July 2, 2019

How to Improve Clinical Workflow: 50 Expert Tips Part 2

Dave Levin, MD

Chief Medical Officer

Healthcare organizations are embracing innovative technologies at a faster pace than ever before, but clinical workflow management remains a pain point for providers. As providers face pressure to do more in less time, technology tools like EHRs seem like a practical solution, yet implementing new technologies doesn’t always solve workflow issues.

Poorly-integrated solutions can actually hinder clinical workflows by making it necessary for clinicians to duplicate data across multiple applications or log in and out of several systems to find the relevant clinical data they need to inform clinical decision-making. Evaluating a solution’s potential impacts on workflow should be a primary consideration when evaluating any new technology solution. For instance, robust API solutions like Integrate reduce the administrative burden on clinicians and staff by enabling the seamless exchange of data across EHRs and non-clinical applications. Integrate empowers clinicians with real-time, relevant data for clinical decision support and supports bi-directional workflow interaction between EHRs and third-party applications, eliminating the need for data duplication and automating tedious, manual tasks such as chart retrieval and copying and faxing records to other providers.

Delivering Value-Based & Patient-Centered Care

31. Utilize EHRs to improve care coordination. “Care coordination is the ability for different members of a care team to communicate with one another about an individual patient’s care. Through robust care coordination, a team may be able to eliminate duplicate tests or unnecessary treatments, not only saving money, but eliminating a burden on the team and the patient.

“EHRs enhance care coordination by automating the communication process. Through robust health information exchange (HIE) providers even in disparate locations are able to collaborate using a patient’s data.

“Through computerized physician order entry (CPOE), one of the primary functionalities of the EHR, physicians can enhance the efficiency of ordering tests or treatments and share patient information. CPOE may also reduce errors due to handwriting or confusion with paper ordering.” – Sarah Heath, 4 EHR Best Practices for Improving Clinical Workflows, EHR Intelligence; Twitter: @EHRIntel

32. Improve access to care by identifying and removing bottlenecks. “A constraint, or bottleneck, is anything that restricts the throughput of patients into and through the clinic system. Constraints occur when the demand for a particular resource (e.g., rooms, providers, tests) or part of the system is greater than the available supply. If changes are made to improve parts of a system without addressing the constraint, the changes may not result in reduction of delays and waiting times for the entire system. To manage the constraint, the practice must first identify the constraint and then drive unnecessary work away from the constraint.” – Find and Remove Bottlenecks, Institute for Healthcare Improvement; Twitter: @TheIHI

33. Allowing patients greater access to EHRs can help to eliminate documentation errors. “It is inevitable that physicians will make documentation mistakes from time to time, and who is better qualified to catch these errors than patients? The ACP report noted that when patients are able to review their medical records, they often find inaccuracies that could be substantial in optimizing treatment. By allowing patients to view their EHRs via online portals, practices may be able to improve their documentation and reap the benefits associated with thorough and accurate notes. This type of information access is a required part of Stage 2 Meaningful Use, so many practices may already be working on implementing the technology.” – Kevin McCarthy, 5 tips to improve clinical documentation,__ NueMD; Twitter:__ @NueMD

34. Mobile computer carts can support meaningful use of EHRs. “Mobile carts are the most important equipment for demonstrating meaningful use of electronic health records, as required by the EHR mandate. The meaningful use requirements have been partitioned into three stages, which respectively promote data capturing and sharing, advancing clinical processes, and improving outcomes for patients and care providers.

“Physicians are expected to incorporate electronic health records into the following clinical processes:

  • Recording and charting height, weight, blood pressure, and BMI for all patients, and plotting growth charts for children aged 2-20.
  • Recording demographic information, such as preferred language, gender, race, ethnicity, and date of birth of all patients.
  • Maintaining active medication and medication allergy lists for patients in electronic form.
  • Recording smoking status for patients aged 13 years and older.
  • Creating clinical summaries for each patient on a per-visit basis.
  • Generating and transmitting permissible prescriptions electronically (eRx).

