Using Technology to Eliminate Waste

While lean advocates are sometimes suspicious of technology, I am a believer in the idea that IT can be an enabler of lean. IT, of course, does not by itself improve processes, and it is almost always better to work on the processes first. But technology is necessary to any business, and IT – properly used – can be a part of a lean strategy.

One person who understands this is Dr. John Halamka, chief information officer of the CareGroup Health System as well as CIO and dean for technology at Harvard Medical School. He writes an excellent blog, “Life as a Healthcare CIO.”

In a
recent posting, Dr. Halamka talked about progress in the year since his organization went live with electronic prescriptions, in an effort through a statewide health information exchange collaboration of payers and providers.

To his credit, he notes that his group did much more than simply adopt new technology when implementing the initiative.

We had to redefine workflows, cleanup old prescription data and refine the our existing applications to adapt to the new features of e-Prescribing (eligibility checking, formulary enforcement, medication history display and prescription routing).

More to the point, he describes some results after one year.

1. Prior to full implementation of e-prescribing, Medical Assistant call-in of prescriptions averaged 350 prescriptions per day. We've reduced this to 80/day and we'll further reduce this to 30/day by next month when all residents go live with e-Prescribing.

2. Each call-in averages 4 minutes per prescription and this equals 23 hours or 3 FTE worth of work per day, approximately $96,000.00 of salary. This has been reduced to 0.66 FTE of Medical Assistant work per day or $21,000.00 salary.

3. The Medical Assistant staff are now available to more consistently perform the core work required to support the patients, providers, and practice. In the past, the lack of control over the daily volume of prescriptions resulted in unpredictable exam room support.

4. We experienced significant improvement in efficiency and patient satisfaction in the time for prescriptions to reach the pharmacy. With e-prescribing,rxs travel quickly to pharmacies verses up to 2 days for the rx to be called to the pharmacy.

5. We have also seen a decrease in medication errors, in terms of wrong patient, wrong medication, wrong dose since e-prescribing has decreased the potential for "communication errors."

Here we see elimination of wasted time, elimination of opportunities for errors, improvement in quality (accuracy), and improved customer (patient) satisfaction. And that is in addition to better use of staff resources. These are all the kinds of results that ought to come from a lean initiative.

This should serve as a model for other organizations, both in healthcare and in other industries.


Brian said...

Great post. I come from a technology company so I always see how it can reduce waste and add poka-yoke.

The specific examples you provide will help lean practitioners have a frame of reference for positive use of tech.

Ian Furst http://www.waittimes.blogspot.com said...

You have hit the nail on the head Ralph. In healthcare, a poor RIO is often accepted with the mandate to improve quality. What's often overlooked is the lean aspect of IT initatives. Velocity of service is a direct correlate to quality of service in patient's eyes. (and why wait times are at the top of most patient lists when judging service). EMR is a great example where the process can be severely disrupted. The other day I was speaking to a family physician who had recently switched to EMR - when I asked her how she coped with busy days she responded "oh - i just don't chart". When process flow is carefully accounted for in an IT role-out it works great, if not it's an uphill battle.