In this, the last of our five part series, we discuss the highest level of IT management, an approach that is tightly integrated and synchronized. We will conclude with an explanation of the relationship between process and technology.

ADOPTION DOESN’T MEAN WE LIKE IT

Practices adopt IT systems to automate a workflow previously done by hand — such as accounting, scheduling, medical records keeping. When a practice adopts software, one of two things happens: either the practice changes its processes in order to use the software or the practice changes the software in order to reflect its processes. You either adapt to it, or you adapt it to you.

These three are actually the critical practice process types: those that treat your patients (EMR and other clinical apps); run your practice (practice management, scheduling) or collect your money (billing and revenue cycle management). Therefore, this final installment of the series is meant to help you apply a centralized approach for productivity that is process-centric first, technology-centric second.

Conceptually, technology is the foundation that automates the processes.

REGARDING IT MANAGEMENT

Once your IT manager has progressed from EMR guru to capable IT manager to risk manager, her final goal is to become the IT process owner, the person responsible for process outcomes. In a process-centric practice, there are many more participants who have this responsibility. And this is why becoming such a practice is a priority.

When your EMR was the focus of your IT world, you were consumed with keeping information flowing. With that challenge met, you now want to focus on keeping knowledge flowing. Everyone reading this article has experienced the problem of staff leaving and taking their tacit knowledge with them, leaving you to re-create the process they managed or executed.

Too many IT managers focus only on information flow and do not advise their superiors about the risks of inadequate process knowledge transfer. Too few IT departments have process control plans written down should the need arise. Once you document your processes, information flow is a natural outcome of standardized, repeatable processes. You need your IT manager to document your processes because your technology person has the “keys to your kingdom” in his head and leaves the building every day, leaving you at risk.

The goal is to morph from tacit to institutional knowledge — removing information from the IT manager’s head and putting it into an all-staff, accessible arrangement.

This is what I call “Process Knowledge Transfer.”

KNOWLEDGE FLOW IN THE PROCESS-CENTRIC PRACTICE

We are transitioning from an information economy to a knowledge economy. In the latter, profit and productivity come from information flow. Medical practices adopted EMR and practice management software hoping for better information flow. In the knowledge economy, your practice’s profit and productivity come from your processes. Process clarity determines operational effectiveness and risk.

Processes often resemble a maze. While many ways exist to get into it, there is only one way to get you through without errors, frustration, false starts and general wastefulness. Your ability to get through that maze will determine your effectiveness and mitigate your risk.

Knowledge loss is a huge and growing risk, and grasping its true detriment to your practice is vital, considering how many more process participants there are. The vast experience and capability within every ophthalmic practice lie almost entirely within the heads of the people performing the work. Without strong process knowledge transfer, day-to-day operations and IT-enabled workflows are filled with workarounds, multiple copies of tools, lots of opinions and lots of unfulfilled innovation.

One of the unrealized problems with knowledge loss is that no one puts in the time to achieve competency anymore. In Outliers, author Malcolm Gladwell talks about mastery of a subject taking about 10,000 hours, which is more than five years on the job. These days we’re lucky if someone stays in the same practice for three years.

So we have this problem of constantly dropping back to a lower competency when someone new starts a job.

We are trying to maximize the knowledge gain and minimize the knowledge loss while achieving two initiatives: operational effectiveness and an improved operational risk/safety profile.

If you only remember one thing, remember this: Improve profits, effectiveness, operational excellence and patient safety using “smart processes”. Earlier in this series, I talked about doing the right things and doing things right. That is the essence of what a smart process enables us to do. Smart processes know who you are, what you are doing, what comes next, and what you need to get it done. Smart processes are the secrets for success for today’s ophthalmic practice. Start by codifying smart IT processes.

Remember, your practice is run by knowledge workers. Harness the energy and ingenuity of your people and make it operational.

INDISPENSABLE PROCESSES

An IT manager whose processes are fully documented is no longer indispensable. That said, the best IT managers are systematic and rigorous about process controls. If you haven’t documented your practice’s processes yet, your IT manager will likely be happy to help, and glad that you want this done.

10 steps to get the ball rolling:

• Step 1. Inventory every process that is a candidate for documentation.
• Step 2. Categorize them into revenue cycle management, practice management (IT, shared services, and anything else that doesn’t pertain to money or patient care), and medical care delivery; i.e., treat my patients, run my practice, collect my money.
• Step 3. Label as must do or would like to.
• Step 4. Prioritize them both.
• Step 5. Identify the process owner, that is, the person who owns the output or outcome for that end-to-end process; e.g., the call center manager is the process owner for inbound call processing.
• Step 6. Identify those people who participate in process execution in each process on your list; e.g., the call center operators are the process participants for inbound call processing.
• Step 7. Review each activity as the process is currently executed. Document what is done, what is received from the previous process participant or required from the previous participant, and what happens after each activity is finished; e.g., for a LASIK inquiry, the call center operator takes the inbound inquiry, she hands off to the refractive coordinator, who determines whether the caller is a candidate for LASIK or not, and if so, hands that person off to a scheduler for an office visit or, if not, offers another service such as optical.
• Step 8. Visually capture the process as an end-to-end workflow using software tools available off the shelf. You will need to have a person designated as a super-user whose responsibility is to master use of the software. No need for this person to be expert with the process, just the documentation. This person will function as a scribe as the process owner and participants deconstruct it. It is particularly helpful if this person has rudimentary facilitation skills; this person is harvesting process knowledge and capturing it in software that visually presents the flow. Process experts then can agree whether the copy is faithful to the original.
• Step 9. Confirm the “as-is” process to be correct and all parties agree that this is the single version of the truth.
• Step 10. If desired, you can capture improvement to the “as-is” process as a “to-be” process with changes that reflect the new improved workflow.

SHOULD YOUR IT MANAGER NOT BE WILLING …

Maybe your IT manager wants to guard his indispensability, or maybe he has just left and taken his knowledge with him. Fear not: There are numerous process documentation software applications on the market. Your new IT manager can likely assist in selecting the right tool for you just like the ex-manager helped select the right EMR for you, but just in case, below are some guidelines.

We would recommend that the software:

• be hosted
• be visual for process capture
• enforce rigor on the process documentation steps and break down processes into activities, tasks, decision trees or branching logic
• have an API (application program interface) so that if your IT department wants to automate a process it may be possible for the process capture software to send and/or receive data with other applications used in your practice
• be readily accessible to less capable or less experienced process participants for ‘just-in-time’ training and on-the-job performance support. The process control plan should allow the attachment of “rich media” and other files on the various steps in the process so less experienced process participants can access performance support tools and short units of instruction.

The only burden these will add to your IT manager’s duties is mastering a new software application. Of course, you may select another process owner to be the super-user for these tools. But learning to think through workflows may come easier to IT personnel as they are usually capable of sketching out process flows.

GETTING YOUR IT HOUSE IN ORDER

This is where I hope all of you will, or have, ended up:

• You have adopted many kinds of technologies beyond an electronic medical record and have a robust technology adoption philosophy
• You are fully committed to automating and building the practice beyond the promise of automating paper-based workflows
• You are using technology to amplify competitiveness through improved productivity and performance — which has helped our practice become one of the premier practices in the area. OM

About the Author

Peter J. Polack, MD, FACS, is co-managing partner for Ocala Eye, a multi-subspecialty ophthalmology practice in Ocala, Fla. He is also founder of Emedikon, an online practice-resource for physicians and administrators. His e-mail is ppolack@ocalaeye.com.