Zen Clinicals: An Activity & Workflow based solution (1 of 4)

December 11, 2015 / OTHERS

Part 1 of 4:

Recently, during the Gartner Symposium, it was predicted that cognitve platforms would take over a lot of activities. Keeping this future at the back of our minds, its important for the EHRs of today to metamorphosize to the Cognitive Computing platforms of tomorrow, and fast.

 With social media, predictive and bigdata analytics become more central to the discussions; the current EHR systems are woefully lagging behind in the ability to catchup with the technology of today. Newer EHRs or healthcare based platforms too are lagging behind in the adoption of these technologies. Most often have observed the similar functionality being rolled out on newer technology.

In most cases I have found the solutions to be non-workflow, i.e., non-BPM, enabled solutions that have the inability to adapt to a new healthcare scenario faced by the solution in the next implementation. With the advent of the Software as a service platforms and the proliferation of the cloud based services in other industries, healthcare solutions have generally gone for the traditional (non-BPM based) approach to delivering a solution. 

 So, One needs to then ask, “What should the future of a patient health record (PHR) or the electronic health record look like?” 

Will we really see the advent of SMART solutions in healthcare, or are the changes to difficult too incorporate into the solution because that’s how the solutions had been developed?

 In this series I present some thoughts on what should the solutions of today morph into to meet the needs of the users and hopefully make it more user-friendly in the process.

And to develop the solution, Zen Clinicals (this is a fictitious name of a solution any resemblance is purely a coincidence), we need to answer a few questions upfront:

  • who do you build it for? 
  • Who are the actors? 
  • And what do they need? 
  • What are their activities? 
  • What do they do daily?
“User Experience strategy lies at the intersection of UX design and business strategy. It is practice that, when done empirically, provides a much better chance of successful digital product than just crossing your fingers, designing some wireframes, and then writing a bunch of code”

UX Strategy by Jamie Levy (O’Reilly)


Lets explore the actors in a small clinic. And list out the answers to the questions.

The Actors: 

  • Physician
  • Nurse
  • Billing Person
  • Customer Service Person
  • Customer (Patient)

The Activities:

Its is important to understand the way each of these people work. Its a mix of their training (the way each of these people perform their tasks) and the requirements of their roles. 

We define an Activity as 

Lets take them up one by one. 


The Physician Activities:

The Physician is the focal point from the operations perspective. What does she need? 

 For this lets consider Dr. Jane’s typical day. She gets ready and heads out for work. Reaches her office, marks her attendance at the biometric scanner. She then heads out to her office and logs into her system.

 On the way to her office, the nurse Jenny informs her of the number of patients that are scheduled for the day and the number of patients that have already arrived.

 Dr. Jane, checks out her emails before starting to see her patients. She then heads over to the system to view the list of patients that are waiting to see her. Before she calls on the first patient, she reviews the patient records from the previous visit to bring herself upto the current status of the patient.

 She calls her first patient.

The Nurse activities: 

The nurse is a master tactician who works as the floor manager in the clinic. She handles the multiple schedules, that of the physician and the patient. While the doctor focuses on treating the patient, the nurse handles not only the administrative work related to that patient, but also the clinical preparations that a patient might need pre or post seeing the doctor. 

 Nurse Jenny, started her day by arriving at the clinic about half and hour before the clinic was to open. She checks up on the list of appointments scheduled for the day and orders the relevant medical records as per the way the patients are scheduled to arrive for their appointments.

 Dr. Jane arrives at the clinic and Nurse Jenny informs the doctor about her appointments for the day and any other Administrative aspects that needs the Doctors attention.

 Meantime, the first patient scheduled for the appointment, calls the nurse to inform if the doctor will be able to consult her via video conference. Nurse Jenny schedules the video conference for the patient with Dr. Jane.

The Billing Person’s Activities: 

The billing person arrives at the clinic and decides to check on the status of the outstanding dues, the patient ledger of the patients visiting the clinic today to review their insurance details and the plan of processing first time patient insurance details.

The billing person also completes the coding activity for the bills that are to be processed. The billing person sends the billing statement to the uninsured patients who owe a balance for their visit. The billing person also issues the billing statement to the insured patients once the insurance company processes their claim.

The Customer Service Person

Elaine starts from her home to the clinic and is immidiately alerted by the customer relationship management system regarding the various appointments that are scheduled for the day. She selects the option to bulk message reminding each of the customers regarding their appointments and the time the customer should arrive at the clinic to attend to the appointment.  

Before, she reaches her office, all the reminders messages to the patient have been sent on their way. And of course, yesterday she had already called each of the customers reminding the customers regarding their visit and the documents the customer should bring along with them for the visit.

