Using Clinical Workflow Assessment Frameworks for Process Improvement of Patient-Provider Communication in a Primary Care Office

The purpose of this project was to assess the current workflow for addressing the needs of patients between face-to-face healthcare visits at a primary care clinic in Northern New England. The assessment served as a framework to inform recommendations for process improvement interventions. Workflow was mapped using Lean’s value stream map (VSM) tool. Observational data and retrospective chart review were performed to collect information on time to complete tasks, equipment used, and personnel involved in each patient request. Key patterns in workflow variation, guided by theoretical frameworks of system constraints, were identified. Finally, a team brainstorming session was organized with practice staff to engage stakeholders and generate actionable next steps for process improvement. Process mapping was especially useful as a visualization tool to engage stakeholders and isolate reasons for variation. There were four maps created to assess the workflow to respond to patient requests. The brainstorming session with staff concluded with two major areas of process improvement and next steps. Interventions would focus on maximizing use of health information technology and adjusting protocols for referrals sent to specialists with long scheduling periods. This approach can be used to systematically assess workflow practice of the primary care team. Results indicate that using the mapping tool in tandem with healthcare-specific assessment tools and theoretical frameworks helps identify opportunities for process improvement in the primary care office

Implications of Vital Sign Monitor and Electronic Medical Record Integration on Identification of Patients in Deteriorating Condition

The manual transcription of patients’ vital signs often delays entry of critical information to Electronic Medical Record (EMR) systems. This documentation delay within inpatient settings results in a lack of recent information on patient condition, decreased ability for providers to make clinical decisions, and an increased risk of data error. To alleviate these concerns, hospitals are adopting device interface systems which digitally integrate medical devices and EMRs. Prior studies have found that this type of system integration can potentially reduce the time spent on manual entry of information in the EMR and support other value-added activities in the hospital. However, these studies suffered from intervention bias from direct monitoring of clinicians using time-motion methodologies, which are resource restrictive and can affect patient care. In this study, we utilize a natural experiment setting to understand how the implementation of a device interface system between vitals monitors used on medical/surgical units and the EMR has impacted hospital workflows and patient care in a regional hospital. Our investigation focuses on two areas. First, we examine if the new system influenced documentation delays, and whether the impact was similar for different employee roles. Since vitals on medical/surgical units are typically taken by Patient Care Assistants (PCA’s) or other ancillary staff, we hypothesize that a greater average decrease in documentation delay will be found in their role. Second, we study the effect of interface system implementation on downstream patient care activities, such as models designed to identify patients in deteriorating condition. We analyze data on documentation delays across more than 5,000 patients and 330,000 documentation events for one week before and after system implementation. Additionally, we intend to utilize hierarchical models to distinguish the impact of systems for various roles (including PCA’s and nurses) across the hospital. Preliminary findings suggest that the interface system results in a statistically significant decrease in time between when vital signs are taken and documented, as well as The findings from this research would inform hospitals of the benefits and the requirements for a successful integration of medical devices and EMR systems, as well as the impact on activities dependent on accurate and timely vital signs documentation

Missing Pieces in Health Services Cost Analysis: Consensus on Modeling, Magnitude, and Micro-Costing

Cost and cost savings have become an important focus for health policy administrators. However, there are missing pieces in our approach to cost analysis; there is no consensus on multivariable methods, no indicators of minimally acceptable values, and no specification of process costing. In this dissertation, I propose to fill the gaps in the literature by 1) identifying which methods are appropriate for large claims data, 2) examine existing methods to establish minimally important difference (MID) in health outcomes to identify MID in costs, and 3) determine differences in sick visit clinic costs using a modified micro-costing method. Most models that were compared to the generalized linear models Gamma distribution with log link found it to be the superior model in both simulated data and real administrative data. We recommend that in cases where acceptable anchors are not available to establish an MID, both the Delphi and the distribution-method of MID for costs be explored for convergence. Our micro-costing approach is feasible to use under virtual working conditions; requires minimal provider time; and generates detailed cost estimates that have “face validity” with providers and are relevant for economic evaluation

Two Essays on Analytical Capabilities: Antecedents and Consequences

Although organizations are rapidly embracing business analytics (BA) to enhance organizational performance, only a small proportion have managed to build analytical capabilities. While BA continues to draw attention from academics and practitioners, theoretical understanding of antecedents and consequences of analytical capabilities remain limited and lack a systematic view. In order to address the research gap, the two essays investigate: (a) the impact of organization’s core information processing mechanisms and its impact on analytical capabilities, (b) the sequential approach to integration of IT-enabled business processes and its impact on analytical capabilities, and (c) network position and its impact on analytical capabilities. Drawing upon the Information Processing Theory (IPT), the first essay investigates the relationship between organization’s core information processing mechanisms–i.e., electronic health record (EHRs), clinical information standards (CIS), and collaborative information exchange (CIE)–and its impact on analytical capabilities. We use data from two sources (HIMSS Analytics 2013 and AHA IT Survey 2013) to test the theorized relationships in the healthcare context empirically. Using the competitive progression theory, the second essay investigates whether organizations sequential approach to the integration of IT-enabled business processes is associated with increased analytical capabilities. We use data from three sources (HIMSS Analytics 2013, AHA IT Survey 2013, and CMS 2014) to test if sequential integration of EHRs –i.e., reflecting the unique organizational path of integration–has a significant impact on hospital’s analytical capability. Together the two essays advance our understanding of the factors that underlie enabling of firm’s analytical capabilities. We discuss in detail the theoretical and practical implications of the findings and the opportunities for future research

Transactions of 2019 International Conference on Health Information Technology Advancement Vol. 4 No. 1

The Fourth International Conference on Health Information Technology Advancement Kalamazoo, Michigan, October 31 - Nov. 1, 2019. Conference Co-Chairs Bernard T. Han and Muhammad Razi, Department of Business Information Systems, Haworth College of Business, Western Michigan University Kalamazoo, MI 49008 Transaction Editor Dr. Huei Lee, Professor, Department of Computer Information Systems, Eastern Michigan University Ypsilanti, MI 48197 Volume 4, No. 1 Hosted by The Center for Health Information Technology Advancement, WM

Mining User-generated Content of Mobile Patient Portal: Dimensions of User Experience

Patient portals are positioned as a central component of patient engagement through the potential to change the physician-patient relationship and enable chronic disease self-management. The incorporation of patient portals provides the promise to deliver excellent quality, at optimized costs, while improving the health of the population. This study extends the existing literature by extracting dimensions related to the Mobile Patient Portal Use. We use a topic modeling approach to systematically analyze users’ feedback from the actual use of a common mobile patient portal, Epic\u27s MyChart. Comparing results of Latent Dirichlet Allocation analysis with those of human analysis validated the extracted topics. Practically, the results provide insights into adopting mobile patient portals, revealing opportunities for improvement and to enhance the design of current basic portals. Theoretically, the findings inform the social-technical systems and Task-Technology Fit theories in the healthcare field and emphasize important healthcare structural and social aspects. Further, findings inform the humanization of healthcare framework, support the results of existing studies, and introduce new important design dimensions (i.e., aspects) that influence patient satisfaction and adherence to patient portal