Using tech to fill gaps: A process-centric framework for change

In 2011, the University of Louisville (Ky.) Hospital sought to implement strategies to eliminate operational waste and improve overall efficiencies. The hospital decided to focus on nursing and pharmacy to find ways to quicken the process of sending orders to the pharmacy and then getting the medications back to the patient.

In analyzing their processes, University of Louisville Hospital emphasized their decentralized (floor-based) pharmacy services. Peggy Brashear, manager of pharmacy informatics operations and automation at the hospital, says orders were coming into the pharmacy from four different pathways, creating a backlog. Also, processing of handwritten notes on orders at times caused confusion and inconsistencies.

Hospital leadership decided to center its approach on narrowing the number of pathways to the pharmacy to increase efficiency and better manage paper records in the pharmacy. To do so, they called upon a long-time hospital partner Ricoh, a global information management company, to assist in the evaluation of its pharmacy order process. Ricoh evaluated relevant software solutions which provided the hospital with the best fit-to-capabilities based on their desired clinical and business outcomes.

In 2011, the University of Louisville Hospital began using DocuScripts, an automated medication orders communication and processing system. Now, medication orders are scanned on a Ricoh multifunction printer and electronically delivered to a pharmacy work queue, with appropriate priority indicated. Additionally, the pharmacy team implemented a key for clinicians to follow when processing handwritten orders to help ensure clarity and accuracy.

David Winkler, global leader, healthcare vertical at Ricoh, says this was key to developing a successful strategy: analyzing processes first and then identifying gaps to be filled with solutions.

"Focus on the process first. There is infrastructure and technology that can be leveraged, and then there are some gaps. That's where we filled the gaps with DocuScripts," Mr. Winkler says. "The key was the partnership relationship, and the agreement from the beginning to be process-centric."

Ms. Brashear agrees, saying focusing on the process helped ensure a smooth transition, especially when working with multiple vendors.

"Anytime you're using a primary to secondary vendor, it gets askew, but [for us] it was like an equilateral triangle," Ms. Brashear says. "No confusion, no complaints. It was an equal partnership."

The new strategy, using a health information software system in tandem with scanned paper medication orders, has worked well for the hospital. Ms. Brashear says communication has improved and there is greater visibility around medication orders.

The key to University of Louisville Hospital's success, according to Ms. Brashear, is the relationship and partnership between the hospital and Ricoh.

Mr. Winkler agrees and adds the importance of analyzing processes before considering technology should not be overlooked.

"Using a healthcare metaphor, if you're going to have a procedure done, do you want to have exploratory surgery or the work done up front to assess and make it as minimally invasive as possible?" Mr. Winkler says. "It's a process-centric approach first, and the fact there was that commitment and willingness from both parties made this process successful."

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