. . .
eBooking:
The Background:
Patient Access Registry Tool (PART)
WHAT IS PART?
• A custom-built IT system and standardized methodology to capture information on all patients waiting for medical consultation and/or surgical services within Manitoba. WHY ARE WE IMPLEMENTING PART?
• To provide wait list/wait time information:
– To specialists & surgeons to manage patient waits
– To RHAs and facilities to manage capacity/resources/demand – To the health care system for service
planning/funding/evaluation
Current State of PART
• Implemented voluntarily in March 2007 – Dec 2009 in various areas
• Process for submission of OR data established with all RHAs and facilities
• OR data being received from 18 facilities throughout Manitoba
• Remote access solution for all offices outside of regional firewalls went live April 1, 2010
• MANDATED – January 2010
Process Before eBooking
Family Physician Surgeon’s Office Assistant Surgeon Patient PAC Slating 2 WeeksProvided by Heidi Adamko, WRHA PMO
Objectives of eBooking
• Collect comprehensive wait time information for WRHA elective surgery cases
• Provide standard process for booking request information transfer
• Improve transparency of case progress • Increase awareness of available slate time
What is eBooking?
• Integration of Patient Access Registry Tool with
an electronic booking request process
• Consists of:
– Electronic version of current paper booking form – Queue screen to track progress of booking form – Message board to post available scramble time
eBooking Process
PART eBooking Process
Slating Slating PAC PAC Surgeon’s Office Surgeon’s Office Submit eBooking form Press “Approve for Surgery” Surgery Review surgery package Fill in eBooking form Send surgery package Press “Ok to Slate” Schedule case Check off “Sent to PAC” Add patient to Waitlist
Provided by Heidi Adamko, WRHA PMO
Benefits of PART/eBooking –
Surgeon
• Immediate notification of open / scramble OR time
• Effortless population of demographics through interface to client registry
• Fingertip access to wait lists and wait time information • Reduction in non-value added work:
– by identifying clients waiting on multiple surgeons’ lists for the same procedure
– as less time is spent tracking and managing cases
– by reducing the number of slate changes and cancellations
Benefits of PART/eBooking –
Facility
• Ability to log PAC appointments
• Reduction of non-value added work:
– with fewer incomplete or illegible forms
– as less time is spent tracking and managing cases
– by reducing the number of slate changes and cancellations
• Timely receipt of required patient documentation
• Ability to view a complete surgeon’s slate to confirm slate utilization
• Provide accurate information for decision making and planning
Development and
Implementation
Planning
• Process engineer from Project Management Office (PMO) visited Winnipeg Regional Health Authority (WRHA) acute care facilities to map current business processes
• Steering committee was formed with representation from:
– Manitoba Health – Pilot sites
– WRHA Surgery Program and PMO
• PMO and Surgery Program developed a future state process map and defined basic requirements
Development
• Initial concept was created in collaboration with the Surgery Program
• Mock ups of the Scramble Time and Queue screens were created and reviewed
• System was built to accommodate both current and ideal business processes
• Development was iterative, with continuous consultation, allowing requirements to be refined
Pilot & Initial Implementation
• The pilot version was purposely designed with very few restrictions, to observe natural system usage
• Following the pilot, additional restrictions were put in place to ensure consistency
• Implementation revealed that some existing business processes were unnecessary, or needed to be revised • Ad hoc processes were discovered that required
Current State
• PART / eBooking implemented in 100% of WRHA Surgery Program offices and all in-scope facilities
– 7 acute care facilities (PAC & OR slating offices) – 179 surgeon offices in 12 specialty service areas
– 289 surgeon office and facility staff trained over 14 months
• PART / eBooking implemented in 90% of WRHA Women’s Health Program offices
• Revisions made to PART / eBooking in June 2011 based on user feedback
• Revisions underway to enable PART to support a hip and knee replacement central intake process
Implementation Plan
• Implement PART/eBooking to remaining WRHA surgery groups and facilities throughout 2011/12
– Plan being developed with Child Health Program
– Includes OR training, PAC clinic training and OR process redesigns
• Implement PART to WRHA medical specialties in 2012 • Continue to implement PART in remaining RHAs
throughout 2012/13
• Make further revisions to PART / eBooking based on user feedback
Lessons Learned from Pilot
& Evaluation
• Importance of end user engagement early in the process • Need for clear understanding and articulation of
requirements
• Value of trialing with few restrictions
• Importance of providing clear expectations to pilot users prior to requesting their involvement
• Importance of providing ongoing support via retraining and help desk
Challenges
• Access to surgeons for communication and training
• No consistent processes or technology, making it difficult to build to a system to accommodate all
• To find a rollout strategy that causes the least disruption to surgeons’ offices and facilities
Opportunities
• Comprehensive wait time information enables better access to care
• Advance notice of future demand
• Improved access to care through central intake
• Enable surgeons to schedule patients for surgery further in advance
• Interfaces with hospital OR systems / ADT systems • Interfaces with physician EMR or scheduling / billing
Acknowledgements
• Manitoba Health • Manitoba eHealth
• WRHA Surgery Program
• WRHA Project Management Office
