August, 1996 Knowledge-based processes depend on workflow The demands of the new healthcare environment By Jamie Mendez, Industry Solutions Manager, Lotus Development Healthcare is one of the most documentation-intensive industries in the world. There are records of patient histories, lab reports, medical images, nurses' observations, insurance forms, billings, payments received and much more. Every case, every patient generates large quantities of detailed information to record and track, no matter how simple the medical case may have been. Because of this, document management is literally a sink-or-swim proposition for companies operating in the healthcare industry. The issue is simple: master it or drown. For straightforward, transaction-oriented data such as billings and payments, much of the healthcare industry adopted mainframe host-terminal applications as its solution years ago. That was successful, and many of those applications continue to run on mainframes to this day. Knowledge-based processes Current trends in medical care and business are making many other work processes more complex, with larger loads of documentation to match. These processes require different approaches. The critical difference is that they are knowledge-based processes where people use their expertise and decision-making powers as a central part of the process. As an example, advances in medical knowledge leads doctors to use specialists more regularly as part of treatment plans. This forces more frequent exchanges of information among colleagues and longer, more detailed patient histories. Similarly, changes in business models within the industry lead to increased communications among functions, all supported by more thorough record keeping. Two business trends in particular contribute to this effect: Growing emphasis of controlling costs: Many healthcare organizations, especially in the for-profit hospital chains, have expanded their review processes for spending decisions and even some patient treatment plans. The fragmentation of medical insurance: Today there are more insurers and more plans available, each with distinct, strict rules for eligibility, payment schedules, and other details. These must usually be clarified in advance of any treatment. Establishing responsibility for payment has always been a complicated subject in healthcare, but it is now more complex than ever. Workflow Systems Today's client/server workflow software makes an effective platform for supporting these knowledge-based processes. This effectiveness comes from four fundamental features of current software offerings: * Process logic: The system designer plans workflow systems to reproduce the strategic flow of processes. This flow can be anything from a clearly defined routing path for approving a form to an ad hoc process that takes different actions based on decisions made earlier in the process. * Information gathering and distribution: Workflow software provides an apparatus for capturing information and making it available to the people in a process. Since the collected information resides on a server which is accessible at any time and from any location by users with the proper client software and password, it eliminates the barriers of time, location, and organizational boundaries. * Process automation: Workflow software can automate process steps that can be reduced to a defined set of rules and responses. This even includes ad hoc steps such as information distribution and routing to lists created dynamically based on decisions in earlier steps. * Document management: The document management system must have broad capabilities to collect, organize and present information easily and quickly. This should encompass both current input and relevant historical information. Although not mandatory, a simple, easy to understand interface that guides users to the correct information is highly desirable. An electronic information service Of these four features, document management is unusually important in healthcare because of the quantity of information record and track. Examination of a successful workflow to record the value of key document management features. Nevada Health Information Network (NHIN) uses Lotus Notes to provide customized electronic information services to organizations in the healthcare industry. NHIN's subscribers represent a cross-section of modern healthcare: primary care providers, preferred provider organizations, managed care companies, utilization review companies, third party administrators, and integrated delivery systems. NHIN collects and moves documentation among these organizations to expedite knowledge-based processes. NHIN requires strong document management capabilities as an essential part of its infrastructure to support this broad mix of clients. Currently there are approximately 100 separate databases in NHIN's system. Most are databases customized to fit a specific client or a specific task such as Worker's Compensation, but some contain assemblages of customized forms and others hold marketing brochures that are scanned as images into the system. Each subscriber communicates with NHIN by entering information into a specific database, and NHIN responds in the same database. NHIN's subscribers use its services to perform numerous workflow processes covering everything from rulings on insurance eligibility, to diagnostic test orders and results, and even hospital admissions or surgery requests. There are also compilations of information where subscribers find useful information on benefit plans, a referral directory, and descriptions of subscriber specialties. One administrative task that has particularly improved with the NHIN service is the authorization for medical procedures from utilization review (UR) companies that work with managed care providers. The doctor's staff fills out the form on-line, then routes it electronically through NHIN to the UR company. Once the UR company approves the request and routes it back, a copy can also be sent to the facility that will perform the treatment or diagnostics for the patient. The patient can even get a printed copy with information such as a map or directions. A process that once took days can now be completed in a matter of hours. Another streamlined process is Worker's Compensation. These claims are famous for the lengthy and frustrating process necessary to obtain approvals. In NHIN's Lotus Notes system, healthcare providers and employers fill out the appropriate forms electronically. NHIN then routes them to as many reviewers as necessary for the appropriate authorizations. Requests for additional information are easily handled by appending pages to the case record. Information related to each case is grouped together for faster reviews and quicker decisions at each step. NHIN's services help its subscribers improve the workflow of their knowledge-based processes. Everyone wins. Patients get answers to questions more rapidly and become more knowledgeable consumers of healthcare. And the providers can focus more time on their true competency: providing care to patients. Summary Effective document management is crucial to workflow systems in healthcare, for without it, the quantity of information can overwhelm the system. The system must be able to collect multiple types of information readily from multiple sources, organize it into easily understood formats, and then present it as needed to the users. Properly applied, document management helps workflow systems deliver improved productivity and reduced costs to the healthcare industry. Jamie Mendez is Lotus Development's Industry Solutions Manager. She can be reached at Lotus Development, 800 El Camino Real West, Mountain View, CA 94040, phone 415-335-6663, fax 415-960-0840, E-mail JMendez@ crd.lotus.com.
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