Nursing Informatics: Benchmark – Create a Workflow Essay

Nursing Informatics: Benchmark – Create a Workflow Essay

Nursing Informatics: Benchmark – Create a Workflow

The purpose of this assignment is to analyze a clinical workflow and apply process modeling techniques to solve an EMR problem. Read the “Integrated Case Study” resource and review the “Oncology North: Navigator Intake Paper Form” and “Oncology South: Oncology Navigator Intake Form,” located in the Class Resources, prior to beginning the assignment. In addition, refer to the instructor feedback you received on the Topic 3 assignment. Part 1: Analyze a Current State Analyze the “Oncology North: Navigator Intake Paper Form” and “Oncology South: Oncology Navigator Intake Form” to identify opportunities for process improvement as they relate to informatics. Consider ways to optimize electronic documentation and reduce the number of steps. Part 2: Create a Future State Workflow Using an Excel spreadsheet or Word document, create a future state workflow that solves the identified improvement opportunities from your analysis with a minimum of six steps and a clearly defined start and stop. The workflow must display the accurate symbols used to indicate certain actions. Part 3: Rationale In addition, support the future state workflow with a 500-word rationale that provides the following: Identify the users of the workflow. Describe the identified opportunities for process improvement and how the future state workflow addresses these opportunities. Describe how the future state workflow optimizes electronic documentation and reduces the number of steps. Evaluate the effects of the future state workflow on patient care quality. Assess how the future state workflow will change based on user needs. Recommend how to develop an improvement plan to enhance the future state workflow. Include three to five scholarly resources to support your findings. Prepare this assignment according to the guidelines found in the APA Style Guide. This assignment uses a rubric. You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance. Benchmark Information This benchmark assignment assesses the following programmatic competencies: Analyze clinical workflow and apply process modeling techniques to support improved use of information and clinical decision making. This assignment aligns to the following AMIA 2017 Core Competencies for Health Informatics Curricula at the master’s degree level:

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An unimproved workflow could result in the facility being unsuccessful, unmotivated personnel and lost revenue. Without an optimized workflow in place, it is impossible for the facility to finish work on time and be productive. This creates a need to streamline the workflow to keep things uncluttered and organized, an important step for getting the teams in the two facilities to complete more work with less effort and in less time. This is especially the case as the facility seeks to implement an electronic documentation system. Implementing the electronic documentation system without optimization is likely to affect provider satisfaction and clinical efficiency negatively. In fact, the system could disrupt the providers’ daily routines thereby souring them against the system and overshadowing its potential benefits. Optimizing the system before implementation can help in reducing administrative burden on providers while improving their satisfaction and clinical efficiency (Volpe, 2022).

Part 1: Analyze a Current State

A review of the present case reveals a need to present an electronic documentation system for the two facilities. Four opportunities have been identified for presenting an optimized system. First, reducing information overload in provider notes. The intake forms for the two facilities give the providers access to more health data at the point of care. However, there is a concern that this information may be too much (Sewell, 2018). Second, presenting a specialized clinical workflow designed for the oncology environment. This would ensure that the system meets the unique needs of the oncology specialty, and the two care settings and health systems (Houston et al., 2018). Third, including tools that improve usability, such as allowing the providers to communicate with each other, case managers, pharmacists or specialists very quickly without going in search of a console or leaving the bedside (Kushniruk & Borycki, 2018). Fourth, involving nurse informaticists in optimizing the system as they serve dual role of system users and experts in data analytics and technical design. This makes them uniquely positioned to optimize the system for workflow and quality improvements (Saba & McCormick, 2021).

Part 2: Create a Future State Workflow

Figure 1. Future state workflow with new electronic documentation system fully interfaced/integrated

Part 3: Rationale

Four opportunities have been identified. The first opportunity is reducing information overload in provider notes. Information overload can overwhelm the providers, and negatively affect their work efficiency by requiring them to spend a lot of time sifting through large quantities of clinical data to find the specific information they need. The intake forms should be redesigned to display less data to the providers to help them in reducing information overload and cutting through the clatter. This can be achieved through a collapsible provider notes design that displays assessment, plan, subjective and objective information. This design would continue to collect a lot of patient information, but hide it when not needed thereby allowing the providers to locate key information in the notes while completing timed tasks. In fact, the collapsible notes design would improve the system usability without requiring providers to learn how to use additional skills (Sewell, 2018).

The second opportunity is presenting a specialized clinical workflow that prominently displays functionality and information most commonly used by oncology providers thus allowing them to more easily navigate the system. This would require that the facility and providers work directly with the system designed/vendor to specialize clinical workflows, ensuring that it meets their needs and improves their satisfaction as part of the optimization. This may involve creating different specialized workflows to save time for providers across the professions and specialties (for instance, a nurse logging in would go to the nurses page while a surgeon would go to the surgeon page) while ensure that the new system is a boon rather than a hindrance to clinical efficiency (Houston et al., 2018).

