Business Process Reengineering in Health Care IT

1
Business Process Reengineering in Health Care IT

• Types of BPR
• Project Management Implications
• Examples from the Field

2
Group 4 Project Agenda

• Overview of Business Process Redesign models
  used in healthcare.
• Applicability of principles of Business Process
  redesign related to overall Project
  Management methodologies.
• Effectiveness of such models as part of a
  Healthcare IT initiative.
• Examples where organizations have used such a
  model as part of a Healthcare IT initiative.
• Class exercise and questions.

3
Health Care Challenges that encourage BPR

• Medical errors and high costs of healthcare
• Underinsured or uninsured population
• Increasing number of heterogeneous and older
  population,
• Globalization/ medical outsourcing,
• Maintaining quality for given cost and cost
  minimization for given quality
• Shortage of clinical and nursing staff

4
Expectations from BPR models

• Increase in efficiency
• Reduce medical and medication errors
• Health care cost reduction
• Better access and quality in healthcare
• Procedure optimization
• Time effectiveness
• Customer and health care provider satisfaction

5
Highlighted solutions

• Automating and monitoring processes in healthcare
• Redesigning or improving clinical processes where
  necessary and possible
• Identifying patient expectations and improving
  patient care processes for better customer
  services.
• BPR models The business process redesign (BPR)
  models are the processes that target
  improvisation and optimization of process outputs
  while maintaining quality.

6
Six Sigma (Six sigma was invented by Motorola in
the 1980s)

• Analytical approach to indentify the
  inefficiencies and inadequacies in the process
  and provide a step by step solution based on
  analysis of real time data.
• Process must have lt 3.4 defects per million
  occurrences (Carrigan, 2006)
• Statistical calculation that suggests customer
  needs /satisfaction to meet 99.99997 or 6-Sigma
  level. (Caldwell 2006)
• Focuses on customer satisfaction, process
  improvement and cost reduction. (Breyfogle, 2003)
• Uses structured methodology and powerful
  statistical tools that provide a scientific
  approach to process improvement and patient
  safety. (http//www.medscape.com)

7
Six Sigma Sub methodologies

• DMAIC Define, Measure, Analyze, Improve, and
  Control (improve existing processes )
• DMADV Define, Measure, Analyze, Design, Verify
  (develop new processes or products at Six Sigma
  quality levels) (http//www.isixsigma.com/sixsigma
  /six_sigma.asp)
• Implementing 6sigma
• Black Belt organize of Six Sigma project
• Green belt implement and monitor the
  project.

8
Applications of BPR models

• Scheduling appointments
• Emergency room allotment
• Diagnostic imaging
• Patient follow up appointments
• Cancer screenings
• Bed allotment systems
• Minimizing duplication of records, bills,
  scheduling of follow ups and refills
• Reduce off time of the systems to improve
  accessibility and promptness
• Reducing wait times at Dr.s office and many more.

9
BPR Obstacles

• Internal and external challenges such as
  resistance to change, financial challenges,
  hierarchical tensions, changing workforce, lack
  of commitment, lack of implementation
• Six Sigma requires a clear goal setting, ample
  training of employees and commitment to implement
  the projects thoroughly.
• success is not guaranteed (Corn 2009)

10
Business Process Reengineering and Health Care IT

• IT often plays a support role in BPE in health
  care
• What has to happen when you design the new
  process, you find how information technology is
  going to be used to support that new process, and
  if you dont have that technological capability,
  youre going to have to go and get it. (George
  W. Whetsell)

11
Denver Health (Lean)

• Pure IT project patient scheduling application
  development
• Project timeline reduced 50, outside consulting
  cost reduced 36.
• IS had previously sat on the sidelines in lean
  initiatives, but sought to use lean to make the
  department more efficient
• Challenge was to fit lean concepts to a longer
  term IT project.

12
Denver Health (Lean)

• Rapid Improvement Event (RIE) model was tweaked
  to fit this specific project
• Embedded into project cycle, redefining how
  project was managed
• Custom templates created
• Special attention given to lean tools, activity
  flow, and frequency of RIE events
• Involvement of end users
• Red phone mentality

13
VAs VistA QUERI system (TQM)

• Quality Improvement initiative within the VA,
  where data from the organizations nationwide
  interoperable VistA EMR system is integral to the
  total process of improving patient outcomes.

14
Hynes, D. M., Perrin, R. A., Rappaport, S.,
Stevens, J. M., Demakis, J. G. Informatics
Resources to Support Health Care Quality
Improvement in the Veterans Health
Administration. Journal of the American Medical
Informatics Association. 2(5), 344-350.
15
Virginia Mason (Lean)

• IT served as a support role to improve areas
  identified as cost-centers
• Implementation of CPOE to reduce unnecessary
  prescriptions and reduce ER visits due to low
  refill allowances
• Implementation of decision support to alert
  clinicians when tests fall into the not useful
  category

16
Bibliography

• Corn, J.B., Six Sigma in Health Care, Radiologic
  Technology. September/October 2009 81(1) 92-95
• Bergman, R. (1994). Reengineering Healthcare.
  Hospitals Health Networks. 5 February, 1994,
  28-36.
• Breyfogle, F.W., Implementing Six Sigma Smarter
  Solutions Using Statistical Methods, 2nd ed.
  2003, Wiley, New York, NY.
• http//www.isixsigma.com/sixsigma/six_sigma.asp)
• http//www.medscape.com/viewarticle/449692_6)
• Carrigan MD, Kujawa D. Six Sigma in health care
  management and strategy. Health Care Management.
  200625(2)133-141
• Caldwell, C., Lean-Six Sigma tools for rapid
  cycle cost reduction, Healthcare Financial
  Management. Oct 2006, 60 (10)
• McQueen, H. E. (1993). The healthcare CIOs role
  in business process redesign. Computers in
  Healthcare. February, 1993, 24-28.
• Schweikhart SA, Dembe AE. J Investig Med. 2009
  Sep 2
• Shaffer, Vi. (2008). Case Study Denver Health
  Leverages Lean for a Breakthrough in Enterprise
  Patient Scheduling Implementation. Gartner
  Industry Research. 17 December, 2008.
• http//www.pqa.net/ProdServices/sixsigma/sixsigma.
  html