Customer Solution Case Study
/ / Prominent MedicalCenter Boosts Efficiency, Optimizes Patient Care Using Analytics
Overview
Country or Region:United States
Industry:Higher education
Healthcareprovider
Customer Profile
The Department of Emergency Medicine (ED) at PennStateMiltonS.HersheyMedicalCenter is a Level 1 Trauma Center and sees 50,000 people annually.
Business Situation
The ED wanted to analyze its processes to pinpoint bottlenecks and adjust workflows accordingly to improve efficiency and better match resources to demand.
Solution
The ED used Microsoft® Office Visio® Professional 2007 and Orlando Software Group ProcessView to prove that analytics tools can provide critical data to streamline processes and improve care delivery.
Benefits
Improved resource allocation
Analyzed workflow processes quickly
Increased efficiency and productivity
Provided best possible patient care / “In three days’ time, Microsoft and Orlando Software Group were able to provide us with more business intelligence and insight than we were able to achieve in two years of study.”
Dr. Christopher DeFlitch, Director and Vice Chair, Department of Emergency Medicine, Penn State Milton S. Hershey Medical Center
The renowned Penn State Milton S. Hershey Medical Center—both an academic medical centerand Pennsylvania State University’s college of medicine, Penn State College of Medicine—were established in 1967 with a U.S.$50 million gift from the charitable trusts of chocolate magnate Milton S. Hershey. Within PennStateHersheyMedicalCenter, the Department of Emergency Medicine sees an average of 135 people per day, many of them patients with potentially serious cardiac conditions. With help from Microsoft certified partner Orlando Software Group, the Department of Emergency Medicine used ProcessView, an add-in to Microsoft® Office Visio® Professional 2007, to analyze and improve process workflows for these cardiac patients. As a result, resources are allocated more efficiently, and patients, who are cared for more quickly, avoid complications, long hospital stays, and extended recovery times.
Situation
To hear him speak about process modeling, you might think that Dr. Christopher DeFlitch is an industrial engineer. In fact, he is the Director and Vice Chair of the Department of Emergency Medicine at the MedicalCenter, and Associate Professor, Penn State College of Medicine. DeFlitch’s passion for medicine and process modeling prove to be a winning combination in helping the department, called “the ED” internally, provide quality medical care. The ED employs about 350 people—physicians and residents, nurses, technicians, hospital staff, emergency ambulance team, and the critical care aero transport service, whose medical team includes pilots, nurses, and paramedics. Every year, there are nearly 50,000 emergency room visits—on average about 135 patients per day.
DeFlitch speaks fervently about how process modeling and analytics tools used in industry can be used to improve healthcare delivery systems. This interest started about six years ago when DeFlitch helped begin to convert the MedicalCenter from paper to electronic records. He and his team mapped existing workflows, redesigning how information would flow and how patients and providers—emergency physicians, cardiologists, technicians, and nurses—would interact with the electronic record. “That’s when I became interested in core process redesign,” says DeFlitch, who was thrilled to find a tool like Microsoft® Office Visio® Professional 2007 drawing and diagramming software. “We all learned the joy of Visio Professional 2007 when we started doing the current state analysis of our hospital. That’s when we really began to understand flow processing and process mapping with Visio 2007.”
But understanding processes is one thing. How do you use process workflows to make actual processes and systems better? How do you prove that if you make one adjustment to a process, it’s going to make a significant difference down the line in a patient’s healthcare outcome?
Recently, DeFlitch began looking at how he could use process modeling tools with historical data to improve emergency room processes. “The Department of Emergency Medicine has a lot of available resources; providing the right resources at the right time is the challenge,” says DeFlitch. “For example, if you don’t have a technician to do an electrocardiogram (EKG), it doesn’t matter what happens downstream. It’s going to adversely affect the outcome of that patient if that step of the process is broken.”
DeFlitch and his associates refer to such challenges as demand capacity matching. “You have capacity within a system—whether it’s providers, EKG machines, or blood drawing equipment, and you have demand—patients coming in to get those services,” explains DeFlitch. “If it happens that they are mismatched in either location or time, the result is an inefficient care delivery system and inappropriate utilization of existing resources.”
But the challenge is not solely about allocating resources; it’s also about assessing the impact of varying patient-demand rates on the organization’s performance and the patient outcome. “Without an analytics tool, people who understand process flow can make educated guesses about where the bottlenecks are and what changes to make in the system, but guesses are not true analytics, and sometimes you’re wrong,” says DeFlitch. Even slight changes, when wrong, can cost hospitals millions of dollars and potentially make patients vulnerable. “We needed to have a true analysis of the processes using operational data to prove where specific needs and opportunities were instead of trusting one or two individuals who you believe to be the smartest guys to make these million-dollar decisions.”
Solution
Fast forward to mid-2007 when DeFlitch and his associates learned about ProcessView, a design and analysis tool and add-in to Office Visio Professional 2007, from Microsoft Certified Partner Orlando Software Group. The partner had applied ProcessView successfully in many other industries, and DeFlitch was hopeful that it could be applied equally successfully in the healthcare setting. “When I saw ProcessView for the first time, I thought, ‘If it does what I think it does, this is a big deal,’” says DeFlitch. He believed the industrial-engineering approach of the program could be a good match to the MedicalCenter’s care delivery systems.
But the real test would be whether ProcessView could perform with real data from complex clinical care situations. For a proof of concept, DeFlitch chose a complex and time-critical process simulation that involved potential acute coronary syndrome (ACS) patients arriving at the ED. For these patients, the ED strives to meet three service-level thresholds. For suspected ACS patients—those complaining of chest pain—the goal is 10 minutes for door-to-EKG service. Patients whose EKGs indicate ST segment elevation myocardial infarction (STEMI) have suffered a heart attack. For STEMI patients, the service thresholds are 30 minutes for “door-to-needle” administration of thrombolytic (clot busting) medication and 90 minutes for “door-to-catheterization.”
