August, 1996
Workflow's unique contribution to healthcare
By Jamie Mendez, Industry Solutions Manager, Lotus Development
Modern healthcare is increasingly a collaborative process, drawing on the expertise and resources of many people and many organizations. Applying today's arsenal of knowledge, equipment and medical processes is more complex than ever. Rare indeed is the medical professional who handles a case from start to finish single-handedly.
In this environment, communication of information becomes a core process for the healthcare industry, directly affecting patient care, customer satisfaction and the costs of delivering care. The industry requires rapid, error-free transmission of an enormous amount of detailed information among medical professionals, administrators, billing clerks and more. Historically, the industry solved this need by using large numbers of people whose primary responsibilities were to record information and move it from place to place.
This labor-intensive approach works, but it is very expensive and often is quite time consuming. New types of workflow software applications now offer an improved solution for many administrative and ad hoc processes in the healthcare industry.
Workflow
software
Workflow applications provide an apparatus to capture information and move it through a process. The primary goal of workflow software is to improve the efficiency of business processes and the effectiveness of the people who work together to execute them. This reduces costs and improves the outcome of these processes, which ultimately results in enhanced quality, faster turnaround, improved customer satisfaction or some combination of all three.
Workflow systems depend on two fundamental capabilities: automating manual process steps and distributing information to members of the workgroup. Historically, mainframe applications have applied these to back-office workflow systems, but in a restrictive format in which the processes, routing paths, data formats and outcomes must be rigidly defined. This older, mainframe-centric approach is quite successful for transaction-oriented, repetitive tasks such as patient billings. However, it has been difficult to produce flexible applications in the mainframe environment that can handle the creation and management of knowledge found in patient care or real-time decision making.
Innovations in workflow software have overcome that limitation and broken down barriers to location, group membership, routing paths and forms of information gathered. These new forms of workflow fit the needs of the healthcare industry well, supporting flexible knowledge-based processes such as linking different specialists together or collecting multiple types of data including lab reports, medical images and nursing observations.
It is the knowledge-based workflow systems in particular that offer distinctive opportunities for breakthroughs in healthcare processes. At each stage, individuals can access the information necessary to perform the job at hand. Members of the workgroup add value by adding more information or by making judgments based on the information available to them through the application. Workflow systems also provide a context in which work is performed and bring resources together across organizational boundaries. These can be separate departments, different sites or even different companies to create an environment that functions like a "virtual organization."
Workflow software accelerates organ transplant matching
The process for matching donor and recipient for organ transplants is an example of where workflow software facilitates the delivery of healthcare, for both patients and healthcare professionals. The organ transplant matching process has many requirements that are well suited for workflow software such as Lotus Notes. For example, the software system must operate over a broad, geographically dispersed area and over many different organizations. Also, the process details vary from one time to the next; and yet the process is well defined in the strategic sense.
Before the workflow system was put into place, organ matching was largely a manual process and very time consuming. When a donor became available, a coordinator from the closest organ procurement organization (OPO) would gather information such as donor blood type, weight, age and signs of infection on a hardcopy form, then forward the form to the United Network for Organ Sharing (UNOS).
At UNOS, the information was transcribed into UNOS's VAX computer system, which searched its recipient database to create a list of potential matches. The list was faxed back to the OPO coordinator, who then began making telephone calls to the transplant program centers responsible for the potential recipients on the match list.
"The coordinator would begin at the top of the list saying, 'Hello, we have a donor who is 36 years old, 180 pounds, A-positive with this blood pressure,'" says UNOS IT Director, David Klein. Normally the transplant center would take as much as an hour to evaluate the suitability of the match and make its decision. During that period, the OPO coordinator would continue down the recipient list, repeatedly calling other centers with the same information. If the donor had several organs being placed, the coordinator went through this process for each organ. This labor-intensive process could add hours to the crucial period that donated organs had to be sustained artificially--time that could degrade an organ to the point that it was no longer usable as a transplant. It was literally a race against the clock."
"One of the most frustrating things we encounter in organ retrieval is the amount of time it takes to place organs and line up the appropriate recipient with the donor," says Dr. Mark Aeder, transplant surgeon. "What we are trying to do is to extract every organ possible and place them into as many people as we can to save the maximum number of lives."
Now each OPO coordinator has the Lotus Notes client program loaded on a laptop computer. The coordinator starts the workflow process by entering donor information into a customized form. The coordinator then forwards the form via modem to the Lotus Notes application server at UNOS.
The server searches the recipient database to generate the list of potential matches just as before. But once the search is complete, the information is immediately broadcast to every transplant center on the match listing via the SkyTel paging service. Thus, every center receives a message such as "Lung available for patient X who ranks third on the match run" in the same length of time it used to take for the OPO coordinator to begin the first of many manual telephone calls.
Once notified, the transplant centers call into the Notes server at UNOS to download the full details. Alternatively the information can be faxed through Lotus Phone Notes, so that all of the centers caring for the potential recipients start their evaluations almost immediately.
"It was a very labor-intensive process, when done manually. But the workflow application completely changes the nature of the process. What used to take hours, now takes minutes," adds Klein. And, of course, the efficiencies are even greater for situations involving multiple organ donations.
What are the basic requirements of a knowledge-based workflow system?
* Locally customizable: A workflow system must adapt readily to fit business processes for multiple users and organizations.
* Process adaptability: Modular construction of the workflow application should permit straightforward changes to the system such as adding fax or paging services to improve the workflow.
* Flexible logic: The flexibility to support ad hoc process logic is important for directing actions, routing sequences and distribution lists. For example, the strategic logic of the process is built into Lotus Notes, but the implementation details can change from one run to the next. This allows exception-driven activities based on knowledge-based decisions embedded in the process flow.
* Scalability: Should easily accommodate new users and new locations whenever they are added to the process.
* Multimedia repository: Most healthcare workflow processes need a multimedia database, capable of holding information in many different formats including reports, electronic forms, graphs, scans from medical imaging instruments, spreadsheets and more.
* Replication: Users should have individual views of shared data, subject to security constraints. The system should flag incorrect or conflicting data entered by different users.
* Multi-platform compatibility: Software should be available for most of the major computer operating systems, including Microsoft Windows 3.x and Windows 95, NT, OS/2, DOS and numerous versions of Unix. The application is then available to users in almost any environment, regardless of the local computer system. This provides true location independence for the users.
* Security: Security features protect information within the system from external unauthorized users. Internally, the system designer should also limit user access to sensitive financial or medical data to maintain patient and company confidentiality.
* Flexible workgroups: Workflow systems can bring together users from a broad, geographically dispersed area and from many different organizations. People and resources come together to collaborate as an ad hoc group on a specific case. These groups work together for as long as necessary, then disperse to form other groups when needed.
Workflow systems have the potential to do for healthcare processes what just-in-time manufacturing has done for production processes. An effectively planned workflow system leverages an organization's information resources to improve interactions between people and create a virtual organization. In almost no other business does information play such a great part as it does in healthcare. When information flows efficiently, healthcare organizations not only improve delivery of patient care, but reduce costs and improve customer satisfaction at the same time.
Jamie Mendez is Lotus Developments' 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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