AN INDUSTRIAL ENGINEERING APPROACH TO YOUR EMR ROLLOUT & GO LIVE EXPERIENCE
- Rollout: The process of introducing an EMR to a medical practice, staff, and patients. (Origin: In keeping with the aviation human factors roots of EncounterPRO's design, "rollout" originally referred to rolling a new aircraft out of a hanger for its first public viewing.)
- Go Live: The period during which a practice begins using an EMR to see patients.
- Production System: Men and Women, Machines, Methods, Materials, and Money organized to produce useful products and services.
- Industrial Engineering: Theory and tools to systematically optimize production system effectiveness, efficiency, and satisfaction. (See Addendum for expanded description.)
THE EncounterPRO PEDIATRIC EMR
IS DESIGNED TO BE USABLE
You may already be familiar with hospital management engineers. Industrial engineering is sometimes called management or health systems engineering ("Cheaper by the Dozen" is based on the lives of the first industrial engineers to study medical workflow). An EMR designed and implemented using industrial engineering principles and techniques is a fundamentally different EMR that the traditional EMR. Instead of starting with a user interface that looks like a paper form, the user interface is essentially derived, using scientific and engineering principles, from the human body's response to physical, physiological, and cognitive workload. Perception, attention, cognition, motor control, memory storage and retrieval all interact with work environment and job demands to result in a body of knowledge about mental workload, vigilance, decision making, skilled performance, human error, human-computer interaction, and training. (This is not dissimilar to the way in which medical knowledge is derived using scientific methods from the structure and function of the human body.)
The resulting EMR should not necessarily look like what has gone before. (In fact, the first use of computer displays in aircraft cockpits mimicked physical dials and switches. Today's "glass cockpits" do not.) Many EMR designers are seduced by the idea that since users are already familiar with paper forms that the paper form metaphor is a good user interface. It is not. EMRs that try to mimic traditional paper medical records are not well designed for high-usability, high-productivity data and order entry. Instead, the EncounterPRO Pediatric EMR Workflow System is "Clinical Groupware for Pediatric Practice." Of course, EMRs do still need to generate hard copy and digital forms that resemble traditional medical forms (and EncounterPRO does), but that is a different issue.
THE EncounterPRO PEDIATRIC EMR
IS DESIGNED TO BE LEARNABLE
The same knowledge that guided the design of EncounterPRO is used to prepare and guide you and your staff through a successful rollout and Go-Live experience. Relying on EncounterPRO's unique workflow system nature, and employing many of the industrial engineering techniques that are used to deploy large and complex production systems, we have devised an EncounterPRO Pediatric EMR Go-Live SYSTEM that will Save You Substantial Time, Effort and Money from the moment you walk in the door on Monday to the Friday five days later when you will be back to seeing 100% of your previous daily patient load. (Further down the road, the sky's the limit. Check out the testimonials about increased patient volume, if you haven't done so already).
High Usability = High Learnability |
In true Industrial Engineering tradition we have analyzed pediatric workflows from over 200 pediatric practices and broken down the skills required for each step in each workflow into 81 separate user functions. We have optimized the EncounterPRO Pediatric EMR workflow process definitions to minimize the "cognitive load" necessary to chart a patient encounter and accomplish related tasks. Each user need only learn the small subset of skills that are relevant to their role. Since the EncounterPRO Pediatric EMR Workflow System automatically serves up the correct screen based on the user's role and clinical purpose, users need learn much less than traditional EMRs that do not rely on an underlying workflow engine and process definition system.
THE EncounterPRO EMR
ROLLOUT & GO-LIVE SYSTEM
| SAVES |
You operate in a relatively fixed price environment. The only things you can effectively control are your costs. You must minimize the time, effort, and money required to get back to pre-Go Live productivity (and then just as systematically minimize the same over the entire life cycle of your use of the EncounterPRO Pediatric EMR Workflow System product line). |
| YOU |
It really is all about you (no matter how proud *we* are about *our* product). It's your time, effort, and money that has to be minimized, not ours. |
| SUBSTANTIAL |
Our claims are documented in three award winning HIMSS Davies Award applications:
And several published surveys:
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| TIME |
Thought experiment: Suppose you could cut the length of a patient encounter in half. All those physical and people resources that used to be tied up seeing a patient are now available to be reallocated however you wish: to see another patient, to spend more time with an existing patient, or to go home on time. We can't guarantee that you will see twice as many patients or double your revenue (although that is exactly what each of the two pediatricians did who won the HIMSS Davies Award). But you will substantially reduce the time it takes to chart a patient encounter.
