Process Engineering & Health IT:

1. Process Engineering & Health IT: Which Comes First - The Chicken or The Egg?

2. Why It Matters…

3. Primary Care Today PCMH “P 4 P” HIT

4. A Caveat…

6. Healthcare IT is the means, but not the end, says Blumenthal September 16, 2009 | Diana Manos, Senior Editor

7. I’m From The Government And I Am Here To Help You…

8. ARRA, RHITEC, & “MEANINGFUL USE”

9. HITECH Priority Grants Program Rollout: Next Steps Toward Nationwide Health Information Exchange • David Blumenthal, M.D., M.P.P.National Coordinator for Health Information Technology, DHHS • The White House has announced the rollout of the first two in a series of HITECH priority grant programs… Some Important Concepts: • Meaningful Useof certified EHR systems… • Health Information Technology Regional Extension Centers • Electronic information exchange

10. Michigan PCMH Definition, NCQA Standard/PGIP Domain, Proposed PCMH Metrics, Meaningful Use

11. Health IT and Transformed Health Care Ultimate vision is to enable significant and measurable improvements in population health through a transformed health care delivery system. *Adapted from National Priorities Partnership. National Priorities and Goals: Aligning Our Efforts to Transform America’s Healthcare. Washington, DC: National Quality Forum; 2008

12. Another Caveat…

13. HIT is NOT Part of “Your Father’s Medical Practice”. . It Can’t and Shouldn’t Be Attempted Without A Change In Practice Culture And Practice Workflow Re-Engineering

14. RHITEC Practice and Workflow Design Regional Centers must be capable of mapping and redesigning work processes, updating roles and responsibilities for clinicians and support staff, and leading continuous quality improvement activities involving rapid cycle feedback.

15. Go-Cart

16. Practice Redesign & Preparing for Health IT

18. . The “Magnificent Seven” Rules For HIT Preparation...

19. Rules For HIT Preparation 1 Culture Is Everything! 2 Re-engineer Your Practice Workflows Before You Electronify 3 Carefully Examine ALL Of Your Functional Options 4 Be A Knowledgeable And Very Wary Consumer 5 Train Like There Is No Tomorrow! 6 Evaluate! Evaluate! Evaluate! 7 The Devil Is In The Interface

20. Prep Work

21. So, What’s a Body to Do?

23. What is PRISM? • A physician driven, non-profit corporation formed in cooperation with nine Michigan PO’s and PHO’s • Providing comprehensive practice and culture transformation services in Michigan and beyond on a “no-lose”, gain-share basis • Able and willing to assist the Michigan RHITEC (and others) in preparing primary care practices to becoming “meaningful users” in the context of helping them undergo transformation

24. Evidence-Based Medicine CURRENT STATE LEAN THINKING CULTURE CHANGE INFORMATION TECHNOLOGY PRISM & PRACTICE TEAM PROFITABILITY CUSTOMER SATISFACTION ANTICIPATED OUTCOMES

25. Strategy For Sustainability & Spread of Practice Transformation in Michigan & Beyond PO #1 PO #2 • No Risk To PCP • Funded from Waste Removed • Physician Directed • Staffed by FT Pros • Consistency PO #3 PO #4 PRISM PO #5 PO #6 PO #7 PO #8 PO #9 PCP PCP PCP PCP PCP PCP PCP PCP PCP PCP PCP PCP PCP PCP PCP PCP PCP PCP PCP # of PCP’s Not Limited By Grant Resources Sustainability & Spread Assured

26. The ASQ Marshall Plan aka PRISM-lite

27. A Modern-Day “Marshall Plan For Healthcare” Would Like To Partner with Communities, Medical Associations, and Medical Groups To Assist In The Redesign of Their Practices

28. Getting to Sustainability and Spread… A Fishing Pole, Not A Fish

29. Communities Considering This Approach

30. One Example Of Process Re-Engineering At Work In A Medical Practice…

31. Meet SJ Family Medical Center

32. I Call Them The

33. Their Story

34. Receive Form When Patient Presents File Form At Front Desk Give Form To Patient Inquire About Form In Box Message: Is Form Completed? Contact Patient to Pick up Form Receive Call: Is Form Ready? Form Is Placed In MA Box Receives Finished Form From Doctor Receive Form From Patient in Room Receive Call About Form Error Receive Form From Patient in Room Inquire About Form Correction Done / Form Completed Inbox Message To Doctor re: Error MA Distributes Form To Doctor Box In Box Message: Is Form Completed? Doctor Completes Form Is Form Ready? Practice Performance In The Current State First Time Quality (FTQ) = 1% !!!!! Value/Cost of Total Practice Time Spent / Yr In Process = $ 169,780 Receive Form By Mail / Fax Patient Calls Re: : Form Status Receive Patient Phone Call: Is Form Ready? Form Error Inquire Re: DX Codes Management Of Patient Medical Forms Receive Call Complaint Re: Form Status Current State

35. Management Of Patient Medical Forms Future State Practice Performance In The Future State First Time Quality (FTQ) = 72% !!! Value/Cost of Total Practice Time Spent / Yr In Process = $ 80,448 PLUS: Process Throughput Time For Forms Cut in Half!!! END

36. The COCQ Applied In One Family Practice • Hard Dollar Annual Savings of $90,000In Only One Process • Energized staff and physicians eager for more improvement • Dramatically Improved First Time Quality • Once learned, can be done by practice itself without outside help

37. In Closing, I’d Like to Leave You with A Song About Health IT…

38. The EMR Blues: “Paper Won’t Be Here Long…“Dr. Sam & the Managed Care Blues Band “…Too many tests A thick chart - for you to read An EMR - is what you need You like to think that you're immune to the stuff, oh yeah It's closer to the truth, you know - Like it or not you know You're gonna have to face it – PAPER WON'T BE HERE LONG…” Dr. Sam Bierstock is an ophthalmologist, an electrical engineer, and a consultant for medical information systems management and design. He has published more than 50 articles on medical information systems, and written a book about medical office computerization.