Posted by: knightbird | July 26, 2010

The Future State

Mark Welch made an excellent point in his comment to my blog about Electronic Health Records, and that is the recognition of a Future State. I wrote about the Snoopy Dance in an earlier blog. As we drafted the problem statement in that Kaizen, we began to recognize the many problems that had been allowed to continue for such a long time, including batching, improper flow, multiple defects, lack of training, lack of transparency and improperly allocating tasks that did not allow medical professionals to work at their highest licensure. When we began to design the experiments (PDCA) that allowed us to make improvements, we used an Affinity Diagram to generate and group improvement ideas. This is what I was referring to when I spoke about the two funny improvement ideas in the prior post, “faster fingers” and “no vacations.” After we grouped the ideas, we then used a 4 quadrant analysis tool and re-grouped the ideas into 4 categories: Low Impact, High Cost; Low Impact, Low Cost; High Impact, High Cost;  and High Impact Low Cost. Our immediate implementation priorities are, of course, the High Impact, Low Cost. We find that a majority of our improvement ideas fall in this category.

For High Impact, High Cost ideas like the implementation of an Electronic Health Record, we need to raise resources before we can tackle implementation. We also try to follow the advice of our Lean Sensei, which is to fix our processes before we automate them together with their incredible waste. As we prepared our improvement plans during that original Kaizen, we realized that we needed a future state to aspire to. That future state was essentially one in which a medical provider would enter the data into the EHR, attach a digital signature, and the Record would be filed in the Patient file, with a billing copy sent to our biller and coder.

With the implementation of our EHR, we are taking another step toward our future state. Deploying the record to our Village Clinics, and implementation of the practice management piece, places us very close to our future state. After we reach that point, then we can focus on network uptime, training for staff using the software, elimination of defects and other continuous improvements.

And the upside for us? We are able to increase our third party revenue by a substantial margin.

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