Stage 1- Workflow research and analysis is accomplished with the vendor and provider teams before starting the training and implementation of the software application. The initial workflow requirements are designed to implement the application with a minimum disruption of quality of care and the business. This launches the basic requirements of a person-centric EMR.
Stage 2- Workflow analysis is accomplished after the basic person-centric EMR workflow has been fully implemented and in use for a reasonable period of time. Additional elements of care including laboratory, radiology, therapy and pharmacy medication management complete the provider’s EMR.
Stage 3 - Workflow expands the person-centric EMR longitudinally by time and dynamic trending. Clinical alerts and eDecision (Clinical Decision Support) software are added so that person-centric care coordination teams can begin to provide proaction, prevention and wellness care plans.
Stage 4- Workflow takes the person-centric longitudinal EMR and incorporates transitional care technology to receive care record information that has been gathered by other providers upon intake, and to transmit information back to a care record upon discharge for use by the next provider or by the individual themselves.
In today’s world of the HITECH Act, healthcare information exchanges and 30-day re-hospitalizations, sometimes interconnectivity with the hospital and physician has to follow Stage 1. In this case, minimum electronic transitions of care patient information will be exchanged before the LTC provider has moved past a basic person-centric EMR. This is acceptable as long as both the hospital and LTC provider realize that this is merely the first step towards the ultimate goal of implementing all four stages of workflow.
I hope this helps to put workflow in perspective and suggests that total patient-centric longitudinal care workflow does not have to all happen at once. Providers have to evolve their workflows over time, but they also should realize that healthcare workflow needs to be is not about dynamic, personal and longitudinal care—not the static, episodic care of the past.