presentations) or
  • read summaries of peer-reviewed papers that offer more in-depth information on workflow and health IT (Research)
• Who should collect & analyze workflow? Regardless of size, your clinic needs to identify at least one person to oversee the assessment of current and anticipated workflows.
• When should I assess workflow?You need to collect workflow information as early as possible, and preferably before implementing a health IT system. As a form of ongoing process improvement, you should continue to assess workflows post implementation.NURS 6420 - Supporting Workflow in Healthcare Systems Case Study Paper

Strategies for Streamlining Nursing Workflow

You've probably heard the adage, "work smarter, not harder." Workflow improvements, such as electronic health records (EHR), allow nurses to spend more time with patients and less time at the computer. Technological resources can streamline workflow at the point-of-care, improve teamwork, provide material for efficient nursing research, and help nurse managers track staff proficiency and provide standardized procedures.

The need to think about workflow design is pressing due to several factors in healthcare, including:NURS 6420 - Supporting Workflow in Healthcare Systems Case Study Paper

• the introduction of new technologies and treatment methodologies into clinical care
• the challenge of coordinating care for the chronically ill
• the participation of a growing number of professionals in a patient’s care team, and new definitions in their roles
• cost and efficiency pressures to improve patient flow
• initiatives to ensure patient safety
• implementation of changes to make the care team more patient-focused.

New Technologies Streamline Workflow at the Point-of-Care 

EHR systems allow nurses quick access to patient information at the point of care that can also map drug information and customize patient handouts. Before implementing information technology in a health care environment, it is important to have an understanding of processes and information flows. In addition, the decision makers must consider the various roles in the different departments, and consider ideas from multiple sources. Each department and role may have a different perspective.NURS 6420 - Supporting Workflow in Healthcare Systems Case Study Paper

Coordinating Care

Valuable information can be lost when poor workflow impedes communication and coordination of care. Characteristics of a poorly functioning work process include unnecessary pauses and rework, delays, established workarounds, gaps where steps are often omitted, and a process that participants feel is illogical. A good workflow will lead to care that is delivered more consistently, reliably, safely, and in compliance with standards of practice.

Improving Teamwork Among the Care Team

Workflow processes are maps that direct the care team on how to accomplish its goals. Nurses can work as a team to create department-specific folders online to store valuable information such as links to research articles, images, alerts, other information needed on the floor, and customized education packets. When communication is smooth, working together as a team comes easily.NURS 6420 - Supporting Workflow in Healthcare Systems Case Study Paper

Making Care More Cost-Efficient

According to www.health it.gov, based on the size of the health system and the scope of their EHR implementation, benefits for large hospitals can range from $37 to $59 million over a five-year period in addition to incentive payments. Savings are primarily attributed to automating time consuming paper-driven and labor-intensive tasks. Using EHR results in reduced transcription costs; reduced chart pull, storage, and re-filing costs; improved and more accurate reimbursement coding with improved documentation for highly compensated codes; and reduced medical errors through better access to patient data and error prevention alerts.

Ensuring Patient Safety

Another unique aspect of technology at the bedside allows nurse managers to provide their nursing staff with standardized procedures and track their staff’s proficiency in skills and procedures with skill competency checklists. This ensures that procedures are being performed the right way.NURS 6420 - Supporting Workflow in Healthcare Systems Case Study Paper

Patient-Centered Care

Patient-centered care is defined as "care that is respectful of and responsive to individual patient preferences, needs and values, and ensuring that patient's values guide all clinical decisions."

Healthcare organizations that are patient-centered engage patients as partners in their care. The evidence for principles and practice of patient-centered care has resulted in increasing recognition of, and greater focus on, the engagement of patients, and the value and benefit of patient engagement.

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Implementing enhanced workflow strategies will build teamwork, save money, improve patient care and ultimately, outcomes.

