Workflow Automation – Where to Start

By Scott Fuller

I like to refer to hospitals that have a very high degree of automation as “High Performance Hospitals”. These hospitals have gone beyond the requirements of the EMR (Electronic Medical Record) and have analyzed and automated their workflows.

I define “workflows” as any process that involves documented communication between departments for the purpose of hospital functionality. Often times in hospitals these processes are paper-based and rely on paper forms that have been revised fifty times over several decades. High Performance Hospitals have captured every bit of cost savings and efficiency by automating paper driven processes into automated workflows.

Oftentimes when we talk about automating workflows in a hospital, people first think this relates to clinical workflows. While the clinical areas of the hospital are riddled with structured workflows, the core of these workflows are usually addressed by the HIS software when CPOE (Computerized Physician Order Entry) or EMR has been implemented. In order for clinical HIS software vendors to meet “meaningful use”, most core clinical workflows are encompassed in the functionality of the software itself. This isn’t necessarily the focus of these vendors, but more of a by-product of eliminating paper driven processes and driving them into a new electronic world like CPOE. The nature of creating an EMR requires the elimination of paper, hence workflows based on paper are mostly consumed by the clinical HIS system.

This isn’t to say that there aren’t opportunities for workflow automation on the clinical side of the hospital, it just isn’t the place where the most impact can be made – unless there is a compelling need that is overlooked by the clinical HIM at your hospital.

To find workflows begging to be automated, one just needs to look to the support services and revenue cycle side of the hospital. Departments in these areas are buried in age-old paper-based workflows and unbeknownst to employees they are caught up in the paper shuffle. For example, while working at my previous hospital, we began automating the PAR (Personnel Action Request) form and the associated workflow when we stumbled across an HR employee who spent the majority of her day simply proof-reading and correcting PAR forms as they were delivered into the department. Because department directors filled out these forms by hand, they would often transpose an employee’s work identification or social security number. I too was guilty of this paper-based blunder because I once submitted a PAR form for an employee named “Maggie”, when her proper first name (the one known in HR and Payroll) was “Margarita”. So this error needed to be corrected on the paper form as soon as it was delivered to HR before the form traveled on to the people that would actually act upon my request.

According to an independent Forrester Research, Inc. report;“Job scheduling is a necessary component of data centers. Without job scheduling, an enterprise could simply not execute long application processes that deal with massive amounts of data and are necessary to prepare for online and transactional processing. Over the past 10 years, we have seen job scheduling evolve into workload automation: Starting from a discipline that used spare computing time to execute batches, we now see an enterprise wide solution to execute asynchronous applications resulting from events or user actions. The increasing use of distributed systems and complex asynchronous applications has brought new constraints to the planning, execution, and monitoring of jobs with a stronger accent on automation. Eventually, we believe that workload automation and IT process automation will go hand in hand to increase IT's efficiency. To reach that stage, another evolution step is required to integrate workload automation with business service management (BSM).”

Needless to say after automating the PAR workflow, the form was no longer in paper form but was filled out on screen. All the directors needed to do was select their employee from a drop-down list and all the pertinent fields were automatically filled in throughout the form because it was linked to the HR data. The form was then automatically routed to the next person in the workflow order without unscheduled interruptions due to data corrections. Fortunately, the HR employee in this situation didn’t lose their job because we implemented workflow automation; rather she was “repurposed” to a new HR position and was happier with her new duties as well.

Still not convinced of where to start? Well, just check with “Frank”. Frank was the interoffice mail man at my former hospital. Frank traveled back-and-forth to the same offices at least ten times a day. Frank was a military man; his work ethic exceeded expectations as he delivered interoffice mail with precision and pride. One day I was walking across campus with him when I looked down at his cart and noticed at least a hundred interoffice envelopes. So I asked him if that day was a particularly heavy mail day? His response was that it was “typical”. I was shocked only because I was thinking about all the forms inside those envelopes and the delays involved as they traveled around campus collecting signatures, sitting on desks, and being sent back-and-forth, person-to-person.  As we continued to walk I quizzed Frank with more questions about the areas where he travels most frequently and suddenly he became a wealth of information. He told me about forms that were regularly returned for corrections, those that had up to six signatures before being delivered to the final decision maker, and the forms that were never filled out correctly at the start of the process and as a result would “always be sent back” the next day. Immediately I put on my workflow automation thinking cap and realized I was talking to the right guy!

Every hospital has a “Frank”. Check with yours and ask where he travels most frequently with his cart full of interoffice envelopes and where he goes to collect signatures in order to rush the envelope back. He or she will help to point you in the right direction.

Whether you talk to your hospital’s “Frank” or start poking around the Revenue Cycle and Support Services departments, you will quickly find a plethora of paper-based workflows in desperate need of automation. Your hospital’s journey to becoming the “High Performance Hospital” is closer than you may think.

Quote from Market Overview: Workload Automation, Q3 2009, Forrester Research, Inc., November 9, 2009 or cite report title and publication date within the text.

Scott Fuller is the Director of Workflow Engineering for FormFast and a former IT Director at Doctors Hospital at Renaissance in South Texas. Scott has also written and published over 12 books in the computer and technology field.