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Working with Workflow: Long-term care's EMR Technology

December 14, 2012
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When long-term care (LTC) first started to move from paper to electronic information systems, we took our workflow check-off sheets and digitized them without thinking much about the new workflows that would be required to take advantage of the new application. This usually happened because we were in a hurry to get the new application online.

But upgrading your technology is much more than reproducing old workflows on a prettier screen with fewer clicks. It’s advisable to examine workflow long before an upgrade or new installation and introduce improvements in clinical care, productivity and efficiency.

Most of today’s leading information technology (IT) vendors do their best to help providers look at clinical and financial workflows, but the pressure and costs of implementation sometimes result in inadequate analysis of today’s required workflows. The study of future workflows based on national programs usually does not happen at all. In previous blogs I’ve pointed out the value of having a dynamic HIT Strategic Plan. If you have done this, you’ve started to look at future workflows. But, your first priority probably is choosing a vendor and application. Your second priority will be the training of the users. Being realistic, most providers focus on today’s issues rather than the future workflows and how they will fit into your strategic HIT plan, especially since all the changes in care and payment models make the future a challenge to predict.

I think it’s important to try to visualize what your skilled nursing facility or home care agency might look like in 2015. A year when there is a national HIT infrastructure to support person-centric, longitudinal electronic medical record (EMR) as well as interconnectivity and interoperability through transitions of care. A projected healthcare future where long-term and post-acute care providers are not silos of care, but are activily engaged throughout the spectrum of care. I can only imagine the trauma of being a project leaders for a new HIT infrastructure implementation and having to know the ultimate clinical and financial workflow in a person-centric, longitudinal care world. When you think about it, it is almost an overwhelming project.

Over the past month I have been working with a number of thought leaders from the Renaissance Technology Consultants Group, LLC in Reading, Mass. on the issue of unbundling workflow. Our goal was to develop a better, less intimidating definition of workflow. We determined that providers should think about workflow in stages over a long period of time, not just when they’re implementing a new enterprise application. We came up with a simple list of workflow stages so that people can understand the timeframes without becoming threatened by the magnitude of workflow change. Remember, changing your HIT infrastructure is an evolution and not a revolution—so take your time. Timing is also influenced by national and regulatory policy. A provider cannot move too fast, since as changes are happening all along the timeline.

The graphic below shows the unbundling of workflow into workable stages.


John Derr

John Derr


John Derr, RPh, currently serves as Health Information Technology Strategy consultant to Golden...