The issue of how to improve hospital workflows is one that concerns senior healthcare management at every level. Maximizing ROI – while remaining attuned to the needs of key employees and delivering a high standard of patient care – is pivotal to the success of a healthcare organization. One of the acknowledged methods of reaching this goal is by achieving workflow optimization in hospitals.NURS 6420 - Supporting Workflow in Healthcare Systems Case Study Paper

Fine-tuning hospital workflow management is a delicate business. Many decisions made by senior management in order to achieve workflow optimization in hospitals affect everybody within the hospital environment – including patients. Unhappy employees and dissatisfied patients will not achieve the objective of improving hospital workflows, and likely have a negative effect on ROI.

In the highly regulated healthcare industry, the process of assessing how to improve hospital workflows also has to take into account regulations governing how certain activities are conducted. One of these activities – the communication of electronic Protected Healthcare Information (ePHI) – is governed by several sets of regulations (HIPAA, HITECH, etc.). A solution exists for the communication of ePHI that has been proven to improve hospital workflows, increase productivity and help to deliver a higher standard of patient care – secure messaging.

Fine-Tuning Hospital Workflow Management with Secure Messaging

Secure messaging is a HIPBATH-compliant communications solution that can be used to replace unsecured and outmoded channels of communication such as voice mail, email, pagers and fax machines – channels of communication that often inhibit critical workflows due to medical professionals playing phone tag in order to facilitate hospital admissions, request physician consults, obtain lab results, organize the transition of care and arrange patient discharges.NURS 6420 - Supporting Workflow in Healthcare Systems Case Study Paper

Each of these processes has its established workflow but – frequently – outmoded channels of communication prevent them from flowing as smoothly as they should. The resulting communication friction wastes time, erodes staff moral and delays patient care. With secure messaging, the mechanisms in place to ensure message accountability improve hospital workflows – eliminating the waste of resources and allowing medical professionals to spend more time with their patients.

The implementation of secure messaging will not change the way in which these processes are conducted, just fine-tune hospital workflow management. In each of the sections below, we illustrate how secure messaging can help to achieve workflow optimization in hospitals in specific scenarios. Not every scenario will apply to every medical facility, but the examples provided have three things in common:NURS 6420 - Supporting Workflow in Healthcare Systems Case Study Paper

• Secure messaging reduces risks, helps healthcare organizations comply with HIPAA and qualify for payments through the Meaningful Use incentive program.
• Secure messaging offers faster, more effective communication that helps healthcare professionals treat more patients with better success rates in less time.
• Secure messaging enables healthcare professionals to use their personal mobile devices for such tasks as prioritizing their workflows and fostering collaboration.

Hospital Emergency Room Workflow Efficiency

One of the areas of a hospital´s operations where fast, secure communications are key to a successful outcome is its Emergency Room. It is in the Emergency Room where critical decisions are made relating to a patient´s healthcare that can have permanent implications for their well being. However, even before patients arrive at a hospital Emergency Room, there are ways in which secure messaging can increase hospital Emergency Room workflow efficiency.

First res ponders and Emergency Medical Services can forewarn healthcare professionals of incoming patients and their injuries, attaching images and video to secure messages in order to give a more comprehensive explanation of the patient´s condition than any pager or radio message can. With this information, Emergency Room teams are in a better position to receive the patient and have the necessary resources available to attend to them.

The ability to send images and videos via secure messaging also enables the fast evaluation of patients by consultants not physically present in an Emergency Room. This not only helps towards eliminating admission delays and ensuring that patients requiring inpatient treatment receive it faster, but also increases hospital Emergency Room workflow efficiency for “treat and release” patients, who may otherwise be backlogged due to priority case congestion.NURS 6420 - Supporting Workflow in Healthcare Systems Case Study Paper

Hospital Admission Workflow Efficiency

In a 2010 study published by Bio Med Central (BMC), admission delays were found to result in an increased inpatient length of stay and estimated to cost an average-sized healthcare organization in excess of $2 million per year. It also found that hospital admission workflow efficiency was influenced more by factors external to the Emergency Department than the admissions process itself.

Whereas some factors cannot be resolved by secure messaging, significant improvements to hospital admission workflow efficiency can be achieved with secure messaging. Bed availability can be monitored with secure texting, lab turnaround can be accelerated by secure texting, and the latest secure messaging apps have an auto-forward feature so that, if one particular physician is unavailable, a consult request is forwarded to another physician who can step in and eliminate the potential admission delay.

