Go With the Flow—Hawaiian Medical Group Overcomes Geographic Obstacles and Mountains of Paper to Improve Workflow
Distributing patient information manually is hard enough. Try
distributing it from one island to another. Here is the story of how
our healthcare group, located throughout the Hawaiian islands, changed
our workflow systems from manual distribution to an electronically
distributed system, and improved external communications and
allocation of administrative time.
Problem
Straub Clinic and Hospital, based in Honolulu, is a part
of Hawaii Pacific Health. We have 200 physicians in 32 specialties
practicing at 14 neighborhood clinics and at the 159-bed Straub
hospital.
Straub faced the unusual challenge of having to move patient charts,
information and administrative data not just from clinic to clinic,
but sometimes from island to island. If a patient had an appointment
in Kailua one day and in Kona the next, we moved the chart from one
place to another, often by airplane.
Our medical data management and workflow systems relied heavily on
paper-based charts, hampering clinicians' and support staff's ability
to track clinical information, such as test results. Daily workflow
consisted of dictation to be distributed, reviewed and signed, lab and
radiology reports to be distributed, reviewed and initialed, and
letters intended for referring physicians. A trip to medical records
was inevitable for physicians to sign operative notes and discharge
summaries. Patient calls resulted in staff making endless chart pulls.
Communication with physicians outside the clinic was by phone or
dictated letter. Internal communication between physicians was by
phone or voice mail. The processes of communication and patient care
documentation were tedious and time-consuming.
Solution
While we considered several IT solutions, most focused
on just one piece of the entire workflow process. We wanted
to improve our entire system of workflow, but were not prepared
to go to a full-scale electronic medical record.
In early 2001, we selected Axolotl's Elysium Clinical Messaging and
Workstation system, a Web-based open solution that we felt would
leverage our existing investment in technology. Elysium automatically
delivers results from our current system to affiliated
physicians—instantly. Once received, physicians can annotate and store
information in patient charts, electronic or paper.
Elysium enables physicians to automate repetitive, multistep processes
carried out in their offices. They can view collections of lab results
for patients and analyze behavioral trends. Graphs display time-series
data, which can be clearly visualized, and appropriate clinical
inferences can be drawn.
Results
Physicians and nurses are now connected, receiving electronic
transcriptions and lab and radiology reports as soon as they
are available. Information is sent into one clinical inbox for
each physician where it is managed, completed and forwarded,
automating workflow throughout our system.
Physicians review dictations on PCs, make edits, and electronically
sign and deliver them to our health information management department
for filing into medical records. Medical records has the signed
results printed in terminal digit batches scheduled at different times
of the day. Results are filed directly into the chart, versus being
separated and mailed to physician offices. These workflow features
have led to an average saving of one half-hour per physician per day.
Lab results are displayed within the system in e-mail format and are
available for review as soon as they are complete. Abnormal results
are flagged for immediate attention. Serial lab tests, such as
prothrombin times, can be displayed as a graph for increased analysis.
When patients call, physicians can immediately access related lab work
and clinical notes. Repetitive workflow processes are automated,
allowing physicians to send a result with instructions to their
medical assistants for immediate follow-up or to attach lab results to
a message and forward it to the appropriate specialist.
Administrative time and costs related to tracking lost and delayed
results with multiple calls to ancillary departments have been
eliminated, as have document management costs.
Our next steps are to pilot the Elysium Prescription module and
Elysium Mobile from the Workstation and Prescription Management
applications. This will give physicians the ability to review labs,
manage clinical information, view cumulative information, write
prescriptions and communicate with their staff—all from a handheld
computer.
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