Process Engineering Health IT Which Comes First

Process Engineering & Health IT: Which Comes First The Chicken or The Egg?

Why It Matters…

Primary Care Today PCMH “P 4 P” HIT

A Caveat…

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Healthcare IT is the means, but not the end, says Blumenthal September 16, 2009 | Diana Manos, Senior Editor

I’m From The Government And I Am Here To Help You…

ARRA, RHITEC, & “MEANINGFUL USE”

HITECH Priority Grants Program Rollout: Next Steps Toward Nationwide Health Information Exchange David Blumenthal, M. D. , M. P. P. National Coordinator for Health Information Technology, DHHS The White House has announced the rollout of the first two in a series of HITECH priority grant programs… Some Important Concepts: • Meaningful Use of certified EHR systems… • Health Information Technology Regional Extension Centers • Electronic information exchange

Michigan PCMH Definition, NCQA Standard/PGIP Domain, Proposed PCMH Metrics, Meaningful Use

Health IT and Transformed Health Care Ultimate vision is to enable significant and measurable improvements in population health through a transformed health care delivery system. *Adapted from National Priorities Partnership. National Priorities and Goals: Aligning Our Efforts to Transform America’s Healthcare. Washington, DC: National Quality Forum; 2008 11

Another Caveat…

. HIT is NOT Part of “Your Father’s Medical Practice”. It Can’t and Shouldn’t Be Attempted Without A Change In Practice Culture And Practice Workflow Re-Engineering

RHITEC Practice and Workflow Design Regional Centers must be capable of mapping and redesigning work processes, updating roles and responsibilities for clinicians and support staff, and leading continuous quality improvement activities involving rapid cycle feedback.

Go-Cart 15

Practice Redesign & Preparing for Health IT

. The “Magnificent Seven” Rules For HIT Preparation. . .

Rules For HIT Preparation 1 Culture Is Everything! 2 Re-engineer Your Practice Workflows BEFORE You Electronify 3 Carefully Examine ALL Of Your Functional Options 4 Be A Knowledgeable And Very Wary Consumer 5 Train Like There Is No Tomorrow! 6 Evaluate! 7 The Devil Is In The Interface

Prep Work

So, What’s a Body to Do?

What is PRISM? • A physician driven, non-profit corporation formed in cooperation with nine Michigan PO’s and PHO’s • Providing comprehensive practice and culture transformation services in Michigan and beyond on a “no-lose”, gain-share basis • Able and willing to assist the Michigan RHITEC (and others) in preparing primary care practices to becoming “meaningful users” in the context of helping them undergo transformation

TE TE TA TA TS TS EN EN RR RR CU CU PRISM & PRACTICE TEAM ANTICIPATED OUTCOMES E ICIN D ME D ASE B CEN IDE EV G KIN N THI N LEA GE HAN EC Y TUR L OLOG HN CU N TEC TIO ORMA INF ITY FITABIL PRO ION TISFACT R SA USTOME C

Strategy For Sustainability & Spread of Practice Transformation in Michigan & Beyond PO #1 PO #2 • No Risk To PCP PO #3 PO #4 PO #5 PO #6 PO #7 PO #8 • Funded from Waste Removed PRISM • Physician Directed • Staffed by FT Pros • Consistency PO #9 PCP PCP # of PCP’s Not Limited By Grant Resources PCP PCP PCP Sustainability & Spread Assured PCP

The ASQ Marshall Plan aka PRISM-lite

A Modern-Day “Marshall Plan For Healthcare” Would Like To Partner with Communities, Medical Associations, and Medical Groups To Assist In The Redesign of Their Practices

Getting to Sustainability and Spread… A Fishing Pole, Not A Fish

Communities Considering This Approach Community Sponsor(s) Anticipated Start Date Akron, OH Employer Health Coalition 1 st QTR, 2010 York, PA Local Health Care System 1 st QTR, 2010 Milwaukee, WI Medical Society & Employer Health Coalition 1 st QTR, 2010 Findlay, OH Employer & Local Hospital 1 st QTR, 2010 Erie, PA Local Health Care System 2 d QTR, 2010 29

One Example Of Process Re. Engineering At Work In A Medical Practice…

Meet SJ Family Medical Center 31

I Call Them The

Their Story 33

Receive Form When Patient Presents File Form At Front Desk Form Is Placed In MA Box Receive Form From Patient in Room Receives Finished Form From Doctor In Box Message: Is Form Completed? MA Distributes Form To Doctor Box In Box Message: Is Form Completed? Doctor Completes Form Give Form To Patient Contact Patient to Pick up Form Receive Call: Is Form Ready? Receive Call About Form Error Receive Form From Patient in Room Inbox Message To Doctor re: Error Practice Performance In The Current State First Time Quality (FTQ) Receive Form By Mail / Fax Value/Cost of Total Practice Time Spent / Yr In Process Receive Patient Phone Call: Is Form Ready? Form Error Inquire About Form Is Form Ready? Correction Done / Form Completed = 1% !!!!! = $ 169, 780 Patient Calls Re: : Form Status Inquire Re: DX Codes Management Of Patient Medical Forms Current State Inquire About Form Receive Call Complaint Re: Form Status

Management Of Patient Medical Forms Future State Practice Performance In The Future State First Time Quality (FTQ) = 72% !!! Value/Cost of Total Practice Time Spent / Yr In Process =$ 80, 448 END PLUS: Process Throughput Time Forms Cut in Half!!!

The COCQ Applied In One Family Practice • Hard Dollar Annual Savings of $90, 000 In Only One Process • Energized staff and physicians eager for more improvement • Dramatically Improved First Time Quality • Once learned, can be done by practice itself without outside help

In Closing, I’d Like to Leave You with A Song About Health IT…

The EMR Blues: “Paper Won’t Be Here Long…“ Dr. Sam & the Managed Care Blues Band “…Too many tests A thick chart - for you to read An EMR - is what you need You like to think that you're immune to the stuff, oh yeah It's closer to the truth, you know - Like it or not you know You're gonna have to face it – PAPER WON'T BE HERE LONG …” Dr. Sam Bierstock is an ophthalmologist, an electrical engineer, and a consultant for medical information systems management and design. He has published more than 50 articles on medical information systems, and written a book about medical office computerization.