Grasp disease management with work-flow automation
Grasp disease management with work-flow automation
Break disease management into subprocesses
If you’re still having trouble coordinating care for patients with multiple chronic conditions, a work-flow automation strategy could be the answer, experts say.
At Henry Ford Health System in Detroit, administrators are considering using work flow automation technology to help integrate their disease management resources. The work-flow concept designing an organized view of a work process that forces the case manager and staff to ask the right questions of the process so that improvements can be made relies on a series of protocols, represented graphically in the form of decision trees, or flowcharts.
Such a model allows disease managers to conceptualize disease management as a series of small subprocesses rather than as "a whole flow on the disease level," says Richard E. Ward, MD, MBA, director of the Center for Clinical Effectiveness at Henry Ford
For example, the process of dealing with a newly diagnosed insulin-dependent diabetic could be organized as a series of tasks to be performed by a variety of different people, says Ward. Those tasks could include office visits, education sessions, telephone counseling, and the mailing of patient education material. "So you can make routine these little chunks within a disease," Ward says. "And at the level of failing to take into account comorbid conditions, those [chunks] are much less worrisome. If the services that are offered relate to a particular part of the management of a disease rather than to the whole thing, then you make it easier for someone else to take that integrative role and say, I want a piece of this and this and that.’"
Instituting such an approach at a systemwide level, however, requires information technology that can allow an institution to define the flow of various tasks, Ward notes. "The computer has to be able to take care of tracking the tasks until some ultimate disposition," he says.
One task, for example, could be the periodic creation of a multidisciplinary care plan. "That plan could be at a high level, such as Take care of the patient’s asthma, take care of monitoring their diabetes, teach them about self-care principles, and reassess at one year," Ward says. "Then, when you drill down to the next level like, what does it actually mean to teach them self-care of diabetes it explodes into another whole level of detailed tasks."
Under this model, different disciplines would be involved in one aspect of a given patient’s care plan, but the work flow structure would allow them to step back and view their contribution in the larger context of the patient’s total care. "It would be like a file folder with all these draft plans in it, flowing around a particular cycle, maybe repeating back to people according to some logic," Ward says. "And ultimately being signed off on by the group, in which case, all those care plan items spill over to become active orders."
Whatever strategy you adopt to address the issue of comorbidities, however, individual decision-makers will ultimately determine the effectiveness of the approach, says Patrice Spath, ART, consultant in health care quality and resource management at Brown-Spath & Associates in Forest Grove, OR. She adds that while work-flow automation could show potential paths to care, a care coordinator still must be responsible for making the decision to place someone on the path."Even if you draw a picture of the process, somebody’s got to be there to make sure the process is working."
Cognizant of the importance of human decision-making in the planning and coordination of patient care, Ward and his colleagues have begun conducting research in developing a multidisciplinary care team for Henry Ford’s geriatrics program. "The concept is that you have an organized process of developing a care plan and routing that around to all the involved people," Ward says.
Unlike with a cancer program, where clinicians from different disciplines can routinely hold interdisciplinary conferences to set the agenda for cancer patients, the needs of geriatric patients are too diverse for such conferences to be workable.
"If you were to apply that approach to every patient with high risk asthma and heart failure and everything else, it would be too expensive and logistically unfeasible for us to have all those meetings," Ward says. "So we’ve been doing some research to try to figure out how we can have the same function as such a meeting accomplishes but without requiring people to actually schedule time and be physically in the same room together, and to try to think of ways to use work flow tools to route a draft care plan that one person does around a group of people. But that’s still in the planning stages. It’s not something that I can report on [now]."
[For more information about work-flow automation, contact:
Richard E. Ward, MD, MBA, director, Center for Clinical Effectiveness, Henry Ford Health System, Detroit, MI. (313) 874-1882.
Patrice Spath, ART, consultant in health care quality and resource management, Brown-Spath & Associates, Forest Grove, OR. Telephone: (503) 357-9185.]
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