Part 3_ Reworkflow Design

Gap Analysis Plan

Adrienne Clark

Walden University

NURS 6421, Section 2, Supporting Workflow in Healthcare System

21 October 2015

Gap Analysis Plan

The workflow inefficiencies identified relate the Armed Forces Health Longitudinal Technology Application (AHLTA), which lacks a database that could capture diabetes, as well as, track veterans with Post Traumatic Stress Disorder (PTSD) at risk of suicide based on past hospitalizations and homicidal ideation. In this light, the focus of this gap analysis plan, is to map out a plan to examine the deficiencies in AHLTA and how the workflow gaps contribute to the inefficiency. This will help inform strategies that could streamline the workflow to eliminate the gaps. For the purpose of this paper, I will discuss a gap analysis plan for PTSD and outline current workflow for diabetes care in Visio.

Meaningful Use Objectives

Monitoring and capturing diabetes could be useful in recording vital signs that inform care, such as height, blood pressure, weight, and BMI. This aligns to one of the objectives in Stage II Meaningful use program, which recommends recording the vital sign for over 80% of the patients (Centers for Medicare & Medicaid Services., 2013). Recording such vital information from the population that the health facility serves is critical for attain Stage II objective, which relate to employing clinical decision support (CDS) with the intent of improving performance related to addressing health conditions that are of the highest priority (Glaser, 2008). This objective mandates that providers eligible for the program implement five of CDS interventions relating to clinical measures in patient care. In this case, the EHR is aligned to CDS if it provided evidence-based interventions drawn from vital signs, laboratory tests, problem list, as well as, demographics (Glaser, 2008).

This also goes for linking referential CDS where the EHR identifies therapeutic and diagnostic reference information using data such as vital signs and laboratory tests among others just mention in evidence-based part (Glaser, 2008). This also goes for facilitating CDS configuration by enabling reference resources and interventions relating to critical patient and issue data, automatic occurrence of interventions and enable user review of sources attributes, including bibliographic citation, funding, release and developer. In this case, the lack of a database recording information to inform diabetes prevention shows lack of vital information needed to attain the CDS objective to ensure diabetes, which is a chronic diseases of high priority is adequately prevented and managed through quality measures identified. These include blood pressure management, low-density lipoprotein control and management, as well as, hemoglobin A1c poor control (Department of Health and Human Services, 2013). Meaningful Use also has a core objective focusing on preventive care.

The objective state that providers use information that is clinically relevant in identifying patient that must receive reminders relating to follow-up/preventive care, as well as, send patients reminders based on how the patients prefer. Providers should be able to track and send reminders to patients with two or more visits to the office when deemed necessary. Deficiencies identified frustrate the ability to deliver preventive care. This is because without a database to track PTSD patients, as well as, identify people at risk of diabetes, it is impossible to initiate interventions leading to preventing suicide in PTSD patients and diabetes in persons at risk (Centers for Medicare & Medicaid Services, 2013).

Gap Analysis Goals

According to Hammel-Jones (2012), gap analysis in the workflow, helps identify the root cause of deficiencies that may interfere with the smooth operation of organizational process and activities. Unertl, Weigner, Johnson and Lorenzi (2009) notes that in chronic diseases, such as diabetes and PTSD, which are the center of workflow issues concerned, identifying the deficiencies help in modeling information flow and workflow in a manner that achieves efficiency. Emphasizing on this, Davis-Ajami, Costa and Kulik (2014) note that gap analysis is critical in not only identifying, but also understanding and addressing bridge gaps that frustrate the delivery of quality services in nursing practice. In this light, conducting a gap analysis offers structure for gathering information, as well as, a process for finding solutions to address the deficiencies effectively. The effect is mapping out, as well as, sustaining corrective actions that help close quality chasm. Based on this information, the three goals for this gap analysis include:

i. Identifying the bridge gaps in AHLTA that frustrate the delivery of the care stipulated to PTSD patients at risk of suicide and people receiving care at the facility at risk of diabetes;

ii. Understanding the bridge gaps in-depth, including factors contributing to the gaps directly and indirectly;

iii. Using the insights garnered from the analysis to formulate effective solutions to streamline workflow and ensure that PTSD patients at risk of suicide and people receiving care at the facility at risk of diabetes receive quality care.