The customer service person is responsible for taking care of the patient appointment reminders, customer satisfaction surveys, patient engagement via social media and many other activities as required by the clinic.

The needs of the clinic will define the various campaigns that the clinic runs for their patients to develop an in-premise and off-premise customer relationship management processes. 

 The customer service person is also responsible for maintaining a constant conversation with the patient to enable a superlative customer experience.
 

The Patient Activities

The customer Jennifer logs into her portal and schedules an appointment with Dr. Jane. She uploads her insurance details as part of her appointment details. 

Jennifer, attaches the latest reports, relevant for this doctor visit and the medications she is currently taking.

One day prior to the date of her appointment, jennifer gets a call from the clinic confirming her appointment and updates on any other documents she needs to carry with her)
   
The patient is the most important aspect of the entire healthcare workflow. Each of the activities and the processes within the hospital are moving towards a patient (customer) facing than being hospital or doctor facing.

The Patient starts her journey by anyone of these scenarios:

  • booking that first appointment with a doctor in a facility
  • booking for a health-checkup
  • booking for a radiology or pathology service, as referred to by a GP
  • and many others…   

 

Activity Interactions

Now that we have identified the various actors in a clinical setting it is important to understand the interactions between these actors. There is a need to consider the interaction between the actors to be connected to other actors and at other times the activities could be limited to a single actor.
 
However, the interactions between various actors also define another dimension to the entire workflow. For instance, the doctor – nurse interaction could have the nurse as the focal point and at other times the doctor as a focal point of interaction. Hence the activities that will be delivered to the user based on her role will depend on the interaction context.

Using the activity interaction map, the system will be able to setup the base set of activities and then progress from there to learn about any new interactions and activities to be performed. 

Newer activities are coded into the system by defining newer objects and the front end definitions will result in the generated page engine to present to the user the screen in which they need to enter the information. This will be achieved by using a combination of an object creator, rules engine and front end designer.

Additional Considerations

To develop a solution of this nature we present a list of features that should be included into the framework of the solution
 
Generated Pages: Using cognitive computing, the system will be able to present the doctor a Patients Health Record as a generated Generated Page which displays the details of the patient record on the basis of the current visit and diagnosis. Included in this generated page are actionable intelligence inputs presented to the doctor by the underlying congnitive computing enabled analytics platform.

Activities presented to the care provider on the basis of the Appointments, ward rounds, patient interactions via virtual visits – doctor is presented with the patient information when the visit is started.

The doctor should be able to type in regular statements and the system responds by pulling together relevant information regarding the patient. For instance, the doctor queries, “display the list of active medications the patient is on and display the list of lab tests that have been ordered in the past three months”. 


Speech Recognition and NLP: The Zen clinicals will heavily employ the speech recognition and NLP capabilities to allow the doctor to perform the following activities. It is important to get the doctor to move away from the system and focus on the patient treatment

  • The doctor will be able to dictate the details of the visit as a recording. While dictating, the system will alert the doctor regarding any mandatory information that is required for the visit, that had been missed out in the dictation. 
  • Secondly, the system will allow the doctor to see the mandatory form that needs to be filled for the patient visit or his ward round and indicate by voice commands the values that need to be selected–deselected or chosen from a list of values etc  

 
Digital Assistant: The Zen Clinicals solution will have a digital assistant available for the doctor to help in performing any of the activities. These activities could be a resulting microinteraction or they could be statements submitted by the doctor to the system. Activities can be performed
 
Data Analytics: At the time of prescribing the medication for the patient, the doctor is presented with the list of medications sorted by their administration to other patients under similar parameters, by cost and availability at the patient location. The Zen Clinicals solution will be developed with a analytical data structure at its core.
Microinteractions: The system should have the ability to allow the users to define microinteractions as a set of rules and trigger criteria to generate activities or alerts based on the rules and trigger criteria. 

Alerts Engine: At the core of the Zen Clinicals framework is also an alerts engine that takes keeps track of all the results generated from any microinteraction and has the visibility of delivering these alerts via multiple channels (desktop alerts, mobile notifications or wearable notifications). The alert engine uses the presence definitions from the unified communications framework component to deliver the alerts to the user

Workflow Engine: The Zen Clinicals framework incorporates a workflow engine at its core to define the various workflow activities, such as authorizations, digital signatures and sign-offs for authorization activities, co-sign actions for activities, peer review and sign-off, order process workflows and many other such definitions.
 
Unified Communications Platform: The Zen Clinicals solution has a unified communication platform integrated into the core of the framework to enable the presence identification and communications framework from within the application. The users will be able to make use of multiple communication channels using this capability to share information seamlessly with their peers.
 
Face Recognition: 50 Face Recognition APIs – Data Science Central http://ow.ly/VNvhI
 

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