In its 2016-2020 ‘Roadmap for Success’ report, Mackenzie Health forecasts that the communities it serves will grow 40-50% in the next 15 years and its population of seniors will increase by a factor of four. No wonder the organization is constantly looking for ways to enhance everything it does- including a focused effort to achieve a paperless operational state.
Mackenzie Health already operates a hospital in Richmond Hill, Ontario and plans to open another in Vaughan in the next three years. The organization has been nationally recognized and rewarded for its commitment to quality health care and the Mackenzie Innovation Unit is transforming the way care is delivered.
Mackenzie Health’s Medical Imaging (MI) Department conducts more than 194,000 exams in 2016, and the volume of exams is increasing by 3% every year. Without additional funding, the staff were spending a lot of their time in distributing and organizing paper. This not only causes inefficiencies but creates privacy risks.
“We wanted to be on top of our patient flow and wait times,” explains Carlene Small, Clinical Informatics Analyst, Diagnostics & Therapeutic Program, at Mackenzie Health. “We wanted to redesign the requisition scheduling workflow” – As much as we streamlined these workflows over the years, we knew they could get even better.” Mackenzie Health targets 2 business days for its requisitions to be scheduled in the scheduling office, it was getting increasingly difficult to maintain this target with volume growth.
Mackenzie Health turned to Process Fusion Inc. (PFI), PFI wanted to create a fully customized workflow application that captures and routes faxed requisitions and adds intelligence to the process to gather meaningful information. That way, requisitions could be digitally routed to the right MI team members at the right time based on pre-determined business rules and provide better control of the process.
PFI used a Rapid Application Development (RAD) design methodology to prototype its solution and involve the Mackenzie Health user community in creating a user interface that met everyone’s needs. According to Small, this was one of the factors that ultimately contributed to the project’s success.
“We did a lot of mapping of workflows, meetings with key stakeholders and significant individuals working with Process Fusion on design and development.” says Lindsay Lankin, Manager Patient Access
One major but unforeseen challenge was transferring more than 7,000 paper requisitions into e-requisitions that were still being processed as the new solution was being deployed. Small says that PFI helped create a hybrid process that efficiently transferred paper requisitions to e-requisitions.
It was also important to consider the unique needs of each stakeholder. Whereas the date and time of a particular exam might be critical to schedulers, radiologists would need access to a patient’s medical history before moving the requisition forward.
“Coding efficiency was the primary consideration for the radiologists. We wanted to reduce the number of ‘clicks’ and to make the interface easy to use,” Fred Lan, Chief Radiologist at Mackenzie Health, explains. “Process Fusion worked with us closely to achieve our goals and was flexible in adapting to our needs. This collaborative approach was essential to making the transition to the new process a success.”
“PFI was very accommodating,” Small adds. “We would come up with these last-minute ideas and they would get it done, no matter what. PFI made it really easy for us to develop what we needed.”
Whereas Mackenzie Health’s internal IT department was involved in setting up the infrastructure, the PFI team took are of the rest.
Less than a year after the deployment, all outpatient requisitions are now handled electronically. It is used by patient registration staff, Radiologists and Technologists to respond to Physicians’ needs. According to the Mackenzie Health team, the advantages have been manifold:
Convenience and Speed
“The algorithm designed for e-requisition has made it faster and easier for the radiologist to protocol requisitions,” says Michele Doherty, PACS Administrator and co-project manager for the e-requisitions project at Mackenzie Health. “The availability of e-requisitions has also eliminated the need for users to walk requisitions to and from the radiologist’s office.”
Thanks to PFI’s eReq dashboard and reporting module, e-requisitions at Mackenzie Health are trackable and can be audited, with multiple reference points along the way, Small says. “These things would just go missing and we couldn’t say why. Now if a fax comes into our RightFax, we know date, time and we know who touched it.”
Communication is more efficient between the Radiologist, Technologist, Supervisory staff and scheduling teams thanks to e-requisitions.“Post it notes were common communication practice between staff,” Small says. Now, questions can be answered electronically and requisitions can be processed by Radiologists all day versus the batch protocolling that was necessary in the past.
Mackenzie Health is preparing to move to a new Electronic Medical Record (EMR) in July of 2017. PFI helped ensure e-requisitions would be a smooth part of that transition by setting up a loose integration with the organization’s backend for now, which can be made stronger once the new EMR is ready.
“The Patient Access Department has seen many tangible benefits with the implementation of e-req. The built-in scheduling algorithm has increased efficiencies and reduced errors,” says Lindsay Lankin, Manager, Patient Access. “We are no longer required to shuffle through paper as all requests are easily searchable. Since go-live, we have not lost one requisition!”