In my last two articles, I’ve reviewed how you can help increase productivity during the implementation process and improve your various training processes. Today, I thought I would discuss one of those dirty little words in EMR implementations: best-practice workflow. While there seems to be consensus that a thorough workflow process plan is critical, few in the field seem agree on how to actually accomplish this.

First, let’s start with properly defining the term. Workflow describes the process of how the office and patient work with each other. It’s the full process from the time the patient calls to make an appointment, through the appointment itself (check-in, intake/rooming, provider visit, check-out), continuing through any post-appointment items like follow-up telephone calls and test results. The workflows touch every aspect of the office’s functionality and are basically the glue that holds those functions together.

When a practice begins the journey towards implementing an EMR system, it isn’t as simple as using a new form in the charts, or changing how patients are seen during an office visit. An EMR implementation will have a major impact on every process within a doctor’s office, from how the patient is seen during the visit, to how phone calls and patient results are managed. It’s crucial to be aware of how large an impact an EMR implementation will ultimately have before you can begin to take steps towards the journey through a successful implementation.

There are essentially two key processes that go into developing a good workflow process:

Current State Workflow

This process is more than just flowing out the individual basic processes of how you function in the office. This workflow should also include measurements of key indicators and specific flow, so you can use these as a baseline measurement for assessing how successful Go-Live has been and identifying any gaps. To create a meaningful Current State Workflow:

1. Define the key indicators you want to measure before and after Go-Live. Examples are:
   • The time it takes the patient to move through the office visit
   • The length of time patients are placed on hold waiting to get through to the office
   • The duration of time it takes for a message to be resolved
   • The number of missing/lost charts

   You may also include disease-specific items along the lines of notifying patients of abnormal/critical results, or sending reminders for health/disease maintenance testing for a certain subset of patients.

2. Meet with the office manager(s) and the leads of each section of the office (providers, clinical, front office, back office, etc) to discuss each section of the office and how it works. This process also gives the users the first look into the different personalities that exist in the office and can give insight into how to best implement from the various project teams’ perspectives.
3. Have the team that will be performing the Current State Workflow spend a day or more ‘shadowing’ the office staff in order to perform an observation of the office workflow, using a stop watch to mark the time it takes to complete the various functions of the office defined by key indicators. This can also help to verify the information collected during the interview process.

You can now begin to fit these pieces together to complete your Current State Workflow. Some tools to help you accomplish this include:

• Reference sheet of your key indicators. This information can be used for future re-recording of information, as well as to create evaluations for the end users to rate how the implementation went and what they feel would enhance the system/workflow.
• Flow charts based on interviews and site observations. Visio or a similar flow-charting application is best for this process.

Future State Workflow

The next step is to design your Future State Workflow. Difficulties may be encountered at this stage because often there are only a few members of the core project team that have been through an EMR implementation before, and if you’ve brought in experienced consultants to help you through the process, they probably won’t have the intimate knowledge of your practice(s) and employees. It’s imperative at this point that you have a solid relationship between your IT/IS staff and your practice management/operational departments. It’s common for IT/IS departments to lead many of these implementations, but they should never be put in the situation where they are changing/effecting clinical workflows without the support of the practice operational management.

It’s also important to note that many features in NextGen can completely change how an entire practice runs. Office staff and providers are often leery of change, especially if they’ve been following the same practices for years or even decades. When you are designing your Future State Workflow, stay flexible yet patient and consistent with your decisions. If you change things on the fly during Go-Live, you are going to add confusion to an already anxious working environment.

Once you’ve completed your Future State Workflow designs, compare the two and perform a Gap Analysis to identify any holes. The Gap Analysis is intended to identify and red-flag any places in your workflow in which you will be unable to perform the functions as you did in the paper world, but the EMR system has no process to support that function.

Remember, ‘you don’t know what you don’t know’

In closing, remember that EMR systems are evolving faster than just about any other similar process out there. Don’t lock yourself in a flow that will not allow for flexibility or ease of change. Once you have a functioning and stable implementation, you can broadly follow the above steps again to perform a ‘Workflow Optimization’ of your design, knowing that there is always room for continual process improvement.