Chapter 5 AB3
Using the attached form fill out the required sections to develop an annotated bibliography for the journal article that you accessed and read this week. Submit your completed form using the above link.
Annotated Bibliography Worksheet
A. Bibliographical Information
B. Summary of Article
C. Evaluation of Article
D. Reflection on Application to Practice or Implementation
Annotated Bibliography Rubric
50 Pts
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Written Criteria |
Exemplary 10 Points |
Developing 7 Points |
Needs Improvement 4 Points |
Faculty Comments |
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Bibliographical Information |
Bibliographical information is accurately stated and formatted. |
Bibliographical information contains 2-3 errors. |
Bibliographical information contains more than 3 errors. |
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Summary of Article |
Article is concisely summarized in one paragraph with no more than one error |
Article is more than one paragraph with one error |
Article exceeds one paragraph and has more than 2 errors. |
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Evaluation of Article |
Article is evaluated in light of its purpose and credibility |
Evaluation is loosely based on evidence but well organized |
Evaluation does not relate to purpose of article and is not evidence-based. |
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Reflection on Application to Practice |
Reflection contains reference to application to current of future practice merits or lack of merit. |
Reflection is vague and only loosely related to current or future practice. |
Reflection does not connect merit or lack of merit to practice. |
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Grammar, Syntax, APA Format |
APA format, grammar, spelling, and/or punctuation are accurate, or with zero to three errors. |
Four to six errors in APA format, grammar, spelling, and syntax noted. |
Paper contains greater than six errors in APA format, grammar, spelling, and/or punctuation or repeatedly makes the same errors after faculty feedback. |
Health IT and EHRs:
Principles and Practice, Sixth Edition
Chapter 5: Healthcare Workflow and Process Mapping
© 2017 American Health Information Management Association
© 2017 American Health Information Management Association
Importance of Workflow and Process Improvement
Identifies opportunities for improvement
Aids in understanding functional requirements needed for health IT
Avoids unintended consequences of poorly designed health IT systems
Reduces costly rework after implementation
Helps manage change through:
Education
Team empowerment
© 2017 American Health Information Management Association
Terminology and Methodologies
Process
Manner in which work is performed to achieve a particular result
Workflow
Sequence of steps and hand-offs taken within a process
Process mapping
Depiction of the workflow and process that is being studied
Process improvement
Analysis of current processes and workflows for efficiency and effectiveness
Also called: process redesign or process re-engineering
© 2017 American Health Information Management Association
EHR Five Rights:
Right clinical data
Right presentation
Right decision
Right work processes
Right outcomes
Process Improvement Goals
Achieve the right way!
Old Way
New Way
My Way
Your Way
Right
Way
Copyright © 2016, Margret\A Consulting, LLC. Reprinted with permission.
© 2017 American Health Information Management Association
Process Improvement Case Study
© 2017 American Health Information Management Association
Benefits of Process Improvement
Copyright © 2016 Margret\A Consulting, LLC. Reprinted with permission.
© 2017 American Health Information Management Association
Steps in Process Improvement
Identify processes to be assessed.
Create process assessment teams.
Select tools.
Map current process.
Validate accuracy of map.
Collect forms and reports to be automated.
Obtain baseline data.
Identify potential problems and root cause.
Identify changes for now, and with health IT
Identify other improvements.
Document proposed changes in new map.
Use new process to create use cases for health IT functional specification.
Test new processes.
Train on new processes.
Incorporate changes into policy and procedure.
Conduct benefits realization and celebrate success/correct course.
© 2017 American Health Information Management Association
Processes to be Mapped for EHR
Copyright © 2016. Margret\A Consulting, LLC. Reprinted with permission.
© 2017 American Health Information Management Association
Process Mapping Teams & Training
Teams should:
Be composed of those who will actually implement project
Be responsible for actual process analysis
Solicit input from potential users
Include those familiar with current processes
Include a coach and access to IT resources
Teams need training on:
Process improvement purpose and goals
Process mapping tools
EHR or other health IT features and functions
© 2017 American Health Information Management Association
9
Thoughtflow
Coined by Sam Bierstock, MD,
“The process by which physicians obtain, assess, prioritize, and act on information.”
Many clinical processes are not visible to another person. They are mental processes
It is the mental processing that is at the core of a clinician practicing medicine, and needs to be at the core of using an EHR and other health IT
© 2017 American Health Information Management Association
Process Mapping Validation
Ensures process map reflects how work is actually performed today
Includes not only the chart and people, but most importantly the information payload
Most clinical process entail a significant amount of mental processing, not directly observable
Many mappers are new to mapping and new to EHR, so need coaching to ensure thoroughness
© 2017 American Health Information Management Association
Current Map Validation
Copyright © 2016 Margret\A Consulting, LLC. Reprinted with permission.
© 2017 American Health Information Management Association
Process Changes
Allow team members the freedom to make change
Solve problems rather than symptoms
Stay focused on ultimate goal
Focus on primary customer
Study existing systems
See the big picture
© 2017 American Health Information Management Association
13
Workflow and Process Mapping Tools
Process mapping denotes sequence of tasks in a process.
Process mapping charts can be simple or complex, often starting simple and progressing to the complex.
Tools
Process diagramming tools
Process Diagrams
Swim Lane Chart
Flow Process Chart
Systems Flow Chart
Use case
Document analysis
Baseline data collection
Benchmarking
Process improvement
© 2017 American Health Information Management Association
Process Diagramming Tools
Process diagram
Swim lane chart
Flow process chart
Systems flow chart
Copyright © 2016 Margret\A Consulting, LLC. Reprinted with permission.