Orders can be placed via a secure group messaging feature that sends automated alerts to the unit managers and nurses who will be responsible for the patient´s healthcare. Unit managers, nurses and administrators can seek order clarification by secure messaging if required, and receive fast responses from physicians – or their deputies if unavailable. Physicians can also receive lab results and radiology images the moment they are entered into the EMR in order to accelerate diagnoses and decrease the number of redundant tests.NURS 6420 - Supporting Workflow in Healthcare Systems Case Study Paper

Hospital Laboratory Workflow Efficiency

Hospital laboratories play a crucial role in the healthcare system. Labs in hospitals and clinics perform over seven billion tests each year, and lab results influence over 70% of all medical decisions. Each specimen passes through up to a dozen steps from collection to the delivery of lab results; and, while processes are in place to maximize hospital laboratory workflow efficiency, some of these steps are often performed manually – not only adding time to lab turnaround, but risking errors that can compromise patient safety.

According to a study conducted by the Tepper School of Business at the Carnegie Mellon University, the integration of secure messaging solutions with EMRs reduces the risks of patient safety events by 27%. Researchers found that the implementation and integration of secure messaging helped with the correct ordering and follow-up of the right test, correct patient identification, and the correct communication of test results, specimen quality and delivery problems.NURS 6420 - Supporting Workflow in Healthcare Systems Case Study Paper

When labs results reveal a serious and urgent health issue, healthcare professionals must take immediate action to avoid a patient´s condition deteriorating. Integrating secure messaging into an EMR ensures lab results do not sit around in a physician’s inbox until he or she has time to attend to them. Instead, EMR alerts are automatically sent and reviewed the moment updates are added to the patient´s medical record, increasing hospital laboratory workflow efficiency and potentially saving lives.

Hospital Pharmacy Workflow Efficiency

An example of how workflow optimization in hospitals can be negatively influenced by outside events is in the hospital pharmacy. Most pharmacies have the key elements in place to optimize hospital pharmacy workflow efficiency – a good system of work, team members with the right skill sets, and an environment that enables prescriptions to be filled accurately and efficiently. However, the optimization of hospital pharmacy workflow efficiency is often compromised by addressing insurance issues and physician callbacks to confirm scripts.NURS 6420 - Supporting Workflow in Healthcare Systems Case Study Paper

With secure messaging, the issues of insurance and physician callbacks do not disappear, but the length of time attending to them decreases. With secure messaging, a pharmacist can address a payment issue or send a request for order clarification to a physician, safe in the knowledge that their message is 100% guaranteed to be received and likely to be answered at the first practical opportunity. Phone tag and workload increases are reduced, while pharmacies are more able to deliver high-quality patient care and maintain employee job satisfaction.

In addition to helping optimize hospital pharmacy workflow efficiency, secure messaging can help both in-house and off-site pharmacies comply with the conditions for the Meaningful Use incentive program. The electronic exchange of information, electronic prescription hand-offs, and the monitoring of medication journeys are all Meaningful Use requirements that can be conducted by secure messaging – securely, from a mobile phone and with no risk of a data breach.

Hospital Discharge Workflow Efficiency

Throughout a patient´s stay in a hospital, secure messaging enables healthcare professionals to improve hospital workflows and coordinate the transition of care. With secure messaging eliminating the short delays that can stack up and push patients past the 72-hour Medicare reimbursement window for many procedures, patient stays are reduced, hospital beds become available quicker and bottlenecks preventing hospital admission workflow efficiency are averted.NURS 6420 - Supporting Workflow in Healthcare Systems Case Study Paper

When it comes to hospital discharge workflow efficiency, secure messaging once again has an important role to play in increasing productivity and delivering a higher standard of patient care. Frequently, physicians will clear a patient to go home; but, due to discharge orders remaining unnoticed in the EMR, unnecessary delays occur. With secure messaging, automated alerts are sent to each member of the discharge team so that discharge planners, unit secretaries, nurses and other members of the team are kept in the loop and move the patient through the discharge process quickly.

