April 29, 2010|Categories:
At athenahealth we recently ran a patient flow study in the office setting. We wanted to find out how clients using athenaClinicals, our electronic health record service, could maintain or even boost their productivity. With the collaboration of my colleague Aixa Almonte and others here, we set out to learn just how.
Lean methodologies were originally invented by automakers to boost efficiency and quality on the production line but have been adopted and utilized by the healthcare industry in recent years. The basic idea behind lean methodologies is to understand the steps in a process and remove or re-engineer waste while preserving and optimizing the steps that add real value.
We used lean methodologies to study how patients are processed in the office setting. We developed a Value Stream map and then collected data over six months from 25 of our athenaClinicals providers at 12 different practices from California and Texas to Massachusetts. We observed over 300 patient visits, logging over 100 hours of study in pediatric, internal medicine/primary care, orthopedic, and obstetrics/gynecology practices.
We all know a patient visit is not a one-on-one encounter between the doctor and patient. From arrival to check-out, a patient interacts not only with the provider but also with administrators, medical assistants, nurses, and technologists. It’s a delicate process of coordinated hand-offs that can go poorly without the right tools and strategies to make it run smoothly.
Armed with stopwatches and clipboards, we measured:
- patient process times and wait times
- triggers of patient flow
- who worked each phase, especially if the right resources were available to complete tasks
- first time quality – did the right thing happen the first time or was rework required?
We had stopwatches but we also had a secret weapon. Our athenahealth web-based platform allows us to measure and monitor performance across our entire network. With that unique insight, we could enrich the data collected in the field with weblog data pulled directly from athenaNet.
So what did we find? After sifting through significant amounts of data, we discovered distinct patterns of provider behavior that clearly separate highly efficient providers from less efficient ones. Our highest performing providers are highly focused on the today’s tasks, adapt well to obstacles that arise throughout the day and employ strategies to ensure their patients move through their offices smoothly and efficiently. These providers minimize wait times while maintaining normal face time with patients. They start on time, do the majority of their work in real-time and, importantly, are supported by flexible, cross-trained staff.
We found that a provider’s strength at executing patient flow processes resulted in their ability to finish all the work of the day’s patient visits on the same day. The efficient ones wrap up work the same day by completing the encounter documentation in real-time instead of waiting until later, on nights or weekends.
The insights gained from this study informed our decision to incorporate the 5-stage encounter functionality into athenaNet to help streamline patient flow and enable us to measure these processes using our EHR platform. Our next step is to deliver this insight, using reporting tools and benchmarking, directly to our providers so they become more aware of their own processes and adopt our best practices that enable smooth patient flow.