Within this single workflow simulation for ACS/STEMI patients, there are multiple decision points and resulting workflow paths that a physician could take depending on the patient’s diagnosis. ProcessView used historical performance data at each decision point and assigned probabilities to those points. The program’s algorithms then identified every unique workflow path and determined the probability of occurrence for each. “In about three hours, we were able to create a top-level process flow diagram for the overall process,” says Frank Kapper, Vice President and principal partner of Orlando Software Group. “We found there were 88 unique workflow paths, and within that, 15 workflows occurred 90 percent of the time.” With this information, the department could focus on the highest-occurrence workflows and make sure it had the proper staffing, equipment, supplies, and other resources.
The proof of concept was scheduled to last two weeks in February 2008, but the results were apparent by the end of the first week. “We started on a Monday morning, and by Friday morning, ProcessView was able to produce a presentation and a full set of analytics for any patient that had come to the ED with suspected ACS,” says DeFlitch. “In three days’ time, Microsoft and Orlando Software Group were able to provide us with more business intelligence and insight than we were able to achieve in two years of study. After seeing ProcessView in action, there was no question that it was going to work.”
In its simplest form, ProcessView runs on a computer with the Windows® XP or Windows Vista® operating system and Office Visio Professional 2007, along with other Microsoft Office products. ProcessView maps and analyzes the current state, identifies improvement opportunities, defines a future state, captures and communicates improvement plans, and then audits the new current state to see how and where performance has improved. To provide enterprise-wide visibility of this information, ProcessView has a server-based solution that uses Microsoft SQL Server® database software with Microsoft Office SharePoint® Server 2007 as the front end. Process flows and performance data can be published to SharePoint portal sites.
Benefits
For the Department of Emergency Medicine at the MedicalCenter, ProcessView has been an invaluable tool in helping to streamline workflow processes. It helps the ED accurately allocate resources to match demand. By eliminating unnecessary work and increasing its efficiency, the department has improved the quality of care and access to care for its patients. Increased efficiency helps to reduce costs, but DeFlitch says the value is in realizing higher quality, more efficient care with better use of limited resources. Financially, lost revenue is captured: The more patients the ED can see, the more revenue it produces.
Improved Resource Allocation
The ED deals with potentially life threatening situations every day, and the number of patients at any given time is uncertain. It’s critical to have resources in the right place at the right time, but determining that mix is difficult to do without analytics. The department could, for example, arbitrarily put 10 nurses at triage to ensure that every patient is seen quickly upon arrival, but the nurses’ time would be wasted if patient flow is low. On the other hand, if only one nurse is at triage and the arrival rate is 15 patients per hour, patients will not be handled as quickly. Without analytics tools, finding the point at which demand and capacity are matched is subjective. “The benefit of using ProcessView is that we have real data by which to manage,” says DeFlitch. “We can identify where processes are broken and know with certainty what step in the process to adjust such that it will improve the total system—that’s the real benefit.”
Analyzed Workflow Processes Quickly
Analyzing workflow processes is both a complex and time-consuming task for organizations of any size and type. It can literally take months or years for consulting firms to analyze current systems and provide recommendations. DeFlitch says the beauty of ProcessView is that it can cut complex analysis time to a minimum. ProcessView automatically identifies all workflow paths; assesses the likelihood of occurrence; analyzes best-case, average, and worst-case scenarios; identifies unnecessary tasks; performs what-if analysis; and develops audit plans. “You can pick whatever workflow you want, put it into ProcessView, and get results in three to five days instead of spending months working with multiple consultants and having people track things,” says DeFlitch.
In the proof of concept, the department looked at only one subset of the population: ACS/STEMI patients. Across the entire MedicalCenter, there are literally hundreds of service delivery lines that could be analyzed. DeFlitch, who is also the Chief Medical Information Officer for the MedicalCenter, says, “ProcessView has spawned an interest in expanding the use of analysis across our institution. We are beginning to analyze larger, more complex systems such as patient arrivals, hospital throughput, and patient discharges.”
Increased Efficiency and Productivity
Since analyzing its workflow processes for ACS/STEMI patients, the department has increased its efficiency and productivity. With a detailed analysis of processes, the ED can easily identify and better allocate resources and eliminate unnecessary work. Not only does wasted effort contribute to higher costs, it is detrimental to the quality of healthcare. “Patients don’t want it and, clearly, providers don’t want it either. We help people identify the gaps—the non-value-added steps—in the process so they can be eliminated,” says DeFlitch.
Provided Best Possible Patient Care
The role of technology in the healthcare industry is to help provide the best possible care for patients. To do that, caregivers must be able to determine what ultimately affects the outcome of a patient, particularly for critical cases such as ACS/STEMI patients. The MedicalCenter’s ED knew that getting patients to the catheterization lab within 90 minutes meant better clinical outcomes with fewer complications. This of course benefits the patient, but also the medical system, which avoids long-term care, medications, and reevaluations.“So, we know that if you can make a system more efficient in a short period of time, patients are more likely to avoid those complications of the disease process that otherwise might occur.”
Although healthcare providers and hospital administrators want to provide the best care, often the systems aren’t set up to make everyone successful. “Frequently in hospitals, you have people worried about dollars or throughput, others worried about quality, and still others worried about different subcomponents of a specific care process,” says DeFlitch. “We want to help people understand that they all want the same thing: the best care for their patient in the most efficient fashion. We want to provide the right tools to help people understand the complexity in the healthcare system. Obviously, after using Office Visio Professional 2007 and ProcessView, we think there is a huge opportunity for us to look through the eyes of an industrial engineer to improve how care is delivered.”
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