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Running head: WORKFLOW REDESIGN 1

Workflow Redesign

Name

Walden University

NURS 6421, Section 01 Supporting Workflow in Healthcare Systems

October 29, 2016

Workflow Redesign

Confusion about patient’s medication procedures while the patients are admitted and upon the patient’s release is the cause of harmful medication errors that could have been prevented. The purpose of the paper is to come up with the new future-state workflow that will realize meeting the needs depicted by the execution of the unfinished medical reconciliation project. The future-state workflow shall incorporate the gaps recognized in the current state workflow and the previous gap analysis. More so, it shall involve the explanation of the proposed solution and how it addresses the gap identified within the current state workflow. There are additional steps for the workflow developed and transition of the current to the future workflow. There are the implementation strategy and its appropriateness.

Explaining the Proposed Solution, and How It Addresses the Major Gap Identified in the Current State Workflow, and How It Relates to Meaningful Use.

The proposed solution will involve ensuring the EHRs to be implemented to have features that automate the medical systems requirements. It means that the medical records are electronically transferrable to the patients and the workflow is defined from the doctor’s prescription to the patient receiving the right medication. Implementation of EHR system, especially in the inpatient setting, will enable documentation, transmission, and communication of medication information. Thus, the system provides an opportunity to perform medication reconciliation within the healthcare setting. Unertl, Johnson and Lorenzi (2012), reported that EHR systems could keep active medication lists as well as order medications that can be transmitted across all clinicians in the healthcare setting. Moreover, the proposed systems will provide functionality to solve incomplete medication reconciliation, and the ability to capture information required to report incomplete medication reconciliation quality (Brown, 2010). The errors realized during medication reconciliation shall be turned into outstanding results regarding the performance of the pharmacy and the entire hospital. The gap involving non-updated records shall be ended by implementing the EHR that ensures real-time updating of medical information as well as other stakeholders like patients, pharmacists, system administrator, and doctors. Meaningful use involves the use of the EHRs in ensuring the medication that depicts quality in safeguarding the health of individuals (Brown, 2010). The solution enhances conventional drugs or medical list that is updated every moment via the available data elements and incorporated codes regarding EHRs (Moore et al., 2011).

The medication reconciliation will integrate the medical team with the objective of keeping up-to-date the medical list after patient’s admission. More so, nurses review the medical prescriptions, pharmacist dispensing the prescription, and discharging the patient after receiving the right medication. Use of the EHRs based reconciliation improves the quality of health care by enhancing medical transition (Unertl et al., 2012). The collaboration of the medical stakeholders ensures that all the requirements including maintenance of the medication list, and harmonize the clinical information. It improves medication, as the orders made, is followed within the right time while avoiding medical omissions, and dosage errors.

Use Case of a Real-World Scenario

The use case below illustrates the flow of information for a patient being admitted for surgery. The system provides an opportunity for various individuals in the healthcare setting to interact with the same system with each having defined roles to facilitate medication reconciliation.

Figure 1: Use Case Diagram for Patient’s Admission for Surgery

Additionally, the new EHR system will incorporate the ability to (1) record and view patient’s medication history, (2) update patient’s medication history and dosages in their chronological order, (3) group medications records by code to enable comparison and reconciliation, and (4) enable clinicians to confirm whether medication reconciliation has been completed and whether any changes have been made to the data provided.

A major challenge for the healthcare organization is to integrate reconciliation through electronic records without compromising efficiency. To implement the system successfully, we need to leverage different health professionals so that reconciliation can occur with minimal workflow disruption and to improve the transmission of medication information to the next provider when a patient is being admitted to the facility.

Organizational Roles and Responsibilities During Transition

When introducing any a system, identifying the various roles and responsibilities is important to ensuring each step is executed in an effective manner for the facility or individual. Choi & Kim (2012) reported some challenges in workflow transition, such as physician resistance or disbelief of the medication information accuracy, and some specialists carrying out medication reconciliation in which they are not familiar with. Thus, proper training will be required for specialists on new medication reconciliation procedures using the proposed EHR. Moreover, enough time and resources needed to implement the new system will be allocated to make it a success. Also, we will assign different clinical staff and specialists the role of updating and confirming the medical record during admission or at the discharge of patients. There will be similar organizational change including automation of various activities within the medical field that ensures fast, and efficient services delivery (Choi & Kim, 2012).