“Mobile computer carts are the best means of facilitating these new workflow requirements because they allow nurses and physicians to access electronic medical records from the examination room, enabling on-the-spot recording of all important information. Patient data and history can readily be updated in the presence of the patient, and physicians at the bedside can immediately access medical history information for patients in order to identify trends, develop treatment plans, and prescribe medication.” – Improve Your Clinical Workflow Solutions with Mobile Carts, Add-On Data; Twitter: @addondata

35. Schedule according to providers’ capacities. “The most common bottleneck is at the traditional check-in counter. Operational and architectural changes can solve this. Know your providers’ capacities and schedule accordingly. No matter what technology or floor plan you adopt, if your practice overschedules providers, patients will sit in a waiting area and fume. Consider the strategic use of exam rooms. Know how many exam rooms a provider can typically handle at the same time. For many, it is two or three. Plan accordingly, then consider ‘swing’ exam rooms—extra rooms allocated among several practitioners to absorb patients at times of high demand. These may be used to enable a patient to see a doctor on schedule, when another patient with a complex visit would otherwise cause a back-up in the schedule. Be careful not to over-use extra rooms. Parking patients in an exam room and making them wait does not enhance flow.” – Marisa Manley, 5 ways to improve patient flow, Medical Economics; Twitter: @MedEconomics

36. Select a unified solution that integrates communications and workflow. “While the drivers for selecting particular mobile solutions may vary by stakeholders, in common is a need for a solution that integrates patient context, alerts, critical lab results, telemetry and other workflow data with a secure voice and text solution for improved patient care and faster response times with care team members and patients. This [is] the promise of a unified smartphone-based solution and is foundational for providers moving forward.” – 5 Ways to Improve Clinical Communication and Workflow, PatientSafe Solutions; Twitter: @PatientSafeSoln

37. Develop evidence-based and easy to follow care models. “Depending on the licensure, education, and training of your team, current team members could potentially fill the staffing needs of the new value-based care model with proper education and redistribution of responsibilities. Utilizing current staff can be cost effective during the initial transition period, but additional staff may be needed as the model continues to be adopted by the practice, particularly since value-based models rely heavily on effective care coordination and require a greater amount of data capture and analytics.

“The care team should be led by a physician to identify, engage and elicit from each team member the unique set of training, experience, and qualifications needed to help patients achieve their care goals, and to supervise the application of these skills.” – Value-Based Care: Promote the Triple Aim, AMA Ed Hub; Twitter: @AmerMedicalAssn

38. Utilize targeted care coordination and management. “With their highest-risk patients identified, practices can effectively target them with proven interventions. Care management is a long-standing concept that, until the advent of value-based care among practices, was associated with health insurers in the managed care industry. Its premise was that care activities that occurred in between office visits, such as telephonic outreach for a follow-up or a status check with patients and/or their caregivers, would proactively allow for early identification and resolution of health and socioeconomic issues that could result in unnecessary utilization of costly services, such as the ED or hospital, if left untreated.

“Now, with value-based models requiring a whole patient approach, some OCM practices are rapidly developing effective and efficient care management and navigation capabilities. Although oncologists and their clinical staff may have performed some elements of care management in the past, these actions were secondary to their traditional role, which is managing the patients’ specific chief complaint in an office-based setting. The nature of fee-for-service reimbursement encouraged this episodic approach to care and discouraged activities outside of the office encounter. Now, OCM practices are organizing and staging dedicated care management programs and integrating them into high-risk patient work flow.” – Charles Saunders, MD; Charles Alcorn, MS; Catherine Cowan, MSN, RN; and Maria Fabbiano, High-Impact Workflow Changes for Value-Based Care Success, __AJMC; Twitter: __ @AJMC_Journal

39. Adopt workflow solutions that help clinicians coordinate care across systems, with the patient at the center of the care continuum. “In today’s world, there are reams of clinical data, but it’s not always easy to find or access. And ultimately, the data is only useful if the people who need it can use it when they’re caring for patients. Enterprises need to recognize that people in different departments have diverse mentalities, workflows, priorities and training. They need workflow solutions that help them coordinate care across systems so the patient is at the center of the care continuum.