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A typical communication path to optimize hospital discharge efficiency with secure messaging would be:

• Physician logs request for patient discharge into the EMR from his/her mobile device.
• Nurse and unit secretary are automatically alerted. Discharge order logged into EMR.
• Discharge planner coordinates medical reconciliation. Nurse instructs patient.
• Nurse text patient´s family to arrange transportation.

Workflow Analysis: The Importance of Clinical Order Sets

Clinical decision making for wound management is dependent on the types of patients evaluated in your care settings, the skill sets of the clinicians making the decisions for those patients, the products available to manage the patient, and the documentation platform used to capture the work performed. Essentially, every step along the patient engagement continuum is strategically guided through process. In order to strategically manage your process, workflow analysis is imperative.NURS 6420 - Supporting Workflow in Healthcare Systems Case Study Paper

A workflow is a set of tasks that are completed to accomplish a goal. Your workflow should be defined with chronological processes, depicted typically through the sequential use of forms for documentation within an electronic medical record, and identified by the set of people or other resources available to perform those processes and the interactions among them. Providing this process-driven approach for yourself and to your employees can maximize the department’s efficiencies and patient throughput and ensure you have completed the necessary quality and patient safety documentation during the patient’s course of care.

It is important to analyze workflows at least annually to ensure you are capturing the proper documentation elements in the proper sequence to maximize clinical, operational, and regulatory efficiencies.

Assessments

Including assessments, such as a nutrition assessment, is key to your workflow. Nutrition risk assessment tools assist the practitioner in understanding the strategies necessary to identify the levels of nutrition risk. Many nutritional components are critically important in the wound healing process. Improper nutrition can affect a patient’s immune function, collagen synthesis, and wound tensile strength, which are needed during and after the wound healing process.NURS 6420 - Supporting Workflow in Healthcare Systems Case Study Paper

Further clinical factors for wound and skin assessment include understanding the physical findings of the wound and skin, the evaluation of the patient’s laboratory values and diagnostic tests, nutrition needs, and management modalities, such as topical dressings, drugs, support surface products, and off-loading devices. Optimizing your workflow with the proper diagnostic and documentation processes is critical to these understandings.

Clinical Order Sets

Including clinical order sets in your workflow is another way to improve compliance and patient outcomes. Let’s take a closer look at the construction of clinical order sets, building upon the aforementioned nutrition assessment and the respective laboratory values necessary for evaluating nutrition.

Clinical order sets (basically, predefined templates) are one way to ensure patient safety and reduce risk. Creating order sets for the wound types seen in your department provides a common platform and support for clinical decisions related to a specific condition or medical procedure. Further, creating wound-specific laboratory values assists with the consistency of ordering and care.NURS 6420 - Supporting Workflow in Healthcare Systems Case Study Paper

Laboratory values are helpful in assessing and monitoring any chronic underlying medical conditions as well as the patient’s nutrition status. These values should be evaluated at the first patient encounter to establish a baseline for care. In addition, if healing is not occurring as expected, these values can be tracked regularly, as triggered within your follow-up workflows, to ensure that local and systemic factors are not contributing to poor healing. Important parameters to evaluate include protein levels, complete blood count, erythrocyte sedimentation rate, liver function tests, glucose and iron levels, total lymphocyte count, blood urea nitrogen and creation levels, protein levels, vitamin and mineral levels, and urinalysis.

Workflow for healthcare, whether it's at a large pharmaceutical company, hospital system, or a small medical equipment manufacturer, requires accuracy and accountability. Automated workflow technology for healthcare provides better internal controls and improved efficiency leading to better customer service, shorter product cycle times and reliable audit trails.NURS 6420 - Supporting Workflow in Healthcare Systems Case Study Paper

In a highly-regulated industry, complete data visibility for both internal stakeholders and external agencies can save countless hours and dollars in regulatory compliance activity. Workflow automation can help healthcare organizations:

• Meet compliance and regulatory requirements
• Improve the workflow of approvals and documentation
• Provide workflow interoperability with other systems
• Reduce go-to-market cycles
• Improve internal audit controls
• Eliminate redundancies and consolidate internal services
• Route documentation and information securely for approval
• Standardize employee hiring and on boarding

