Hospitals, Health IT

Workflow remains the key to health IT project success

“We see some pretty big failure rates around project management,” Melissa Swanfeldt of EHR vendor Meditech. She spoke at CHIME last week.


It can’t be said enough: electronic health records are no cure for poor workflows and processes. Hospital CIOs have probably heard it a million times, but that doesn’t mean many of them don’t need a refresher, in the form of a case study showing how process improvement can make health IT projects successful.

That is exactly what attendees heard at the College of Healthcare Information Management Executives (CHIME) Fall CIO Forum in Phoenix last week in a session on operational excellence.

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“We see some pretty big failure rates around project management,” according to Melissa Swanfeldt, associate vice president for sales and marketing at EHR vendor Meditech. She cited research suggesting that 70 percent of large operational projects fail.

“We’ve had a lot of really good projects that failed over the years,” added Ed Ricks, vice president and CIO, of Beaufort Memorial Hospital, a 197-bed facility in Beaufort, South Carolina. Poor workflow often is the culprit.

The ones that are successful tend to take human factors in workflow into consideration. “Value the end-user experience,” Swanfeldt said. “They need to understand how the technology impacts them.”

Swanfeldt had an experience with broken processes during a health scare she had in the last 12 months. Even though the hospital she was at had an EHR, it took hours for some test results to come back. Others who had been seen after her had already gotten answers, she said.

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“You can imagine how scary that is when you are in the hospital, waiting there for test results, and the other patients are all getting their results,” Swanfeldt said.

It turned out that the hospital had paper processes as workarounds to the EHR. In her case, the department kept records of patients awaiting test results on paper cards. Swanfeldt’s card had fallen on the floor, so nursing staff were unaware she was kept waiting for hours.

Beaufort Memorial, a Meditech customer, had plenty of similar workflow issues.

“We’ve had a major problem in our ER with holding patients too long before they are admitted and moved to a floor,” CIO Ed Ricks said during the same CHIME session. This hurt both patient and staff satisfaction, and also increased costs and likely compromised patient safety, Ricks said.

The response to this problem was to improve communications and standardize processes. Whenever there is a question about whether to admit a patient, a clinician from the emergency department texts a hospitalist to arrange a phone discussion.

If the patient is to be admitted, the hospitalist enters a registration order into the EHR, the ED clinician writes basic orders and the patient is admitted. A nursing supervisor gets the order on a mobile device and assigns a room. After a face-to-face handoff discussion, an ED technician and a unit nurse take the patient to the appropriate hospital unit.

And the early returns suggest the program has been highly successful. Prior to implementing collaborative rounding in late July, it took an average of 147 minutes for patients to leave the ED for a floor following a decision to admit. By the end of August, that time had dropped by more than half, to an average of 70.8 minutes, according to Ricks.

For those already in inpatient wards, communication between patients, physicians and caregivers lagged, particularly when it came to care plans and any current patient concerns, Ricks reported.

The answer was to institute what Ricks called “collaborative rounding.”

Hospitalists were assigned to patients “geographically,” according to Ricks. The IT department added the hospitalist assignment list to the Beaufort Memorial intranet so all clinicians could know who was in charge of a given case. All physicians were instructed to huddle in care teams.

Nurse communication on the initial test ward improved dramatically and median discharge time dropped from 226 minutes to 185 minutes within a year.

Collaborative rounding worked so well that Beaufort Memorial greatly expanded its use. “This has been brought to all of our inpatient units,” Ricks said.

Photo: George Rose/Getty Images