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Workflow AnalysisAndrew SharpinDeloitte Consulting"Reviewed November 2014"
Workflow Analysis OverviewProcess MappingWorkflowAnalysisTime MeasurementsStaff InterviewsPre-Pilot AnalysisEnd-Pilot AnalysisApril-2012Feb-201313 Sites Evaluated10 Sites Evaluated2D Barcode Scanning Impact
Immunizer DemographicsPractice ic89EMR VendorPractice Size1311-5526 - 1011 Office PracticumeClinicalworks15AllscriptsEpic2Practice Partner
Process Observations1. There is limited supply of 2D barcoded vaccines in the practices2. Single doses are given less frequently than combination vaccines3. The location of EMR data entry can impact user adoption4. Delaying EMR data entry increases the possibility of entering incorrectinformation5. EMR integration with 2D barcode scanning improves usability, which increasesadoption6. Adding NDC documentation when scanning can incentivize use7. Adding 2D barcodes to the vaccine package/box allows for a more seamlesstransition8. User product preference may influence technology acceptance
Vaccine Documentation Location & TimingEMR Data Entry LocationVaccine Prep Station24 Proximity to inventory fridge hasminimal disruption on workflow Document during vaccine prepNursing StationMobile Laptops3Vaccine Prep StationNursing Station Data entry hubExam Room1Mobile LaptopsEMR Data Entry Timing3Before Admin4After Admin3Mix Plug/ unplug scanner Scanner location dictates data entrylocationExam Room Physician practices Multi-dose vials returned to fridge Document after patient has left room
Clinician Feedback“The lot number and expiration date are hard to read onsome of the vaccines we get. When those vaccines getbarcodes we can scan, it will be a huge help.”Lot number and expirationdate stamped on M-M-Rpackage“I often see transcription errors where eight (8) and “B” or zero (0) and“O” have been mixed up. Scanning will fix these issues and reduce thenumber of times I can’t find the lot I’m looking for in our inventory.”
Clinician Feedback“Some of the vaccines are easier to scan than others Ithink it might have to do with size or darkness of the 2Dbarcode”“Right now, I can only scan one out ofthe five vaccines I’m entering. It’s a painand hard to always remember. Once I canscan all five, it will save me a lot oftime.”
Summary Results of Efficiency Findingst Inventory is initial point of vaccine dataentry Lot number and expiration date manualtranscription eliminatedn Experienced user maximized baselineprocess efficiencies Scanning efficiency will improve as thenumber of vaccines scanned per patientincreases* Overall average based on 10 sites with data from pre-pilot and end-state workflow analysis; NYS-2 excluded due inconsistent data from new staffPreliminary results
Inventory Management Efficiency FindingsPractices using their EMR system for inventory management all saw efficiencyimprovements when scanning 2D barcodeseR* Overall and EMR averages based on 10 sites with data from pre-pilot and end-state workflow analysis; NYS-2 excluded due inconsistent data from new staffPreliminary results
Vaccine Administration Efficiency FindingsImprovements in vaccine administration efficiency were closely tied to a practice’sexperience scanning 2D barcoded vaccineseR* Overall and EMR averages based on 10 sites with data from pre-pilot and end-state workflow analysis; NYS-2 excluded due inconsistent data from new staffPreliminary results
Enhancement OpportunitiesEMRs Product identifyinginformation Alerts Vaccineadministrationrecognition Multi-levelpackaging barcode Data entryrequirementsScannersManufacturersProviders Scanner technology Multi-levelpackaging barcode Data entry location Label direction Data entry timing
Key Study Findings1.Increase industry adoption Number of 2D barcoded vaccines Practice awareness of vaccines with 2D barcodes2.Increase data entry efficiency Quicker data entry Reduced error correction3.Optimize practice workflow Office layout and scanner locations EMR software functionality
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Practice Partner . Immunizer Demographics . Practice Type . Practice Size Specialty EMR Vendor . Process Observations . 1. There is limited supply of 2D barcoded vaccines in the practices 2. Single doses are given less frequently than combi