The other step that is necessary would be ensuring that every department within the organization has enough workable ad facilities that will enhance EHRs implementation. It helps in comparing the products and the available support. The team will eliminate some activities or tasks involving the use of files and paper records to the database mode of information storage. It ensures automation of medical information whereby it becomes easy for the medical team to exchange medical information of the patients without physical movements within the clinic or hospital (Moore et al, 2011). The third step shall involve feeding of the papered records to the EHR system to promote medical reconciliation. It helps analyze the costs and benefits related to the EHRs. All the history is fed into the system that makes easy to retrieve while counterchecking the medical reports by the medical team during the prescription stage. It becomes efficient to locate needed information when using the system than previous means that gaps where it lacked the knowledge of who does what at a stage of medication. The reconciliation implemented by the system ensures that the organization becomes digital in the sense that such task can take few minutes to have complete checking of the medical records. More so, the patients can get instant medical results and information before discharge or go back to their homes due to the EHRs implementation (Unertl et al., 2012).

Implementation Strategy Useful for the Project

A possible implementation plan becomes the critical aspect of the organization. It ought to focus on the goals as well as objectives of the entire organization. One of the strategies involves ensuring the results-based project management. The approach is useful since it will focus to ensure the recompilation process of the medication is adequately achieved. Successful delivery of the demands raised by the project including linking the gaps realized within the current state workflow will ensure improved productivity of the organization (Moore et al, 2011). Focusing on the results will always make sure that the changes necessary are implemented early enough hence ending up with the error-free project. It becomes appropriate within the workflow and the practice setting because the major goal of the medication is to promote service delivery to the patients. Results regarding treatment should leave no chances of failure hence the appropriateness of the implementation strategy (Choi & Kim, 2012).

The main strategy to be employed in the implementation of this system is the utilization of training in the parallel changeover. The process starts with reviewing project goals and creating responsibilities document (Dennis, Wixom & Roth, 2015). We will have to ensure all modules works well and users understand their roles in all subsystems. A training schedule will also be developed for orientation where users can ask a question and get clarification regarding the system. This will give the team an opportunity to identify any additional issues that are not addressed in the EHR. The system will run in parallel with the current one until users fully familiarize with it.

In summary, the paper evidently shows that the future-state workflow will ensure that all the gaps within the current workflow are addressed. It ensures medical reconciliation process is incorporated into the EHR system. Organization Transition automatically involves various steps that help to adopt the new system. An implementation strategy is paramount in realizing the success of any project and particularly the medical reconciliation (Moore et al., 2011). Thus, the proposed system will improve communication and medication standards hence reducing the possibility of incomplete medication reconciliation.

References

Brown, B. (2010). 25 Steps to Meaningful Use. JOURNAL OF HEALTH CARE COMPLIANCE, 12(3), 33-34. Retrieved from http://web.a.ebscohost.com.ezp.waldenulibrary.org/ehost/pdfviewer/pdfviewer?sid=ee93efdb-cbc6-40e6-8f77-bb0f1d0e3d4c%40sessionmgr4008&vid=1&hid=4212

Choi, J., & Kim, H. (2012). A Workflow-Oriented Framework–Driven Implementation and Local Adaptation of Clinical Information Systems: A Case Study of Nursing Documentation System Implementation at a Tertiary Rehabilitation Hospital. Computers Informatics Nursing, 30(8), 409-414. doi: 10.1097/NXN.0b013e3182512ffd

Dennis, A., Wixom, B. H., & Roth, R. M. (2014). Systems analysis and design. John Wiley & Sons.

Unertl, K. M., Johnson, K. B., & Lorenzi, N. M. (2012). Health information exchange technology on the front lines of healthcare: workflow factors and patterns of use. Journal of the American Medical Informatics Association, 19(3), 392-400. Doi: http://dx.doi.org/10.1136/amiajnl-2011-000432

Moore, P., Armitage, G., Wright, J., Dobrzanski, S., Ansari, N., Hammond, I., & Scally, A. (2011). Medicines reconciliation using a shared electronic health care record. Journal of patient safety, 7(3), 148-154. doi: 10.1097/PTS.0b013e31822c5bf9