In addition to the myriad healthcare-specific workflows that can be built in Integrity, healthcare companies need the same automated processes as other organizations including processes for Finance, HR, IT, Operations, Marketing and Customer Service. Because Integrity is use case agnostic, customers are free to build any kind of automated workflows needed including:

• Employee Request Forms
• Financial Approvals
• Requests for Marketing Materials
• IT Support Tickets
• Security Requests and Approvals
• Issue Reporting

In the design of successful healthcare information technology implementations, patients matter. Although the importance of addressing the workflow needs of clinicians cannot be overstated, focusing on patient needs helps ensure newly designed workflows leverage the full capabilities of information technology tools. In addition, this delivers the clinical and financial outcomes desired by organizations. Entities that ignore the needs of clinicians in designing HIT-driven workflows can expect to experience either low levels of HIT adoption among clinicians, sub optimal patient care results, or both. Focusing on patient care provides a framework in which to create effective workflows that leverage new technology to deliver promised value to caregivers and their patients.

The Institute of Healthcare Improvement—founded by former administrator of the Centers for Medicare and Medicaid Services, Don Ber wick, MD —displays this mantra throughout its facility: Every system is perfectly designed to achieve exactly the results it gets. 1NURS 6420 - Supporting Workflow in Healthcare Systems Case Study Paper

Therefore, organizations that utilize new information technologies to mimic the existing workflow of clinicians deliver results no better than outcomes previously reached. In some cases, the inherent complexity of the information technology when deployed within a paper-based workflow can deliver results worse than originally obtained.

To effectively implement HIT, organizations must understand in-depth the capabilities of the available information technology, the requirements of the practicing clinicians, and the expected outcomes of all impacted stakeholders (i.e., patient, clinician, organization). Teams built from a cross-section of disciplines and perspectives hold the greatest promise in designing effective workflows. Building a comprehensive workflow across caregivers allows for efficient use of resources to achieve specific patient goals.

Workflow Defined
Workflow is defined as any task performed in series or parallel by two of more members of a work group to reach a common goal. “Tasks” refer to any activities or actions undertaken by individuals. “Series or parallel” implies tasks performed one after another or simultaneously. “Work group” means a team of individuals working on the same project. Finally, “common goal” indicates that a group’s various activities are performed in concert to contribute to a well-defined and agreed-upon outcome.NURS 6420 - Supporting Workflow in Healthcare Systems Case Study Paper

At a granular level, workflow functions to (1) deliver information to the appropriate people, (2) organize information to be immediately useful, (3) ensure that the information is acted on, and (4) file information and record actions taken.

The specific needs of the healthcare industry make it an ideal match with workflow concepts. Healthcare involves complex procedures that include both clinical and administrative tasks. As a result, workflow increases efficiency and effectiveness through the maximal integration and use of relevant, timely information. Due to its heavy reliance on information, healthcare is in a unique position to take advantage of the information benefits provided by the implementation of workflow concepts.

• Creating a particular workflow requires the stringing together of various healthcare tasks, both clinical and administrative, to achieve a desired outcome in the most efficient manner possible. Patient-centered workflow fuses clinical and administrative protocols by sequencing care tasks, coordinating medical and non medical care resources, and establishing a defined timeline for completion of set tasks. Patient-centered workflow involves:
• Identifying a target process (e.g., patient care post-myocardial infarction).
• Defining both clinical and administrative tasks to be performed by a work group.
• Breaking down tasks, in some cases, into more specific actions that can be performed by different individuals but which, when completed together, accomplish the original tasks.
• Deciding on the skill set required to perform each task or action (e.g., skills of a physician, nurse, technician, receptionist, patient).NURS 6420 - Supporting Workflow in Healthcare Systems Case Study Paper
• Understanding the sequence in which the tasks are to be performed.
• Recognizing and applying conditional rules and logic branching, so that only necessary and indicated tasks are performed.
• Planning the sequence of tasks, assigning the tasks to individuals, and then documenting the process so that others can understand and follow it.
• Creating the forms, documents, and instructions needed by individuals at each step to perform the tasks (e.g., patient hospital discharge instructions).

