Optimization of an EHR and Workflow Redesign at a Small Cancer Center in the Michigan Upper Peninsula

This study was performed to examine the efficacy of a newly adopted electronic health record (EHR) system at a small rural cancer center. I evaluated the current system, and interviewed key medical staff members in an attempt to identify issues with the current set up and find solutions to major problems. I uncovered many barriers to the practice success such as user buy in, work redundancy, lack of knowledge and/or training, interoperability and template issues. The physician had issues with obtaining maximum benefit from the system such as inability to generate practice productivity reports and lack of efficiency. In an attempt for optimization, suggestions were made to redesign workflow and focus on key EHR functionalities. Successful optimization of an existing EHR system post implementation is key to efficacious growth of a practice as we move into a new health care environment which is highly reliant on health information technology

Realizing the Value of EHR Systems: Critical Success Factors

Now that a majority of hospitals and primary care physicians have made the transition to electronic health record (EHR) systems, realizing value from this investment has become a major issue. The issue raises two key questions: Why do so many EHR implementations continue to fall short of achieving intended healthcare outcome goals? What differentiates those that succeed from those that fall short? This article builds on prior research using a systems framework to analyze the EHR implementation process. It focuses on ten common themes (CSFs) that appear to differentiate institutions which achieve positive healthcare outcomes from those that do not. Results are highly relevant for healthcare institutions now seeking to focus on realizing the value of their EHR systems

Business Process Management for optimizing clinical processes: A systematic literature review

Business Process Management is a new strategy for process management that is having a major impact today. Mainly, its use is focused on the industrial, services, and business sector. However, in recent years, it has begun to apply for optimizing clinical processes. So far, no studies that evaluate its true impact on the healthcare sector have been found. This systematic review aims to assess the results of the application of Business Process Management methodology on clinical processes, analyzing whether it can become a useful tool to improve the effectiveness and quality of processes. We conducted a systematic literature review using ScienceDirect, Web of Science, Scopus, PubMed, and Springer databases. After the electronic search process in different databases, 18 articles met the pre-established requirements. The findings support the use of Business Process Management as an effective methodology to optimize clinical processes. Business Process Management has proven to be a feasible and useful methodology to design and optimize clinical processes, as well as to automate tasks. However, a more comprehensive follow-up of this methodology, better technological support, and greater involvement of all the clinical staff are factors that play a key role for the development of its true potential.This work was supported by the Ministerio de Economía y Competitividad of the Spanish Government (ref. TIN2014-53067-C3-1-R) and co-financed by FEDER

Optimising hospital electronic prescribing systems:A Systematic Scoping Review

Considerable international investment in hospital electronic prescribing (ePrescribing) systems has been made, but despite this, it is proving difficult for most organizations to realize safety, quality, and efficiency gains in prescribing. The objective of this work was to develop policy-relevant insights into the optimization of hospital ePrescribing systems to maximize the benefits and minimize the risks of these expensive digital health infrastructures. METHODS: We undertook a systematic scoping review of the literature by searching MEDLINE, Embase, and CINAHL databases. We searched for primary studies reporting on ePrescribing optimization strategies and independently screened and abstracted data until saturation was achieved. Findings were theoretically and thematically synthesized taking a medicine life-cycle perspective, incorporating consultative phases with domain experts. RESULTS: We identified 23,609 potentially eligible studies from which 1367 satisfied our inclusion criteria. Thematic synthesis was conducted on a data set of 76 studies, of which 48 were based in the United States. Key approaches to optimization included the following: stakeholder engagement, system or process redesign, technological innovations, and education and training packages. Single-component interventions (n = 26) described technological optimization strategies focusing on a single, specific step in the prescribing process. Multicomponent interventions (n = 50) used a combination of optimization strategies, typically targeting multiple steps in the medicines management process. DISCUSSION: We identified numerous optimization strategies for enhancing the performance of ePrescribing systems. Key considerations for ePrescribing optimization include meaningful stakeholder engagement to reconceptualize the service delivery model and implementing technological innovations with supporting training packages to simultaneously impact on different facets of the medicines management process

Reducing Delays in Follow-up Care through Process Optimization

Primary care follow-up after an emergency department (ED) visit is an important component of comprehensive healthcare, contributing to both improved patient outcomes and reduced readmissions to emergency care. In alignment with the Clinical Nurse Leader (CNL) roles of risk anticipator and lateral integrator of care, this project aimed to support improvement in care continuity for patients at a large primary care clinic in London. At this clinic, a team of physicians, nurses, and support staff care for a diverse population of adult and pediatric patients who account for nearly 3,000 ED visits annually. Assessment of the clinical review process used to coordinate post-emergency follow-up revealed that less than 22% of patients receive timely care and the process to initiate care takes an average 15 days to complete. To address this gap in quality and efficiency, an interprofessional team utilized root-cause analyses, process optimization, and small tests of change to develop an optimized clinical review process for post- emergency department follow-up care. Implementation of the process resulted in an 81.3% decrease in clinical review time and a 34.5% increase in on-time follow-up care. Process optimization is an effective framework through which rapid improvements in care processes can be implemented to enhance care quality and efficiency