What you do with the time you save is up to you.
During rollout and go-live, the less time it takes to use EncounterPRO, the less time it takes to learn to use EncounterPRO. That time you save can be used to take advantage of the EncounterPRO EMR Workflow System, instead of figuring it out. |
| EFFORT |
Your (and your staff's) mental effort to go-live with an EMR is a function of how easy the EMR is to use plus how well prepared you are to use it. By combining the EncounterPRO Pediatric EMR's unique workflow system with our EncounterPRO Rollout & Go-Live System, we minimize the total cumulative mental effort that must be exerted by you and your staff in order to quickly get back to pre-Go Live productivity (operationalized as patient per provider per day). |
| MONEY |
In the short run (basically until Day Five of Go-Live) we are not the least expensive pediatric EMR. From then on, and in the long run, we are by far the least expensive.
First of all we save you time. Second of all we allow tasks to be shifted from more expensive staff to less expensive staff, all the while allowing you to monitor task progress in real time to make sure everything that needs to be done is in fact accomplished.
Pediatrician Dr. Jeff Cooper (winner of the first HIMSS Davies Award) explains it as directly and credibly as it possibly can be explained when he says:
"I cannot express enough that an EHR must save a physician time. If I can save two minutes of a visit then I can get from six patients an hour to eight patients an hour. (I don't do that every day; I spend more time talking to parents and then charting quickly.) Time is what a physician has to sell. Time is what I have to sell and anything that saves me time or lets someone else do it saves me time!"
Dr. Cooper's quote is from his 2003 HIMSS Davies Award presentation. If you click on the following screen, you can watch and listen to the entire 50 minute presentation.
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ADDENDUM: EncounterPRO's
INDUSTRIAL ENGINEERING FOUNDATIONS
You may be startled to find an outline of Industrial Engineering on a website that sells a pediatric EMR, but bear with us. It's not just a pediatric EMR, it's a pediatric EMR workflow system (workflow systems are the most successful examples of clinical groupware), and workflow systems are the bread and butter of industrial engineering. Your practice isn't just a collection of health professionals; it is a full-fledged production system for managing your patients' healthcare. As you skim the following, mentally substitute "my pediatric practice" for each use of the phrase "production system," and you'll see what we mean (what *isn't* relevant to running your practice?).
- Work Study and Human Factors: Tools to improve efficiency in production systems, motion and time Study, job evaluation, human factors (including aviation human factors) and ergonomics (usability).
- Industrial Engineering Tools: Production and inventory management, scheduling, facilities location and layout, material handling, production chain management, engineering economics.
- Operations Research and Decision Theory: Statistics, optimization of production systems, probability theory, queuing theory, game theory, graph theory, decision analysis, and simulation.
- Quality management: Basic tools of determining quality problems in production systems.
- Automation: Impact of computers on design, implementation and management of production systems; for example, workflow-oriented groupware systems.
- Project Management: Project planning networks and identifying critical paths.
- Systems Design: Planning, installing and managing of production systems.
We used all of this knowledge and these techniques to:
- Design the EncounterPRO Pediatric EMR Workflow System
- Design the business process management add-on modules to systematically improve clinical performance, user and patient satisfaction, and practice profitability.
- Design our unique EncounterPRO Rollout & Go-Live System, so you can go "Live After Five!" (Days, that is.)
