Transcription
Closed Loop Referral CommunicationsSession 223, March 8, 2018, 11:30 AMKristen Wohlford, Regional Director Practice Operations, Mission HealthBridget Schmidt, Ambulatory Nursing Informatics, Mission Health1
Conflict of InterestKristen Wohlford, MHABridget Schmidt, B.S., R.N.Have no real or apparent conflicts of interest to report2
Agenda Mission Health overview Referral Management Project overview DMAIC Approach Project Vision Prior State of Referral Management Initial Analysis “Ideal” Future State Implementation–New Tools–End User Communication Project Wins Future Optimization3
Learning Objectives Identify what triggered the initiation of the referral managementproject Describe 3 challenges faced by referral coordinators with theprevious workflow Assess 3 ways the new process has remediated the challengesidentified with prior current state Define Closing the Loop as it pertains to the referral managementworkflow Identify the vision for future state reporting4
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Mission Health System – EMR HistoryCerner PowerChart Client since 20025 Hospitals live on full Cerner suiteCerner PowerChart Ambulatory (PCA) Client since 201495 Practices live on PowerChart Ambulatory7 Waves of ImplementationPrimary Care, Internal Medicine, OB/Women’s, Pediatrics/Genetics,Surgery/Orthopedics, Neurology, Vascular/Interventional Radiology/Vein,Infectious Disease, Weight Management, Oncology, Employee Health,MyCareNow/Urgent Care, Cardiology6
Mission Health System – AmbulatoryProvidersCountyProvider cDowellBuncombeTransylvaniaGrahamHaywoodGrand 22484322677614
Mission Health SystemsClosed Loop Referral Process8
Overview of Referral ManagementProjectWhy? Pattern of Patient Safety Event logged related to a Referral RL logged related to delay in referrals– RL is a patient risk management software tool Minimal, inconsistent tracking workflow and tool No transparency into referral management Staff and providers frustrated with process9
DMAIC Approach Define Measure Analyze Improve Control10
Referral Management Project VisionThe project purpose, in accordance with Mission HealthSystem’s BIG(GER) AIM of Patient Quality/Safety, is to: Improve the efficiency and effectiveness of the patientreferral process Standardize the referral workflow process acrosspractices Insure patients receive necessary services and referringproviders receive pertinent patient information Monitor Key Process Indicators related to referrals11
Prior State of Referral ManagementAnalysis showed 41 steps from order placement to closing the loop47 call outs of re-work, inefficiencies, problems, no standard process12
Prior State Workflow13
Prior State Workflow Continued14
Prior State Workflow Continued15
Prior State Workflow Continued16
Initial Analysis17- Waste and breakdowns incommunication between practices- Duplicate documentation in multiplesystems- Unknown volume, patterns andperformance associated with referrals- Inconsistent processes acrosspractices- Training gaps
“Ideal” Future State Tracking Tool – sortable to support monitoringDiscrete dataReportableUtilize shared chartSet standards around processing Referrals18
ImplementationSprints– EMR Alert Notifications– Retrospective Referral Clean Up– Update and modify encounter selection window in PCA19
New Referral Management ToolsInnovative use of current Cerner Tools New Referral Orders build with Order Entry Format (OEF) updates New Custom Referral Management MPage Custom Rules for automation – closing the loop Reporting New Custom Referral PowerForm Playbook for standard workflow Direct Message Provider letter SOP for referral management20
New Referral Management Tools –New Order Entry Format for ConsultRequestsPrevious Order details:New Order Details:21
Referral Management Tools –Consult PowerFormPrevious form for consults:22
Referral Management Tools – NewConsult PowerFormNew Referral PowerForm – sharedby ordering (sending) and consulting(receiving) offices, when both are onPCAEach of the 3 parts will be discussedon the next slides23
Referral Management Tools – NewConsult PowerForm24
Referral Management Tools – NewConsult PowerForm25
Referral Management Tools – NewConsult PowerForm26
Referral Management Tools –Ambulatory Referral WorklistNew worklist – viewable to ordering and consulting offices (both onPCA); Updates are real-time27
Referral Management Project –End User CommunicationTraining PlanRoadshowsSuper User CommunicationsNewsletter BlastsOperations Meeting CommunicationCommand Center28
Referral Management Project WinsNew referral workflowSummary page allows ReferralCoordinators to manage andtrack their referrals within theEMR and is viewable in real-timeby consulting clinics on PCAReduced process from 41Steps to less than 15 stepsImmediate increase inReferral Coordinatorjob satisfaction29
Referral Management ProjectWinsAutomation to eliminate the repetitive manualwork required to close the referral loop for practicesOver the first 4 weeks after implementation, anAverage of 153 referrals were SYSTEM closedper week. With an estimated savings of 9 min/Referral with the new process, that equates to23 human hours saved each week.30
Referral Management FutureOptimization “Vision” for future state Reporting – Mission Clinic Vital Signs(MCVS)– Volume of referrals– Internal and External Referral Patterns and Needs, Throughput– Key Process Indicators Time from Ordered to Sent Time from Ordered to Scheduled Time from Ordered to Completed31
Project Recognition32
Questions? Kristen.Wohlford@msj.org Bridget.Schmidt@msj.org33
Mission Health System -EMR History Cerner PowerChart Client since 2002 5 Hospitals live on full Cerner suite Cerner PowerChart Ambulatory (PCA) Client since 2014 95 Practices live on PowerChart Ambulatory 7 Waves of Implementation Primary Care, Internal Medicine, OB/Women's, Pediatrics/Genetics,
