So while workflow management technology sounds like a winner, it has to be implemented well.
Vendors try to make their products very flexible -- and highly integrated among work functions -- so that physicians and others in the practice can use them without too much interruption. The lesson learned is that technologies that are too disruptive tend to fail. "They serve some purpose for a little while, but after some time, people realize it doesn't fit into the physician's workflow, and they stop using it," explains Ahmad Hashem, MD, global industry manager for healthcare at Microsoft. In fact, healthcare technology vendors have a less-than-stellar history when it comes to working with physicians. "The focus had been controlling or changing physicians' behavior, not helping physicians become more productive," Hashem says.
Unfortunately, a product that is meant to improve workflow management can't simply fit into the existing workflow. It needs to change it for the better. Otherwise, "there is a risk of paving the cow path," as Brandt puts it. If a process was bumpy and cumbersome in a paper-based scheme, reproducing it in an electronic format isn't necessarily going to help. Workflow management systems have to ride a thin line between being usable enough to be adopted and innovative enough to be effective.
Physicians looking into workflow management software need to be ready to change -- and so do staff. If your billing manager has spent the past five years creating systems and forms and permission slips, it will be hard to get him to change, warns Walker. In fact, some staff might feel a better workflow makes their paper-shuffling jobs redundant. "The resistance comes more from the office staff members who are worried about their jobs, not from the physicians," Yonis says.
Or, do it yourself
The truth is, no technology will help if poor processes are in place. Often, practices believe that they a have problem with technology, when the real culprit turns out to be related to manual workflow, explains Rosemarie Nelson, market development manager with medical technology developer and manufacturer Welch Allyn in Syracuse, N.Y. For example, a practice with a pile of denied claims may blame their billing system -- even though the problem is that insurance coverage isn't being verified before the claim goes out the door.
Technology can't do it all, so some consultants advise that physicians interested in improving workflow should first take a do-it-yourself approach. Forget technology for now; look at your processes -- every single one.
Create a culture of change, urges Walker. "Let people know there are no sacred cows, [that] we are not going to stick with the status quo. Ask questions about the current structure, about the piece of paper you are filling out. Ask, 'Why did we start doing it this way?'"
Such inquiry and reflection can be exhausting. Walker suggests taking it one step at a time. "Pick one critical function each quarter to ask if there is a better way." Measure how long, or how many steps, or how much cost or staff time the process takes in its current form, then measure later to see if you improved it, she adds. Visiting other practices and reading journals is a good way to pick up new ideas.
Even do-it-yourselfers can benefit from eventually adopting technology, Nelson points out. "Technology will often force change," she says. If improvements don't happen manually, a technological kickstart might help.
Pamela L. Moore, senior editor of practice management for Physicians Practice, can be reached at [email protected].
This article originally appeared in the July/August 2002 issue of Physicians Practice.