Invaluable New Technologies
Readily available healthcare information technologies offer invaluable tools such as single sign-on (SSO), roaming desktops, location awareness, and fast-user switching to support impactful patient-centered workflows.

For example, let us consider an inpatient post-myocardial infarction diabetic patient on the day of discharge. Administration of medications requires a nurse to sign-on to multiple HIT systems including a medication administration system to obtain a list of prescribed medications and an electronic medical record system to document patient care.

Single sign-on allows for rapid access to multiple systems through the use of a single two-factor authentication process: who you are (e.g., proximity identify card) and what you know (e.g., password). As the nurse previously reviewed the patient’s record at the nurses station, roaming desktop technology permits rapid access to the identical desktop in the patient’s room without needing to open or position the required applications on the display screen. With such technologies, devices function independently, allowing for the use of computers and tablets interchangeably during the continuum of patient care workflow.NURS 6420 - Supporting Workflow in Healthcare Systems Case Study Paper

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As some applications may be inappropriate for display in a patient’s room—email, human resource systems, web searches—location awareness technology filters in only information that is relevant to the patient. Such filtering allows for the use of dual displays that deliver simultaneous viewing of clinical information by the clinician and the patient. In addition, location awareness directs the convenient printing of relevant documents, in this case, patient discharge instructions at the patient’s bedside printer.

Lastly, fast-user switching facilitates the use by multiple clinicians of the same HIT platform (e.g., bedside computer) by rapidly presenting user-specific displays, as defined by role (e.g., nurse, physician, specialist). The technology eliminates the need for frequent, complete sign-out and sign-in by each user, a ghastly process that is off-putting for clinicians.NURS 6420 - Supporting Workflow in Healthcare Systems Case Study Paper

Patient-centered workflow requires stringing together individual steps, the linking of processes, and the bridging of activities by multiple caregivers to create an effective and efficient orchestration of resources to enhance the health of the patient. Technology provides only the tool kit to achieve these workflows. Knowledgeable professionals from multiple disciplines synergistic ally working together hold the potential to build efficient models for care. By focusing on the patient, rather than the technology or the any individual participant in the workflow, provides the greatest opportunity to achieve successful outcomes that benefit the clinician, organization, and patient.

Caregivers are faced with new challenges every day as the worlds of medicine and technology collide. The use of technology in healthcare environments can help to connect physicians, nurses, and clinical staff; streamline their workflows; automate routine tasks; and ultimately, improve clinical outcomes.NURS 6420 - Supporting Workflow in Healthcare Systems Case Study Paper

However, all too often, technology can also introduce complexity, confusion, delays in care, and risks to patient safety and care. The outcomes produced by the use of technology depend on how that technology is designed, implemented, and used.

To create the best patient outcomes, technology partners need to focus on how the technology interacts with the caregivers who use it, as well as with other technologies and systems in the environment. They need to design and build solutions that facilitate care team collaboration through integration and interoperability. It’s all about enabling workflows that produce desired patient outcomes.NURS 6420 - Supporting Workflow in Healthcare Systems Case Study Paper

Below are five workflows, all used today by healthcare organizations that rely on Spok. They illustrate how technology can enable caregivers to achieve positive outcomes in patient care.

1. Admit and Discharge Consults

Streamline the communication process between caregivers and reduce bed turn-around times by referencing scheduling data to send a consult request to the admitting hospitality, then sending an acknowledgment back to the electronic health record (EHR).

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2. Critical Codes

Improve the delivery times of critical codes (Code Blue, Code STEMI, etc.) and increase patient safety by automating the process of notifying code teams. When a patient is in distress, a caregiver pushes the code button in the patient's room. That quickly alerts and assembles the code team. Alternatively, this process could be initiated when a patient medical device measures a critical alarm value.NURS 6420 - Supporting Workflow in Healthcare Systems Case Study Paper

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3. Medication Orders

Improve response times for medication orders by referencing scheduling data to send an order to a patient’s nurse, then sending an acknowledgment back to the EHR.