The third opportunity is adopting tools that improve usability. Integrating the new system can improve care delivery and clinical processes. However, the new system would add functionality for the providers, further augmenting their administrative burden and diverting their attention away from the patients. As such, the new system should prioritize usability as a strategy for improving clinical efficiency. For instance, it can relay information about admission, discharge and transfer for each patient, thereby closing the communication loop between the attending providers. This can also include a provider directory that offers insight into what the different providers and teams are working on, who is caring for which patient, and who is available at any given time. In addition, smart phone access should be allowed to accommodate the needs of mobile care teams (Kushniruk & Borycki, 2018).

The fourth opportunity is involving nurses informaticists in the optimization as they can make the appropriate adjustments to the system. Nurse informaticists have the dual role as both system users and experts in data analytics and technical design. They are uniquely positioned to optimize the system for workflow and quality improvement that cater to the needs of the providers. Trained with a diverse set of tools to expertly provide nursing services, and correct any accountability, training, workflow and system issues, the nurse informaticists can lead the partnership between the system users and builders to keep their needs at the forefront (Saba & McCormick, 2021).

Overview:

Throughout this course, you will use this case study to demonstrate knowledge of the following course content:

  • Clinical decision support
  • Assessing user needs
  • Analyzing and documenting workflow
  • Designing and customizing fields, forms, and templates
  • User testing
  • Evaluation metrics
  • Designing user documentation and training

In a series of assignments, you will use this case study to integrate user interface design (including usability/human factor principles) into a design document, analyze and develop workflows, evaluate users’ needs (including their involvement in user testing), develop evaluation metrics, and design end-user training materials.

The case study, which will be used throughout the course, will focus on various components of the course topics. It focuses specifically on the unique needs of oncology patients and the health care needs of oncology navigators and prior authorization/financial coordinators.

The Case:

Universal Health is a large not-for-profit health care system with 12 hospitals in three states and two large oncology programs in Arizona. One of the oncology programs is affiliated with Academic Hospital and the other with a larger national oncology health care system. Although both oncology locations are part of Universal Health, there are significant differences in how each of the locations operates due to a recent merger/acquisition of the Academic Hospital oncology program (Oncology South) and the affiliation of the other oncology program (Oncology North) with a national oncology health care system. To compound these operational issues, Oncology North had been part of Universal Health for 8 years, so its Electronic Health Record (EHR) was Chrystal, which was the EHR platform for Universal Health and became the model used to convert Oncology South from its EHR to align with the rest of the organization. Management of oncology patients is quite complex and there was significant concern from Oncology South about the EHR conversion, as well as changes that would affect its operating model. Previously, both oncology programs worked relatively independently with IT to create custom solutions, but now they will need to work together to create a standardized oncology solution for Universal Health.

If a merger/acquisition of a large academic hospital and its oncology program was not complex enough, adding the conversion of an EHR certainly made the situation more difficult. Also compounding the issue, Oncology North—although it had been on the EHR Chrystal for almost 8 years—had significant issues with the current build and felt that there were several gaps related to functionality for oncology clinicians to service its unique population. Since Universal Health was in the process of converting the EHR at Academic Hospital and Oncology program, the EHR vendor, Chrystal, was actively involving its alignment specialists to assist in the conversion. One of the key first steps of the Chrystal alignment specialists was to do a gap analysis and prioritization of EHR functionality for oncology as well as throughout Universal Health.

The gap analysis done by Chrystal found that the oncology build for Universal Health overall did not align to its recommendation for oncology specialties in several areas within the EHR. As a result, a focused team (including a project manager, nursing informatics, Universal Health IT resources, Chrystal oncology alignment specialists, and Chrystal oncology IT experts) was created to systematically address the recommendations from the Chrystal oncology gap analysis. Although there were recommendations globally related to Universal Health’s overall EHR build, there were some specific recommendations related to the build of the oncology platform within Chrystal. Some of the initial focus was related to concerns related to prior authorization/financial gaps and the functionally/workflow of all the oncology providers/clinicians, but also the oncology navigators who really did not have any oncology functionality within Chrystal.

Servicing an oncology population is a significant part of the patient demographics of any large health care organization. Oncology patients have unique needs due to the frequency of their visits and the length of their treatments and follow-up, which can last a lifetime. A cancer diagnosis is life changing and can cause great emotional, physical, and financial stress. Oncology navigators exist to assess and assist patients and their families during their cancer treatment and hopefully into remission/survivorship. Unfortunately, cancer treatment can be costly, and dealing with insurance companies for prior authorization is an unfortunate reality in the current health care system. For health care providers, there is great financial responsibility in providing cancer treatment, so obtaining authorization from insurance companies and ensuring that patients are aware of their own financial responsibility are essential for both the patient and the organization.