Improving Patient Safety for Surgical Clearance: A PreOp One Stop Shop

Problem: Medical clearance is required for patients scheduled for surgery, also known as “patient optimization.” Ineffective and inefficient patient optimization is a major contributor to surgery postponements, procedure cancellations, and patient dissatisfaction. Context: Ambulatory care clinics often lack resources to medically clear patients prior to scheduled surgery. Poor surgical optimization continues to occur on the same day of surgery, resulting in case cancellation or delay in a suburban, 169 bed community hospital with 9 operating rooms and approximately 500 surgical procedures per month. Interventions: A nurse-led PreOp One Stop Shop (POSS) utilized a standardized checklist to perform preoperative surgical assessment. Measures: System-generated reports assisted in ranking contributing factors that impacted day of surgery cancellations rates, outpatient care experience scores, and staff engagement metrics were reviewed and analyzed weekly between August 2021 to July 2022. Results: A nurse-led POSS decreased the number of same-day surgical cancellations from 10% to 3%, improved the standardized patient care experience measures from 78% to 79%, and increased internal staff engagement scores from 72% to 77% by July 2022. Conclusion: A standardized checklist and associated workflows are recommended for routine presurgical assessment to expedite medical clearance and promote reliable patient optimization. The implementation of a nurse-led PreOp One Stop Shop (POSS) can lead to improved patient safety outcomes and add value for organizational metrics such as patient centered care and staff engagement. Keywords: surgical cancellations; patient optimization; workflows; care experience; medical clearance; safet

Scalability challenges in healthcare blockchain system - a systematic review

Blockchain technology is a private, secure, trustworthy, and transparent information exchange performed in a decentralised manner. In this case, the coordination and validation efforts are simplified as the records are designed to update regularly and there is no difference in the two databases. This review focuses on how the blockchain addresses scalability challenges and provides solutions in the healthcare field through the implementation of blockchain technology. Accordingly, 16 solutions fell under two main areas, namely storage optimization and redesign of blockchain. However, limitations persist, including block size, high volume of data, transactions, number of nodes, and protocol challenges. This review consists of six stages, namely identification of research question, procedures of research, screening of relevant articles, keywording based on the abstract, data extraction, and mapping process. Through Atlas.ti software, the selected keywords were used to analyse through the relevant articles. As a result, 48 codes and 403 quotations were compiled. Manual coding was performed to categorise the quotations. The codes were then mapped onto the network as a mapping process. Notably, 16 solutions fell under two main areas, namely storage optimization and redesign of blockchain. Basically, there are 3 solutions compiled for storage optimization and 13 solutions for the redesign of the blockchain, namely blockchain modelling, read mechanism, write mechanism, and bi-directional network

Evaluation of an Innovative Program to Improve Outcomes among Military Beneficiaries with Diabetes

Patient Centered Medical Home (PCMH) is a health care model implemented in all United States Air Force (USAF) medical facilities which uses a team-based approach to promote accessibility, quality care, and appropriate service utilization, while decreasing costs. To measure the effectiveness of this model, the National Committee for Quality Assurance (NCQA) has developed a tool to document and recognize facilities that incorporate all model elements. However, the effects of the full model implementation on patient outcomes in military settings have not been studied. This research fills an important gap in the literature because it studies the effect of PCMH implementation in military settings, which has been mandated by the Assistant Secretary of the Defense. The five-phase implementation plan for PCMH in the USAF was described in the first manuscript. The second manuscript specifically identifies the hypotheses studied, the methods for data collection and analysis, and provides a synthesis of results. This study evaluates the effects of PCMH implementation on patients with type-2 diabetes (T2DM) in military clinics. This study also explores whether NCQA Provider Practice Connections-Patient Centered Medical Home (PPC-PCMH) recognition scores, based upon the standards of the PCMH, explain variations in glycated hemoglobin levels (HgA1c), emergency department (ED) visits, and hospitalized days among T2DM patients. The results show support for the effect of PCMH implementation on HgA1c for patients with T2DM seen in military clinics. Support was mixed for PCMH having a positive effect on hospitalized days and ED visits. Evidence was not found for the ability of NCQA PPC-PCMH recognition to explain variation in HgA1c