Data Collection Method

In examining the workflow to identify gaps, the focus will be on observing and collecting data from relevant individuals (Malagon-Maldonado, 2014). In this case, the focus will be on interviewing the staff members in the nursing informatics department who handle designing and implementing the EHR system, as well as, those using the EHR system particularly those attending to health needs of the PTSD and Diabetic patients. The manual for design and implementation of EHR will be reviewed to show whether the design anticipated the problems highlighted in the workflow or not. The interview focusing on the nursing informatics department heads responsible for designing will focus on asking the heads and staff whether they anticipated the issues they experienced and whether the issues are caused by deficiencies in design or implementation elements.

This also goes for what they have done to address the issue, its effectiveness and why the problems identified still notable. The consultation will be made with an independent EHR/informatics expert to help in cross-examining the information derived to the information given by the expert to avoid the inclination to biased information from the facility. Also, observations will also be made and interview conducted with those attending to health needs of the PTSD and Diabetic patients to identify the difficulties they face in using the current database and their effect on care. This groups will be required to answer questions, such as “what are the problems you experience with the database when delivering care/track PTSD with suicidal tendencies and recording information that could help prevent diabetes?” and “how do these problems affect care and how do you think the problems could be addressed?”

Minimizing Workflow Disruption

To minimize workflow disruption, I will become an undercover which is typical of being a hidden participant observer. Considering that I work in the same facility, I will approach the facility manager, inform him about the research and request to be posted in the diabetic and then the PTSD department. While there, I will act as typical employees while the actual intention is observing and listening to employees discussions regarding the EHR system to identify workflow gaps causing the deficiencies noted (Davis-Ajami, Costa & Kulik, 2014)

Recording, Quantifying and Analyzing Data

Interviews, including those from the heads, the independent consultant and the staff members attending to the two specific groups identified will be one-on-one, thus recorded using audiotapes. Data from the design and implementation report/project will be entered into a notebook in summary form. On the other hand, observations will be entered in the journal each day, as crucial information emerges from observation to avoid forgetfulness. Data will be analyzed by making impressions of the data collected through observation (Malagon-Maldonado, 2014). Coding will be made to identify patterns (phrases, words, and means) that tell the differences and similarities in the interviews conducted and data collected through other means, such as observation, reading the design and implementation report and consulting the independent expert. Baseline metrics will be attained by going through the data collected to group similar patterns/meanings together and then assigning a code name to the meaning/data to normalize data found in different sources (Malagon-Maldonado, 2014).

Conclusion

In brief, the GAP analysis will be aligned to some of the Healthy People 2020 Objectives specific to the issues identified in the AHLTA workflow, such as objectives for prevention, and establishing clinical decision support for high-priority chronic illnesses. The primary focus on the gap analysis will be to identify the gap bridges in the workflow analysis related to the issues identified and understand the gap bridges to inform interventions to streamline workflow by eliminating the bridges (Vankipuram, Kahol, Cohen, & Patel, 2011). Data collection and recording will comprise of audiotaping interviews, noting observations through audio tapes and making summary notes from reports while data analysis will be done through coding (Malagon-Maldonado, 2014).

References

Centers for Medicare & Medicaid Services. (2013). Stage 2 eligible professional meaningful use core measures measure 12 of 17. Retrieved from https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_12_PreventiveCare.pdf

Davis-Ajami, M. L., Costa, L., & Kulik, S. (2014). Gap analysis: Synergies and opportunities for effective nursing leadership. Nursing Economics, (1), 17.