The Importance of Accurately Documenting Workflows

March 6, 2019

Importance of Accurately Documenting Workflow

In the mid to late 1990’s, EHR vendors started focusing on workflows– and not just the feature function of the system.  A great example of initial focus on workflows are Flex Orders.  A flex order made it possible for a provider to make another order based on the results with little navigation to other screens.  EHR vendors expanded their solution offerings by developing specialty modules with workflow as the root of the design. The goal focused on targeting the right data, for the right patient at the right time.

As EHR vendors now target smaller hospitals, they pack their implementation services with tighter timelines, while accepting the EHR vendors tools, content and workflows.  Although the hospitals may be smaller, they still have complex requirements to collect and process the data in their unique environment. While an out of the box solution from the vendor is a great start, it may not provide enough focus on workflows.

Here’s one example from an EHR vendor:

  • Five years ago, the hospital employed trainers who would own the workflows. The vendor provided Viso diagrams of workflows so the hospital trainers could modify them as design decisions were made that required the workflow to change.
  • Now the same vendor recommends hospitals outsource training roles allowing the vendor to provide the trainers. However, now they aren’t documenting them accurately, if at all.

The same software company providing the roles that own your workflow is a self-serving offering.  Rather than the software vendor modify the workflow to accommodate a hospital, the hospital is now asked to modify their workflow to adopt the software.  This isn’t always a bad approach.  However, unless a hospital makes a specific focus to evaluate workflow design, it won’t happen on its own.  The vendor is focused on getting their software live as soon as possible.

Here’s an example of the impact on the hospital.

  • Five years ago, when a hospital went live, the Visio diagrams of the workflows would be referenced for training prior to Go-live and troubleshooting after Go-Live.
  • Now based on the out of the box implementation methodology, no one has the workflow diagrams which they have been implemented and trained on.

Many top EHR vendors have implemented their software several times –why not trust the out of the box solution?  When workflows are not properly documented and tailored for the specific health organization, loss in revenue can occur.

Excite Health Partners is currently working to correct a 27-million-dollar issue due to inaccurate workflow design and supporting documentation. During the implementation, the vendor did not document the workflows, and the revenue cycle test scripts weren’t customized to the hospital’s needs.

At Go-Live, the hospital realized the workflows hadn’t been built out (or tested) for one of the modules, pre-collections. They also discovered the Medicaid billing process actually had 2 different workflows the employees were following.  90% of the revenue cycle issues came back to workflow and building the system to support the hospitals processes. Excite is now helping our client resolve these issues. Important to remember to properly design and document workflows to void these types of issues.

Todd Klein

VP EHR Services & Digital Solutions