Determining Workflow Issues

Workflow is a term used to describe the interconnected steps and processes that nurses and other health care professionals complete on a day-to-day basis (McGonigle & Mastrian, 2012, p. 226). Many existing workflows contain inefficiencies and areas that could be improved using new technologies or evidence-based practice. Workflow issues are often referred to as “gaps” because they indicate a disparity between the current state and the optimal, future state. Many gaps in health care exist related to the implementation and optimization of electronic health records (EHRs). The Health Information Technology for Economic and Clinical Health (HITECH) Act was passed in 2009 to assist organizations in identifying these gaps and encouraging the “meaningful use” of EHRs. The meaningful use objectives seek to fulfill the IOM six aims of patient care (patient-centered, timely, effective, efficient, equitable, and safe).
 
In this Discussion, you examine scenarios that feature workflow issues related to the HITECH Act and its meaningful use objectives. You identify specific workflow gaps and consider how you would conduct a gap analysis to gather more information about the gaps. This Discussion allows you to explore workflow gaps and meaningful use objectives to prepare you for completing the Course Project, which is also centered on workflow gaps and their relevance to meaningful use objectives
 
Scenario
 
General Health Hospital is implementing new outreach programs and preventive care support groups for patients with certain conditions or health risks such as diabetes, smoking, and obesity. Philip, a nurse leader, is the manager of a team of nurses who have been asked to organize these programs and groups and to identify patients who would be eligible for and interested in being involved in these opportunities. However, Philip and his team have run into a variety of challenges and problems as they attempt to complete these tasks. In identifying patients to contact about the outreach programs and support groups, Philip’s team has had to browse the hospital’s EHR system. The team has also run across significant holes in the EHR system as they try to contact patients; many patients’ contact information is inaccurate or out of date. Furthermore, Philip’s team has partnered with the hospital’s Appointments Desk personnel in sending reminders about meeting dates and times to patients who express interest. However, the Appointments Desk often either neglects to send out these reminders or sends duplicate reminders to only a few patients because the personnel do not have a way of tracking who should be contacted and when.
 
 
 
To prepare
 
Your Instructor will have assigned you to respond to a specific scenario. Review this week’s Learning Resources on workflow, gap analysis, and meaningful use, and consider how they connect to the scenario you were assigned.
 

  • Determine the most prominent workflow gap you see in the scenario you were assigned. Where does the gap lie, what factors contribute to the gap, and what are the consequences of the gap?
  • Explore how this gap relates to one meaningful use objective. Refer to the articles in this week’s Learning Resources for more information on meaningful use.
  • If you were involved in the scenario, consider how you would go about conducting a gap analysis to gather more information about the gap you identified, and determine possible strategies for addressing the gap. How would you gather data? Who would you contact, interview, and/or observe? How would you determine strategies for addressing the gap?

 
 
 
Post by tomorrow Tuesday 9/13/16, 550 words essay in APA format with a minimum of 3 references from the list provided below. Include the level 1 headings as numbered below:
 
1) An explanation of the most prominent workflow gap in the scenario you were assigned, including who is responsible for the gap and the outcomes or consequences.
 
2) Identify the meaningful use objective to which the gap relates, citing specific points in the Brown article. (See Attached File)
 
3) Explain how you would conduct a gap analysis to gather further information and determine strategies for addressing the gap.
 
 
 
Required Readings
 
Dennis, A., Wixom, B. H., & Roth, R. M. (2015). Systems analysis and design (6th ed.). Hoboken, NJ: Wiley.
 

  • Chapter 2, “Project Selection and Management” (pp. 35–80)

 
This chapter describes the organizational steps involved in selecting an appropriate IT project, creating a viable project plan, and finally, managing and controlling the project once it is implemented.
 
 
 
McGonigle, D., & Mastrian, K. G. (2015). Nursing informatics and the foundation of knowledge (3rd ed.). Burlington, MA: Jones and Bartlett Learning.
 

  • Chapter 14, “Nursing Informatics: Improving Workflow and meaningful Use”

 
 
 
Better clinical outcomes, increased efficiency and improved care coordination are a few of the benefits afforded by the use of electronic medical records. In this chapter, the authors illustrate how nurses are actively supporting, developing and utilizing informatics to improve patient care and fulfill meaningful use standards by improving workflow in their respective health care organizations.
 
 
 
Brown, B. (2010). 25 steps to meaningful use. Journal of Health Care Compliance, 12(3), 33–34, 68–69.
 
Retrieved from the Walden Library databases.
 
As part of the implementation of the HITECH initiative, three different stages of implementation have been outlined. This article dissects the first phase and describes the different steps health care organizations must achieve to be in compliant with the meaningful use standards.
 
 
 
Blumenthal, D., & Tavenner, M. (2010). The “meaningful use” regulation for electronic health records. The New England Journal of Medicine, 363(6), 501–504.
 
Retrieved from the Walden Library databases.
 
The authors explain HITECH’s objective in creating the meaningful use policies in order to help create a consistently high quality nationwide system of EHRs. The article reviews the key regulations that are tied to meaningful use and what they mean to health care organizations.
 