“For example, a radiologist who is interpreting a study could find clinical context in many forms. Sometimes seeing the ordering physicians note, correlated pathology results or surgical history, can shed light on the images themselves. The Catch-22 is that these notes are stored in the EMR.” – Laurie Bergeron, as told to Deborah Konrad, Q&A: Laurie Bergeron on workflow efficiency and value-based care, Radiology Business; Twitter: @RadiologyBiz

40. Improve patient retention. “One of the most critical workflow strategies for healthcare organizations looking to make the transition to value-based care is improving patient retention.

“Making sure that there is a high level of price transparency is a surefire way to help stabilize the cost of healthcare for patients. This naturally leads to a higher patient retention rate when patients feel they are getting exactly what they are promised. Of course, this transparency in price is not possible unless a system for collecting, organizing, and presenting price reporting to employees and employers is at hand.

“Improving both the quality and quantity of patient interaction will keep patients engaged and help to keep a bead on their satisfaction levels as well. A smart healthcare organization will do everything it can to raise the levels of patient satisfaction.

“Having comparative performance measures data readily available to physicians and making sure that they have the confidence to dig deep into it and make assessments based on their findings is essential to helping them become champions of the performance assessment side of the program.” – Barry Wightman, Three Ways to Speed Your Transition to Value-Based Care, Forward Health Group; Twitter: @ForwardHealthGp

Staffing Strategies to Improve Clinical Workflow

41. Supplement your full-time staff with part-time staff during peak times to keep physicians’ schedules on track. “The opening bell is critical to getting started on time and staying on time; that means having sufficient staff to prep and room patients and answer phones first thing in the morning and again after the lunch break. The use of part-time staff can supplement your full-time staff so that you do not have excess capacity as the day winds down.” – Rosemarie Nelson MS, Top 10 Tips to Improve Overall Practice Workflow, MedPage Today; Twitter: @medpagetoday

42. Dedicate staff to support care transitions. “ACOs are still financially responsible for the quality and cost of care provided for any patients transferred to a post-acute facility such as a SNF. Many successful Medicare ACOs are developing networks of high-performing skilled nursing facilities and dedicating staff to support care transitions to better control quality and costs.

“Many of the most successful Medicare ACOs establish a network of high-performing SNFs by finding available data or creating scorecards themselves that measure the SNFs performance in areas such as – prevention of rehospitalization, improving patient independence, and length of stay. These SNFs then become preferred facilities that patients are referred to.

“Other successful Medicare ACOs are going so far as to dedicate staff to support care transitions and better quality and cost control. This could include a care manager, nurse, or physician. These staff members can either work in a SNF or reside in a corporate office where they can conduct consults via text, video or phone calls and come out for visits only periodically or as needed.” – CMS Toolkit for ACOs: 5 Care Coordination Strategies, TigerConnect; Twitter: @TigerConnect

43. Before hiring new staff, evaluate time-consuming tasks and consider how they could be done more efficiently. “Finding the right number of staff is hard. Hire too few, and you’ve got front office chaos–long wait times, disorganization, and unhappy patients. Hire too many, and you’re taking on additional personnel costs. It’s a delicate balance. Front office staff are the face of your practice and are responsible for creating that critical first impression. If they have too many administrative tasks, it can slow things down making patients feel they aren’t the #1 priority. The solution isn’t to hire more staff, it’s to look at the tasks that add to wait times and find a way to do them faster or more efficiently. This will free up your staff to do what they do best – treating your patients like valued customers.” – Practice Management Staffing & Workflow Tips, __AdvanceMD

44. Appoint a dedicated care coordinator. “Understanding the transition in policy by which payouts and reimbursements will be measured by the quality of care as well as the efficiency of the organization will require the involvement of a dedicated care coordinator. A care coordinator can stay up to date on legislation and policy changes, update your organization’s financial policy, and work with providers and patients to optimize care under the new value-based model.