© 2017 American Health Information Management Association
15
Flow Process Chart
Free-form illustration utilizing common set of symbols
May be combined with swim lane chart to illustrate simultaneous processing in different departments
Copyright © 2016, Margret\A Consulting, LLC. Reprinted with permission.
© 2017 American Health Information Management Association
Swim Lane Process Map (Example)
Copyright © 2016 Margret\A Consulting, LLC. Reprinted with permission.
© 2017 American Health Information Management Association
Flow Process Chart
Older tool uses a list structure with accompanying symbols to illustrate flow
Very suitable for those not comfortable drawing pictures, especially physicians
Excellent for marrying process mapping and baseline data collection
© 2017 American Health Information Management Association
Flow Process Chart Template
Copyright © 2012, Margret\A Consulting, LLC. Reprinted with permission.
© 2017 American Health Information Management Association
Basic Systems Flowchart
Most common tool for information process mapping
Terminator symbol contains information on the boundaries of the system being mapped (where process begins and ends)
Process is the performance of an operation. It should be described precisely for each and every step in a process
Decision symbol describes decisions made within an operation. There must always be at least two choices (e.g., Y/N). Three choices might reflect <, =, or >; or action A, B, or C
Terminator
Process
Decision
© 2017 American Health Information Management Association
20
Basic Structure of Systems Flowchart
© 2017 American Health Information Management Association
For Complex Decision-Making:
Choices?
A
B
C
D
E
Decision Table
Copyright © 2016, Margret\A Consulting, LLC. Reprinted with permission.
© 2017 American Health Information Management Association
Special Systems Flowchart Symbols
Copyright © 2016 Margret\A Consulting, LLC. Reprinted with permission.
© 2017 American Health Information Management Association
Sample Current Process Map
© 2017 American Health Information Management Association
Use Case
Another way to describe workflows and processes; especially to illustrate roles of user and computer
Two forms:
Graphic notations following the standard Unified Modeling Language symbols
Essential use case, aka use case scenario, uses narrative that is often preferred by users not accustomed to diagrams
© 2017 American Health Information Management Association
Use Case Diagram
© 2017 American Health Information Management Association
Essential
Use Case
Example
Copyright © 2016, Margret\A Consulting, LLC. Reprinted with permission.
© 2017 American Health Information Management Association
Document Analysis
Ensures that all data needs are accounted for in the process assessment
For direct patient care
For reporting purposes
Collect all forms and reports.
Analyze their data elements.
Who collects the data, for what purpose?
Who uses, how, when, frequency?
© 2017 American Health Information Management Association
Document Analysis
Copyright © 2016, Margret\A Consulting, LLC. Reprinted with permission.
© 2017 American Health Information Management Association
Data Element Analysis
In a database, record all data used in all applicable documents
Identify source
Identify use
Used in clinical decision making?
Intent is to capture data once and use many times to avoid repetitive work and errors.
© 2017 American Health Information Management Association
Data Element Analysis
Copyright © 2016 Margret\A Consulting, LLC. Reprinted with permission.
© 2017 American Health Information Management Association
Compare Processes
Compare process maps drawn by people essentially performing the same process, but in different locations (such as nursing units, clinic sites).
Identify variations
Compare maps directly
Use a spreadsheet
Evaluate variations
Are some variations necessary? (such as different nursing staff may have different credentials)
How can processes be made more standardized to reduce variation and potential errors?
© 2017 American Health Information Management Association
Process Variation (Clinic Example)
Copyright © 2016, Margret\A Consulting, LLC. Reprinted with permission.
© 2017 American Health Information Management Association
Baseline Data Collection
Purpose
Identifies opportunities for improvement
Helps set goals and expectations for what can be accomplished with EHR
Benchmark how well the EHR is performing the desired goals
© 2017 American Health Information Management Association
Baseline Data Collection
Baseline data collection captures current:
Volume of work
Time to complete steps
Number of errors or near misses
Helps:
Identify opportunities for improvement
Set goals
Conduct benefits realization studies
© 2017 American Health Information Management Association
Benchmarking
Process of comparing process performance against an industry best practice or industry standard
Often used in comparison with organization’s baseline data
© 2017 American Health Information Management Association
Process Redesign
Team Empowerment
Process assessment requires teams of various skills and knowledge
Teams should be given responsibility and appropriate authority
A system of checks and balances must be established so no group can be an outlier
Group Leader
Facilitates proceedings
Keeps group on track
Encourages participation by all
Source: Schuman (2004). Reprinted with permission from the Institute of Cultural Affairs, ICS-USA, Chicago, IL
© 2017 American Health Information Management Association
Group Facilitation
Brainstorming
Round Robin
Double reversal
Nominal group process
Probing
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Opportunities for Improvement
Bottlenecks
Sources of delay
Rework due to errors
Role ambiguity
Unnecessary duplications
Long cycle time
Lack of adherence to standards
Lack of information
Lack of quality controls
© 2017 American Health Information Management Association
Effecting Change
Change management is the process by which an organization gets to its future state
Facilitates adoption of health IT, through:
Education
Providing feedback
Reducing fear
Process assessment
© 2017 American Health Information Management Association
HIM and IT Professionals
Frequently are trained explicitly in workflow and process mapping and can help train, coach, and facilitate
To be effective in these roles, however, they must be neutral and unbiased
© 2017 American Health Information Management Association
Start
Choice
Action
Action
Action
Choice
Action
No
No
Yes
Yes
End
Basic Flowchart