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Optimizing Workflow

October 8, 2007
by Mara Burdick
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Carolinas HealthCare System (CHS) tackles workflow and comes out on top.

Workflow is one of those "religious" issues within the world of IT. Everyone has strongly held opinions on what it means and how to do it best. Even the name is a point of contention. Which term is preferred, "workflow" or "business process management" (BPM)?

By either name, we have managed to unify a number of disparate processes over the past several years, and successfully implement a series of workflow projects at CHS. In the process, we have reduced our operating costs, enhanced customer service, facilitated staff responsiveness, and improved our ability to produce better audits and respond to federal and state requirements.

Carolinas HealthCare System is the third largest public healthcare system in the United States, with some 29,000 employees; 75 physician practice groups in 150 locations; and 19 hospital campuses across the Carolinas. The Information Services department has approximately 450 employees supporting a highly complex technology environment deployed across the entire enterprise. Applications range from department-specific to enterprise-level. Our IT budget varies from year to year and is dependent upon capital projects.

We began the RFI process in 2001 — 2002 and implemented our first procedure in 2003. As such, we began using TIBCO BPM software almost four years ago, in order to move away from various manual and paper-intensive processes, such as denials management, information requests between billing office and ambulatory Care practices, and routing of customer service requests. In the past, it could take two weeks or more to transmit and receive back requests for various kinds of information from our expansive base of physician offices. This information included requests for explanation of benefit, date of service verification, copy of insurance card, worker's comp notes, and medical records to name a few.

Now that workflow is a part of our established way of doing business, our requests to physician offices take only a day or two to be returned. (See the table below.)

How did we do it?

First, we marshaled the support of upper management.

Getting started with workflow is a major endeavor. It is an exploratory process that will quickly highlight any problems with the status quo, while also stirring up possible territorial issues. In order to take on a project with these types of flashpoints, it is imperative to have the support of upper-level management. This ensures a mandate to address and solve these problems as they arise. Without this support, it will inevitably take longer to achieve workflow goals.

One of our initial goals at CHS was to automate denial processing at the billing office. Because of the complexity of denial processing, though, we started with the less complex system of manual customer service procedures. We then progressed to denials, a sequence which allowed us to walk before running.

Second and of utmost importance, we spent significant time understanding our own business processes.

If those people who serve as subject matter experts aren't familiar with their workflow procedures, it is hard to use software to automate those procedures. In order to ensure that our automated processes were effective and reflected best practices, we worked very closely with our subject matter experts on system design. We made sure that the inputs and outputs were clear and the relationships between them understandable. Without this partnership, it's unlikely we would have been as successful. The point was to position this initiative so that it was not perceived as an "IT project." We wanted its scope to extend from IT all the way to both internal users and external customers.

We decided that our first workflow implementations should focus on the most manually intensive procedures, such as denials management. We then moved on to a more complex process that involved a fuller integration of the entire physician practice management system. Eliminating excessive manual work seemed like a good way to speed payback.

For example, our clerical staff members were using manual, paper-based methods to keep track of more than a dozen different billing processes. These methods were cumbersome and prone to error. It was difficult to route information to the right person in a timely fashion. Our workflow system now keeps track of all routing and logging, and frees staff to focus on more important activities, such as working cases rather than documenting productivity on tick sheets, concentrating on customer service. We estimate that our savings in facilitating requests between the business office and physician practices will total some $300,000 annually.

Third, we had a formal program to ensure that our end user staff was fully engaged with the new workflow applications.


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