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| TESTIMONIALS |
"Waiting times have been dramatically reduced every step of the way—not just the waiting room time. Parents are happier because going to the doctor no longer takes two hours out of their already overcrowded schedule. I can see more kids per hour with an actual increase in preventive services like screenings and vaccines—thus improving healthcare and increasing revenue at the same time." Jeffrey D. Cooper MD Pediatrician EncounterPRO User Since 1995 (and HIMSS Davies Award Winner)
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"It has allowed our physicians to increase the number of patients they see in a day...And it has given the physicians that were already high-volume the opportunity to spend a little more time with their patients and be more personable." Dee McGee, Pediatric Practice Manager EncounterPRO User Since 1995
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"It's really helped my lifestyle. I'm working three and a half days a week, I used to work seven days a week. So it's really made life much easier, and the staff love it!" Armand Gonzalzles MD Pediatrician EncounterPRO User Since 1999 (and HIMSS Davies Award Winner)
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"The payroll savings and increase in collections repaid our total investment in 18 months." Allen R. Carter Jr., Business Manager, Family Medicine EncounterPRO User Since 2000
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"We have seen incredible results as to the increase in patient volume we can handle." Patricia Hernandez, Clinic Administrator, OB/GYN Practice EncounterPRO User Since 2000
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"At a time when physicians are being squeezed by cost constraints of record proportions while trying to continue to provide quality care, it is absolutely imperative that you look for a system that delivers security, cost efficiencies, and unparalleled quality of care in a new way—EncounterPro is that system." John Ivan Sutter MD Pediatrician EncounterPRO User Since 2000
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"One Monday in the winter we had only two of our five doctors in the office. Then my partner was stuck at the hospital and I was left by myself. At the end of a long day I had seen 79 patients! I wasn’t even frazzled." Karen Kamachi MD Pediatrician, EncounterPRO User Since 2000
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"My office went live 2 days ago and it's unbelievable! For the first time in my nearly 15 years in pediatric practice I left my office with all my charts and notations completed for the day...Thank you so much for giving me a life again!" Angela D. Hunt MD Pediatrician EncounterPRO User Since 2001
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"When I selected EncounterPRO, the biggest motivating factor was the concept of having an office screen that displays the necessary patient activities. This is similar to the ER board that many of us are familiar with that lists where each patient is and what procedure needs to be done next. In a procedure-oriented practice like ophthalmology, the efficiency from this tool is tremendous. The idea of telling staff what to do silently without disruption took me over the top. Features like this can eliminate the need for signaling lights or flags on exam room doors. The final big feature is workflow. Essentially, the program automatically sequences through your documentation depending upon the type of exam you have chosen." Phelgar Washington MD Ophthalmology EncounterPRO User Since 2001
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"We have seen a dramatic impact in lower cost, higher quality and increased speed of healthcare services. Parent satisfaction has dramatically increased as a result of the improved quality and timesavings of our healthcare services." Charles Gregg Pediatric Office Manager EncounterPRO User Since 2002
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"EncounterPRO has reduced the amount of time it takes to produce medical records. The system promotes more teamwork and greater staff efficiency." Linda Hall Office Coordinator Pediatrics EncounterPRO User Since 2002
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"The EMR user interface is akin to the touch screen-oriented systems in restaurants: one screen at a time, with only the most relevant data displayed and options presented (although, of course, a user can always jump out of a particular screen sequence to accomplish an arbitrary task), and the sequences can be tweaked through the workflow management to make such occurrences infrequent...The workflow plans are tailored for each type of patient seen in the office (obstetrics, gynecologic, annual exams, family practice) assuring that key elements of the present illness, history and physical are addressed and documented. Work plans contain required laboratory tests for specific conditions, assuring that key tests are not forgotten." Jeffrey Harris MD Obstetrics Gynecology and Family Practice EncounterPRO User Since 2003 (and HIMSS Davies Award Winner)
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"Benefits I have noticed personally included: decreased turnaround time for telephone messages, decreased turnaround time for prescription refills, decreased turnaround time for referrals, improved efficiency of office procedures such as immunizations and tests, decreased time spent at the end of the day returning phone calls, writing refills, and completing charts." William Long MD Pediatrician EncounterPRO User Since 2004
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"Many pediatricians operate with narrow profit margins. Reducing costs, capturing charges correctly, and increasing the number of encounters can increase profit. If a pediatrician cannot chart a routine otitis media encounter from start to finish in 30 seconds, the EHR will slow him or her down and reduce profit. The EncounterPRO EHR’s workflow engine essentially pushes tasks to users as fast as they can accomplish them. However, pediatric offices accomplish tasks in many different orders, so the workflow definitions can be changed to accommodate a specific pediatric group preference." Michael Blum, DO, Pediatrician EncounterPRO User Since 2004
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"EncounterPRO has made our workflow very smooth. We see 30-40 patients daily and we are almost always finished with all work by 4:30 in the afternoon. No need to stay late and file charts." Stephen Dentler MD Pediatrician EncounterPRO User Since 2004
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"EncounterPro's simplicity and design distinguishes it from the competition. It is a workflow-based system. An office equipped with EncounterPro has a computer terminal in every exam room. At any of these terminals, you can find out what is going on in any room, if a room needs cleaning or setting up for a new patient, if a patient is waiting for vital signs to be taken or a nursing assessment to be done, or if a physician is interviewing or examining a patient. EncounterPro features a very simple interface, with large, clearly marked buttons and interchangeable screens. You can switch from nursing-intake screens, to vital-signs screens, to prescription and super-bill generating screens. From any screen, you can create a comprehensive office note from a series of lists. EncounterPro has received many awards for design." Contemporary Pediatrics 2001
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EMR / PMS
