Current day EMR software suites are able to support in-line industry/agency “best practices” that can ‘guide’ patient processing at the individual transaction level. The thing is healthcare is complex so no best practice can cover all eventualities.
The solution is to augment the core Business Process Management (BPM) methodology used to develop and implement best practices with a methodology called Adaptive Case Management (ACM) that accommodates ad hoc interventions.
ACM/BPM makes BPM workable on a day to day basis. When it seems appropriate to follow a best practice, staff follows Best Practices. When necessary, staff is able to deviate from Best Practices and introduce ad hoc interventions.
There are significant improvements in staff efficiency, increased patient throughput to be gained from the consistent use of best practices. Business rules at ‘patient carepathway steps’ decrease admin/clinical errors and compliance checklists at key process points along patient carepathways keep things ‘on track’.
All of this infrastructure is great but no amount of experience and training can completely eliminate the need for ‘collaborative consultations’ where a healthcare worker has a question at some stage of patient processing and needs to reach out to a colleague or domain expert for advice and assistance.
The options are limited – the worker can try to reach out by phone but telephone-tag makes this difficult. An e-mail message, tagged ‘important’, that goes to the colleague’s/domain expert’s InTray may or may not be seen promptly.
Then we have the issue of timeliness of responses – the big problem is a person can compose a query at 1545 hrs, then go off shift at 1600 hrs, and the result is an automatic 16-hour imposed delay.
The solution is simple – its called “Point of Service Messaging” (POSM) and here is how it works.
A worker who has a query sends out an internal EHR message for advice and assistance at the POS – the POSM goes to one or more designated recipients who receive the message/e-mail at their cell phone, for example, and respond. The response goes not to the initiator of the query but to the POS and now, whomever comes on shift and inherits the in-progress task sees both the out-mail and the in-mail at the POS.
The activity I have just described is called ‘Collaborative Consultations’. CC ‘s are needed for real world healthcare service deliveries. ACM/BPM provides the environment for carrying this out. POSM is the technology that makes it work.
Admin/Clinical errors give rise to highly negative consequences – we may lack the means to completely eliminate all errors but Collaborative Consultations can greatly reduce the frequency of such errors.