After a patient receives a cancer diagnosis, the next step is usually a referral to an oncology specialist/program like Oncology North or Oncology South. That referral can come from a patient calling an oncology specialist/program directly or from the diagnosing physician contacting an oncology specialist/program. Oncology South and Oncology North both have dedicated intake referral specialists who work directly with patients, families, and referring physicians to get patients scheduled with an oncology specialist based on their diagnosis. Before the patient sees the oncology specialist for the first time, many documents need to be sent to the prior authorization team for review to ensure that the appropriate prior authorization is obtained from the insurance company, as well as making sure that the patient will be seen by the most appropriate oncology specialist for the specifically diagnosed cancer. These documents vary from pathology reports, diagnostic results, and referring physician notes that can be sent to the prior authorization specialist at different times for different patients. It is essential to have a standard workflow and expectation of standard documentation in a certain place in the EHR, so that everyone involved in the initial authorization and clinical care knows what steps have been taken and what actions are pending. While these financial steps are occurring behind the scenes and are important details that need to be secured before a patient’s first appointment, it is worth noting that at this juncture patients have just received some of the worst news in their life and they just want to get treatment as soon as possible.

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Oncology navigators are nurses that specialize in assisting patients navigate their cancer journey from diagnosis through treatment and into survivorship. After the first contact with the oncology intake specialists, oncology navigators are the next foundational step in the patient’s journey towards treatment and recovery. After the initial documentation is completed by the intake specialist who provides some basic information, including name of person calling, contact information, referral sources, provider information, and diagnosis information, such as type of cancer. Based upon the type of cancer on the intake documentation, an oncology navigator who specializes in that cancer type is notified of the new patient and contacts the patient to initiate a custom navigation plan based upon assessment of needs. The oncology navigator role is an extremely important part of the oncology team. However, oncology navigators were identified as being significantly underdeveloped within Universal Health EHR based upon Chrystal’s gap analysis, so there needed to be focused attention on this group within the organization.

As a result, a dedicated team needed to be formed to include individuals from nursing informatics from Universal Health, Chrystal oncology alignment and IT specialists, Chrystal IT staff, and oncology navigators from both Oncology North and Oncology South. This team would be responsible documenting workflow, assessing end-user needs, and submitting a final design recommendation (including training materials) to the Universal Health IT build team. The completion deadline for the design document is 8 weeks.

Assessing current state and understanding end-user needs must be one of the first goals of this dedicated team. Two days were dedicated for onsite observations of oncology navigators at Oncology South and Oncology North, during which it was discovered from the observations that even though the oncology navigators at both locations performed the same role, they had some significant differences that needed to be overcome to be able to collaborate and create a single oncology navigator solution. The grid below outlines some of the differences.

Operations Differences Oncology South Oncology North
Initial Contact With Patient Phone interview within 3 days Initial physician clinic visit
Patient Oversight All oncology patients Only oncology patients that have identified needs
Documentation Paper form: See document: Nav Assessment 2018 Paper form: See document: Oncology North

Although each location has operational differences, they also have several similarities in how they used some of the tools in the EHR, as well as their need for data and the ability to track/trend the outcomes of their patients. One key request was to make it easier for all oncology clinicians to be able to see their documentation within Chrystal. These foundational similarities aligned to what Chrystal oncology specialists had implemented at other institutions, having already created an Oncology Navigator Recommended Design Document that could be used at Universal Health. The table below provides some similarities between Oncology North and Oncology South. Nursing Informatics: Benchmark – Create a Workflow Essay

Operations Similarities Oncology North and Oncology South
Position Navigator/Coordinator RN
Data Request Wanted discrete data for reports
Electronic Documentation Used same two electronic methods to chart:

1.      Electronic forms shared by all types of navigators (e.g., ortho, pulmonary)

2.      Free-text note also shared by same navigators above

Electronic Documentation Wanted it to be easier to find specific oncology navigator documentation

Health care is all about data. In addition to using EHR for recording documentation, it is used to extract data to evaluate outcomes. Data in the EHR can come from discrete data from ICD10/ICD9 used by providers/coders, SNOMED, IMO codes used clinicians, but also directly from forms and flowsheets from discrete data fields. Understanding the unique data requirements of the oncology navigators, as well the initial prior authorization team, is foundational to creating the appropriate discrete fields or using existing data fields like ICD10 to help sort and organize data. Nursing Informatics: Benchmark – Create a Workflow Essay

 

References

Houston, S. M., Dieckhaus, T., Kircher, B., & Lardner, M. (Eds.) (2018). An Introduction to Nursing Informatics, Evolution, and Innovation (2nd ed.). Taylor & Francis.

Kushniruk, A., & Borycki, E. (2018). Usability and Health Care Technology. Elsevier Science.

Saba, V. K., & McCormick, K. A. (2021). Essentials of Nursing Informatics (7th ed.). McGraw-Hill Education.

Sewell, J. (2018). Informatics and Nursing: Opportunities and Challenges (6th ed.). Wolters Kluwer Health.

Volpe, S. (Ed.) (2022). Health Informatics: Multidisciplinary Approaches for Current and Future Professionals. Routledge. Nursing Informatics: Benchmark – Create a Workflow Essay

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