VA View Module 3: Process Analysis
Overview
[Murielle Beene, MS, MPH, MBA, RN-BC; Acting Director of Health Informatics, Department of Veterans Affairs]
Hello Health Informatics Students, my name is Murielle Beene, I am the acting director of the Health informatics division within the Office of Informatics and Analytics for the Veterans Health Administration.
[Module Three - Key Topics: The Concept of Health Care Process and Process Analysis Process Mapping Theory and Rationale Acquiring Clinical Process Knowledge]
You're now in Module Three. In Module three, we’ll cover topic areas such as “The Concepts of Healthcare Process and Process Analysis,” “Process Mapping Theory and Rationale,” and “Acquiring Clinical Process Knowledge.” You'll also learn the basic concept of healthcare process analysis and redesign. There are many national efforts directly focused on the redesign principles, especially as it applies to healthcare information technology and the redesign of clinical information systems.
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The Concepts of Health Care Process and Process Analysis
The first area of this module is called "The Concepts of Health Care Process and Process Analysis” which covers the importance of redesign within healthcare, its application to clinical workflow, and to support the quality improvement efforts. The Veterans Healthcare Administration (VHA) recognizes the significance of process redesign and its implications for organizational change. These activities are critical and essential to achieve healthcare transformation as reflected in the Institute of Medicine's Six Quality Areas.
The VA has actually created a National Systems Redesign Office that supports the culture of quality and process improvement. This office has the responsibility to engage activities within the Veterans Health Administration and within the culture to actually support all types of process redesign efforts. So, for example, this office created an actual improvement framework called TAMMCS, T-A-M-M-C-S, which stands for Team, Aim, Map, Measure, Change, and Sustain. This TAMMCS model has been widely implemented across the Veterans Health Administration. It is actually the framework utilized in many of the quality improvement efforts within our healthcare system.
The goal of all these efforts for the Veterans Health Administration is to adopt principles of continuous improvement, keeping their focus and eye on value, safety, and quality within the healthcare system and to optimize the clinical environment.
The VHA's efforts in quality improvement also enhances the way in which we interact with our electronic health record within our clinical environments. Process redesign drives improvement and drives change that aligns our initiatives squarely with some of the criteria and requirements for meaningful use.
[Working Towards Meaningful Use Stage 1 Requirements and Certifications]
The VA is actively working to meet Meaningful Use Stage 1 requirements in certification. As a note, the VA does not reap any financial benefits or incentives for compliance with Meaningful Use requirements. The Veterans Health Administration believes that it's important to support the meaningful use of electronic health records to improve the quality of healthcare for veterans and for everyone who participates in the healthcare discipline.
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Process Mapping Theory & Rationale
The next area of this module is process mapping theory and rationale, and from my perspective, this is one of the most important skills of an informatician. This skill set allows one to look at a process from an abstract level to a detailed level for different purposes. It's a visual representation or a step-by-step process of decision-making areas and a series of steps that actually chronicle the way work is done.
[Screenshot of a High Level Workflow Steps Chart]
Some of these process maps are also referred to as flow charts and these flow charts are often done in tools such as Visio®, but there are many various and sundry tools where these process maps are actually created and utilized.
They're such an information source for anybody who is looking at how to optimize a health information system, where there are gaps in the process of health information system, or in processes in the way we do work. These maps will actually help you visualize these processes and identify where there are changes that need to be made. To me, this is one of the most important documents that can inform the way a health information system is built, designed, the way that it is either purchased, or interfaced. From my perspective, we don’t use enough of this skill set within the acquisition or the development of our clinical information systems.
Right now a lot of these activities are actually already occurring within the Office of Health Information. The Office of Health Information is located within the Veterans Health Administration; and within the Veterans Health Administration, the Office of Information has an entity called The Enterprise System Managers. Some of these Enterprise System Managers actually have a skill set of business architecture that heavily relies on these types of documentations for the documents for their processes; where they look at the intricacies of clinical workflow and the way data and information is exchanged and stored.
They do not really care about the physical location; they are really looking at the actual exchanges of these entities. Where the Office of Health Information and the Office of Informatics and Analytics collaborate is that while these process maps are created, there is an intricate back-and-forth dialogue that actually occurs with both entities to ensure that, from a health informatics and subject matter expert perspective that these are validated, not only with our field, but with informatics principles. This is one area in which I urge all of you to start a revolution in how we actually look at and actually how we perform these types of activities.
This is one of the most critical activities I think, again, that can help us make smarter decisions about how we develop our systems, how we acquire a system, and what are our needs to actually perform and optimize patient care.
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Acquiring Clinical Process Knowledge
Now we move on to the last area of this module, which is “Acquiring Clinical Process Knowledge”. And, truly, knowledge is power. The value of the knowledge that an informatician has gained through courses such as this one and other external activities needs to be demonstrated to our stakeholders; such as our other clinical partners, our medical center directors, our nurse execs, our network directors, and our other peers within our informatics space. But, most importantly, our information technology colleagues.
Everyone needs to understand their role in the processes that help us actually develop our clinical information systems and actually deliver the care that we are so notably known for. As you all know, the complexity of the VA clinical processes vary from medical center to medical center. Therefore, the knowledge of that VA informatician to actually intercede in some of these conversations and to provide the analyses of our workflow in our processes and our needs is so critical. Right now our VA informatics workforce is actually defined as our clinical application coordinators, our barcode medication administration coordinators, our VANOD site coordinators are just a few that actually comprise our current health informatics workforce.
Just to give you an example of how the knowledge an informatician has can help change a direction or help change a situation is one that’s near and dear to my heart. There was a national decision that the clinical information system for the ICU was going to be purchased, and this purchase of these ICU systems was going to be made VISN by VISN and probably some of you watching this probably well know the story. But I believe truly that some of the paths that we have gone down can really be changed if there was some informatics principles and some informaticians at the table that really can help define for the organization what the best approach to actually purchasing these systems would have been and the downstream impacts of how the systems were implemented.
[CIS/ARK]
Right now, this project is affectionately called CIS/ARK and I know that there are many watching this video who know very intricately, like I mentioned, about the CIS/ARK project. But think about if some of these informatics principles that you're learning now through this course were engaged in some of this decision-making. Where would we be now? How would things be much different? I encourage you to utilize and leverage everything that you're learning in these courses to make an impact, not only for the VA, the informatics workforce within the VA, but the impact on the national scene as VA is so well known in this space. We need to take the informatics discipline to the next level, to take these skills and this knowledge that you’re learning through courses such as this one and apply to how we can optimize, again, our clinical environments. Thank you.
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