MedStar Health is a not-for-profit, community-based healthcare organization comprised of 25 integrated businesses, including seven major hospitals in the Baltimore/Washington area. The hospitals, which include both teaching and community facilities, are Franklin Square Hospital Center, Good Samaritan Hospital, Harbor Hospital, and Union Memorial Hospital in Baltimore; and Georgetown University Hospital, National Rehabilitation Hospital, and Washington Hospital Center in Washington D.C. MedStar Health hospitals and healthcare organizations serve more than half-a-million patients each year. With 22,000 employees and 4,000 affiliated physicians, it is one of the largest health systems in the mid-Atlantic region.
Challenge: OR scheduling requests
At the time of implementation the vendor for the OR scheduling and clinical documentation system that MedStar purchased had not completed development of its Web-based self-scheduling module. However, MedStar says it still selected the application because they were assured that the module was in development at the time of purchase. This forced MedStar to find an interim solution, a traditional fax-based system, in order to reduce the time and staff required to manually process OR scheduling requests.
Using the fax-based system, an OR scheduling request is submitted by a clinical practice to schedule an OR room in the hospital. The scheduling request form, which is faxed to the OR scheduling office, contains information about the surgical procedure to be scheduled; necessary equipment and medication required; demographic, insurance, and brief medical information about the patient; and requested surgical dates.
The OR scheduling office reviews the form and either approves the request and faxes the form back with the OR date/time, or returns the form to the practice with a request for additional information.
Though the traditional fax-based system worked, it was inefficient. Problems included lost faxes, the lack of easily traceable records, and frequent phone calls to clarify information between the requesting practice and the OR scheduling office. The inefficient workflow resulted in prolonged scheduling time and a decreased ability to proactively plan cases. In addition, patient safety was potentially compromised because of illegible faxes, a large majority of which were handwritten.
With the new computer-based OR system, the process would be further complicated because the hospital scheduling representatives would now have to toggle between the new software and the old faxing method. Why not just stop accepting faxes? Is that not practical? Is there a point at which you can insist on electronic scheduling? The challenge was how to make the process less onerous for the clinicians, their practice, and MedStar Health.
Complex solution: Web-based form
The MedStar e-Health team, created by the MedStar Board to provide its clinicians with information on available e-health applications and emerging technology, was contacted to devise an interim solution to quickly and inexpensively ease the effort of OR scheduling. The first idea considered was to create a Web form to submit scheduling requests. The clinician practice would complete a multi-page schedule request form that would be securely transmitted to the OR scheduling office via the MedStar Clinician Portal Application (a MedStar developed application reported in January 2007 Healthcare Informatics).
At first, the idea of a Web-based form seemed like the ideal solution as it would leverage existing systems, and most MedStar clinicians already had accounts on the Clinician Portal. A more detailed analysis quickly proved that this workflow solution was not viable. The first flaw was the real-world clinical office workflow and the Clinician Portal's idle timed automatic logout. In a modern clinical practice, the staff is often simultaneously working on multiple tasks and the OR scheduling request form is frequently completed over a period of time. However, when the staff member stops working on the scheduling form in order to complete another task, the Clinician Portal would force a logout put in place for security reasons, and all the previous work on the form would be lost. The only way to prevent this loss would be to devise a mechanism to auto-save the form as it progressed, which would add significant development time before delivery of the solution.
The second flaw in the Web form idea was the need for interactions between the OR scheduling office and the clinical practice. A scheduling request often changes as a result of refinements to the request, as well as the requirement to provide the final form to the clinical practice. A document management system to track the Web-form would need to be created or purchased — either way adding significant time and/or cost to the solution.