Tuesday, October 4, 2011

A Patient's Viewpoint of Provider Workflow

My wife is having surgery on her knee tomorrow -- we hope. Somewhere along the way, somebody dropped the ball. She was supposed to be called last week for a pre-surigical appointment and tests, and to get the schedule. That never happened. Friday was a bit crazy, so she didn't call the office then. When she called the office Monday morning, the person she talked to said that her surgery appointment hadn't been confirmed. She confirmed it face-to-face with the scheduler at her last appointment. I told her to call back and raise hell.

You see, my mother came here this week to help out, and won't be able to easily come back later because then she'd be coming from Florida. I'm glad I work from home because my wife volunteers at the local elementary school. While the surgeon's office is scrambling to correct their mistake (something that I do appreciate), I'm fielding calls and forwarding information to her when she's at school and cannot be reached (bad cell service). So, right now, she's dropping what she is doing to head over to the office to get her pre-surgical tests (a CBC [I get it] and an EKG [I don't get it because she had an EKG in June]), and go over meds, prep, et cetera.

As a patient, this situation sucks. There are at least four different ways that they can contact us, but it winds up that we seem to have to keep pestering them in order for this to happen in a way that works for us. We like the surgeon, and want to stick with him, but boy, if I was in the office, or my wife had to work, there would be no way we could easily get this done before November at this stage. While it could easily wait that long, because it's not urgent surgery, but what a royal pain it is to make it convenient for us. I also think about what it cost my mother to come make this visit.  It isn't terribly expensive, but it was already a sacrifice for her.  I know how lucky I am to be able to work with this provider and make sure that we get everything done, and I'm grateful that they are working with us.  I know of so many stories where it is so much harder.  We have three people to attack the problem from different sides, but so many have to go it alone.

My question to myself: Where could IT help to solve this problem? In this case, doing what it does best, which is simple, brainless work. There's a list of things that need to be done: Scheduling the CBC and EKG. Scheduling the pre-operative visit. Ensuring that the results of these tests are available a couple of days before the surgery. Making that information available both to the patient, and to the surgeon's staff.  This particular procedure is one the surgeon does quite often. There is probably an order set of these things that he wants to have done somewhere. Putting this list of things together, providing workflow automation to ensure that things happen on schedule, and ensuring that the patient is contacted are all things that workflow automation can really help with.

IHE PCC is looking at several profile proposals that involve workflow this year, and anticipate using Cross Enterprise Document Workflow (XDW). This is a perfect example of a use case that could be aided by XDW.  There are several others, most of which are more complicated.  We may need time to study XDW and figure out how to use it in a workflow profile.  We may have to try different approaches to see which works best.  We will almost certainly struggle with how to specify a workflow and what needs to be included, and make it easy for different systems to participate in one.

Another question:  How could this have been handled better by the surgeon's office?  A simple sheet of paper with the list of things that have to get done, given to the patient, along with orders for the necessary tests (which could be done anywhere).  No IT changes necessary, just enabling the patient to help.  For an office with low volume, this is the low-tech equivalent of what an XDW workflow profile would look like.  We'll need to keep that low-tech equivalent in mind when we design XDW-based profiles.


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