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4. Nurse Call Requests

Reduce alarm fatigue for nurses and enable them to quickly respond to patient needs by automating nurse call alerts. When a patient presses the nurse call button at the bedside, the notification is delivered securely with relevant context to the nurse’s smartphone or Wi-Fi phone. With just a few taps, the nurse can be connected to the patient and follow up on his or her needs.NURS 6420 - Supporting Workflow in Healthcare Systems Case Study Paper

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5. Critical Lab Findings

Improve response times to critical test result communication by automatically sending secure alerts with clinical context to caregivers when critical values are measured and recorded in the lab information system.

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Each of these workflows can help improve clinical outcomes in different ways, leading to improved patient satisfaction, better patient care and safety, and increased quality of care. These things can help hospitals improve HCAHPS scores, core measures, nursing-sensitive indicators, and other quality measures.NURS 6420 - Supporting Workflow in Healthcare Systems Case Study Paper

Streamlined workflows, accomplished by connecting technology systems and caregivers, lead to more efficient and effective care coordination. It’s important to implement tools that can facilitate connections between caregivers and the systems they rely on for information, such as nurse call systems, EHR systems, lab and radiology information systems, and patient monitoring equipment. By connecting care providers to this information, and to one another, technology can be what it is supposed to be in healthcare:

Health care has often faced the pressure to design, or redesign, its workflows to be more efficient and effective. In many cases, the trigger for examining workflow is in response to changes in how things are done. Today, the need to think about workflow design is more pressing due to several factors, including:NURS 6420 - Supporting Workflow in Healthcare Systems Case Study Paper

• The introduction of new technologies and treatment methodologies into clinical care
• The challenge of coordinating care for the chronically ill
• The participation of a growing array of professionals in a patient’s care team, and new definitions in their roles
• Cost and efficiency pressures to improve patient flow
• Initiatives to ensure patient safety
• Implementation of changes to make the care team more patient-focused

One important reason that workflow is of pressing concern for today’s clinicians is the introduction of new health care information technology (health IT) into clinical practice. Health IT promises many benefits for improving quality and efficiency. However, the introduction of health IT can be very disruptive to existing workflows in an organization. Health IT systems often implicitly assume a workflow structure in the way their screens and steps are organized. Organizations that are thoughtful about workflow design are more likely to be successful in adapting to health IT.^{1NURS 6420 - Supporting Workflow in Healthcare Systems Case Study Paper}

In contrast to industries such as manufacturing, health care is a service industry that relies heavily on good information. In closely following and taking care of patients, nurses are guardians of a rich source of information. This valuable information can be lost when poor workflows impede communication and coordination or increase interruptions.² Characteristics of a poorly functioning work process include unnecessary pauses and rework, delays, established workarounds, gaps where steps are often omitted, and a process that participants feel is illogical.

The design of good organizational workflow is not simply about improving efficiency. Workflow processes are maps that direct the care team how to accomplish a goal. A good workflow will help accomplish those goals in a timely manner, leading to care that is delivered more consistently, reliably, safely, and in compliance with standards of practice. An excellent workflow process can accommodate variations that inevitably arise in health care through interaction with other workflow processes, as well as environmental factors such as workload, staff schedules, and patient load.NURS 6420 - Supporting Workflow in Healthcare Systems Case Study Paper

In recent years, healthcare institutions have had problems accessing and maintaining the large amounts of data they deal with. This paper identifies current approaches and technologies which relate to patient administration systems. It argues that, in the near future, WWW-based multimedia patient administration systems would become the norm for healthcare institutions. The development and acceptance of web-based multimedia patient administration systems is likely to aggravate the problem of healthcare institutions being flooded with large amounts of clinical data. A large amount of clinical procedures relating to patient management are repetitive and Workflow Management Systems (WFMS) can automate these repeated activities.NURS 6420 - Supporting Workflow in Healthcare Systems Case Study Paper We believe that the introduction of WFMS would enable healthcare institutions to face this challenge of transforming large amounts of medical data into contextually relevant clinical information. The central contention of this paper is that there is a dynamic connection between healthcare, workflow and internet technologies, which is being ignored. This paper further establishes that it is possible to build a virtual electronic health record database based on the client server architecture using current internet and object-oriented (OO) technologies. NURS 6420 - Supporting Workflow in Healthcare Systems Case Study Paper