“Positive medical outcomes will be the product of stronger patient/provider collaboration, and care coordinators can serve as those liaisons between both parties, helping clinicians better understand patient concerns and health hurdles, and motivating patients to claim a larger role in their treatment and wellbeing.” – Joe Fleming, 5 Smart Tips for Improving Revenue Cycle Management, ReferralMD; Twitter: @getreferralmd

45. AI can support adaptive staffing. “Health systems are beginning to use machine learning to adjust staffing to support fluctuating emergency department patient volumes and to reduce wait times in ambulatory services. By leveraging historical data across multiple sources, organizations can understand when to staff up to handle an influx of patients for the upcoming flu season or ramp up other support staff during warm weather to ensure a smooth patient experience in the emergency room.” – Josh Gluck, How Automation in Healthcare is Boosting the Bottom Line, HealthTech Magazine; Twitter: @CDW_Healthcare

46. Use patient navigators to keep care moving forward throughout departments. “Patient navigators, sometimes called patient expeditors, communicate with patients, help them address any issues they may experience, accompany them from one part of the examination process to the next, among other duties. Their role is to ‘ensure patient care continually moves forward throughout the department,’ which keeps stress and drama to a minimum and helps technologists perform their tasks with the minimum number of distractions or issues.” – Michael Walter, [5 ways to reduce burnout among CT technologists], improve workflow, Radiology Business; Twitter: @RadiologyBiz

47. Optimization teams can support users directly at their work sites, adding value to clinicians and staff during the EHR optimization phase. “As organizations begin to manage the EHR post-live optimization phase, they need to plan for multiple approaches to support clinical optimization efforts. As optimization requests from end-users are captured and prioritized, there are usually specific themes that evolve. Common themes include: training, optimization of procedures and medication ordering preferences, and optimization of documentation tools. These common themes can be addressed using optimization teams who are deployed to work directly with end-users at their work site. Optimization teams can provide immediate value to clinicians and staff during the optimization phase.” – Organizing Clinical Optimization Teams to Support Post-Live Optimization Efforts, Impact Advisors; Twitter: @ImpactAdvisors

48. Leverage clinical decision support systems to reduce the need for ancillary staff. “CDSS are often combined with computerized physician (or provider) order entry systems (CPOE), through which medications, tests and procedures are ordered. When replacing hand-written, physically conveyed systems, integrated CPOE and CDSS systems can offer significant time savings and safety gains. The literature suggests a number of valuable benefits:

  • between 23 and 92 percent reduction in laboratory turn-around-times
  • 48 percent reduction in medication errors
  • reduced need for ancillary staff

“Decision support is not just for doctors, it can provide a powerful resource for other staff, particularly in settings where they may not have easy access to other clinical staff and patients.” – Dr. Mark Britnell, Richard S Bakalar MD, Ashraf W Shehata, Decision support and standardized workflows, KPMG; Twitter: @KPMG

49. Focus your staff on the highest-value activities. “Oncology staff are a precious, limited resource. Make sure that they are spending time on the activities they are uniquely able to perform.

“In addition to rethinking workflow, cancer programs are taking a hard look at staff members’ roles and responsibilities to focus each individual on the highest-value activities.” – Focus your staff on the highest-value activities, Advisory Board; Twitter: @AdvisoryBd

50. Implement physician-led team-based care. “Physician-led team-based care engages a greater number of staff in patient care and affords physicians the time they need to listen, think deeply and develop relationships with patients. Team members are aware of the patient’s health history and conditions and are thus better equipped to answer patients’ between-visit questions, calls and messages. As a result, all members of the physician-led team feel engaged in their key role of caring for the patient.” – Christine Sinsky, MD, Ellie Rajcevich, MPA, Implementing Team-Based Care: Engage the entire team in caring for patients, AMA Ed Hub; Twitter: @AmerMedicalAssn

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