 
 
Centers for Disease Control and Prevention. (2011). Meaningful use: Introduction. Retrieved from http://www.cdc.gov/ehrmeaningfuluse/introduction.html
 
This page offers an overview of meaningful use as outlined in the HITECH initiative. It highlights the rationale behind the meaningful use standards and how they relate to health outcomes policy priorities.
 
 
 
 
 
Healthcare Financial Management Association. (2008). Gap analysis helps nurses become better leaders. Retrieved from http://www.hfma.org/Content.aspx?id=3398
 
This article presents how gap analysis aids in optimizing unit performance and management. By examining a real-life example of how gap analysis was employed in this study, the authors demonstrate its real-world applications and benefits.
 
 
 
 
 
HealthIT.gov. (n.d.). Meaningful use. Retrieved January 2, 2014, from http://www.healthit.gov/policy-researchers-implementers/meaningful-use
 
The meaningful use initiative is part of the governmental agenda to further advance the use of electronic health records in the health care community. This article outlines the conditions and projected timeline of meaningful use’s national implementation.
 
 
 
Required Media
 
Laureate Education, Inc. (Executive Producer). (2012a). A discussion on meaningful use. Baltimore, MD: Author.
 
Note: The approximate length of this media piece is 7 minutes.
 
This audio interview provides an overview of the meaningful use component of the HITECH law and how it affects the use of electronic health records.

A Discussion on Meaningful Use” Program Transcript
DR. CAROLYN SIPES: This is Dr. Sipes. My background is Doctor of Nursing Science, Ph.D. I’m also a clinical nurse specialist, a nurse practitioner. First of all, I think it’s important to get and understand the impact of the new and revised federal regulations and to understand why the regulatory requirements are important.
The HITECH Act is part of the overall ARR, American Recovery Act, of 2009. And what this does is define, specifically, what must be done to meet regulatory requirements for health care organizations. Specifically, the HITECH Act sets priorities to define what a meaningful user is. These are to improve quality, safety, efficiency of care, while reducing disparities as you take care of patients.
So what is meaningful use? Meaningful use is a policy standard that incentivizes health care organizations to become meaningful users of electronic health records. Organizations must meet specific requirements for health care to use electronic health records. And these also must meet the requirements to become certified. They must meet a set of standards, of functional definitions, to even be eligible for reimbursement.
Specifically, there are three main components to meaningful use. Number one is, they must use a certified electronic health record in a meaningful manner, such as e-prescribing. The second criteria is that organizations must use a certified EHR technology for electronic exchange of health information to improve health care. The third criteria is that organizations must use a certified EHR technology to submit clinical quality and other measures. So overall, as part of this larger health transformation, it will require working with data, using standards, understanding of regulatory requirements, such as those coming from Medicare and Medicaid.
The criteria for meaningful use, again, this was set forth in three stages to be accomplished over the next five years. Stage one was implemented in 2011. And it’s referred to as the adoption stage. Organizations also must be building out applications, which are to include the problem list, nursing notes and flow sheets, order sets, decision support and alerts. It also is to include the education on the use of the systems and also, at this point, this is where the organizations are to start entering data.
So the role of the informaticist in this stage one– they must understand how to gather and disseminate the information, design and document workflows, this is critical for stage one. In this they will go out, again, and do the initial workflow analysis. They will do a current state analysis, look at what the organization is proposing for future state, and define the gap around that to define which applications need to be built.
© 2012 Laureate Education, Inc. 1
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
For stage two, this stage is referred to as optimization. Within stage two, the initial data collection and analysis should have been completed, and continuing, and revising. So the role the informaticist will play in this, again, is to monitor and assess optimization. And this includes revising, revising, reviewing, continually reviewing workflows and updating those, continually conducting a gap analysis so that these are overall, for all of the organization, these are to include specifics for the different departments in a hospital or an organization.
For stage three, overall goal is to approve outcomes. And this includes organizations must analyze data from an electronic health record that they’ve supplied. They must review, again, and update workflows. They need to start reporting on measures for the clinical processes for health status especially focusing on quality of health. They need to start reporting on health care patterns and resource utilization, health care costs and financial impacts.
The role of an informaticist in all of this will, again, be to continue gathering data, disseminating this information, and educating the end users. And this includes leadership. Workflows and meaningful use tie in together in that meaningful use has set the criteria of the regulatory requirements. It’s really critical to revise the workflow, really critically analyze that to see what happened and what needs to be improved.
I’ve been out there for over 10 years doing 21 implementations around the country and the UK, and the one thing that I consistently see within the organizations is how much they undervalue the value of a workflow and really collecting that data, getting good data, or they might have overlooked a specific group of providers or end users of the system. The importance is highly valuing the value of a workflow, collecting the data, accurately going over, and over, and over again, revising and continually updating.
And again, it’s not just a one-time process. It should be an intricate process throughout the whole implementation and even after the implementation. With going forward, then, and looking to the future with this, I think the importance that an informaticist who clearly understands the value of a workflow can do, is go out and conduct this workflow, bring this information and data back to leadership, and, again, demonstrate the value of this going forward.

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