It’s Not Easy Being Lean, But Scripting Can Help

An integrated healthcare network of 26 hospitals using 14 different databases to support patient data gets serious about streamlined workflow and efficiency.

In this millennium, all healthcare organizations are challenged to be as safe, thorough, productive, cost-effective, efficient and accurate as possible. That’s a tall order, and while most healthcare organizations strive to achieve the goal, how they get there can differ dramatically from one organization to the next.

An integrated healthcare network of 26 hospitals using 14 different databases to support patient data gets serious about streamlined workflow and efficiency.

Avera Health, a network of hospitals, nursing homes, clinics and related health services at 215 locations, serves the people of eastern South Dakota and surrounding states. We are a very progressive hospital system and pride ourselves on providing the best possible services to our patients.

In 2004, we initiated a systemwide “lean” project. Many people are familiar with “Lean Processing,” an operational strategy famously used by companies such as Toyota to streamline business. Lean processing is based on the idea of optimizing time, human resources, assets and productivity—and it certainly is not limited to automobile manufacturing.

The result of this focus on business process is better products and services for customers. At Avera Health, we had long been focused on process improvement in order to meet high standards for patient care, and we felt that it was time to take the lean approach to healthcare.

Lean by Any Other Name Is Still Lean
By applying the concepts of lean processing, we realized that workflow throughout the hospital network would see the benefits of simple automation. Bringing on outside consultants to help guide the lean process, we identified key people in departments that would be responsible for the lean initiative in that department. Those people were then directly accountable for seeing the project through.

Initially, the lean mentality took some getting used to, but as people across the organization began to brainstorm ways to make things happen, the trend started to catch on. The thing that really started a fire under our lean initiative was the involved role our management team took. Their enthusiasm for improving the hospital by streamlining many of our processes was contagious; it got everyone at the hospital thinking about ways in which their own departments could be involved.

In the IT department, we began to realize that although the term “lean” was new to the hospital, the projects it entailed were not. In fact, we had been using a workflow automation tool, Boston WorkStation from Boston Software Systems, for nearly 10 years to make many of our manual processes lean, although we hadn’t applied the terminology until recently.

Growing Pains
In addition to the 490-bed hospital, the Avera McKennan campus includes the Avera Cancer Institute, the Orthopedic Institute, the Center for Family Medicine, McGreevy Clinic Avera and the Sioux Falls Surgical Center. As the presumed Y2K disaster approached, many small area hospitals feared what would happen to their IT systems, and were seeking to join larger hospitals to take advantage of their superior IT infrastructure.

In 1996, Avera McKennan adopted its first smaller outreach hospital. This began a period of rapid growth for our hospital system, which soon came to support 26 different hospitals with 14 different databases of patient and hospital records. The growth was exciting, but it led to some major problems for our IT team.

The old database systems the acquired hospitals were using were difficult to work with, and it was hard to extract information in more than flat file format. For example, the Master Patient Index needed to be updated with basic patient information. We had to quickly convert the records of all these small hospitals into our own MEDITECH system.

It was an intimidating project with three possible solutions. We could hire an outside company to convert the data. This carried a potential cost of up to $80,000, which was more than we had available. Alternatively, we could assign our own staff to manually key-punch the data, a process that would take months to accomplish. Our IT staff realized that if we could automate the conversion of this data, it could save a great deal of money and get the new patients into the system faster and more accurately than by doing it manually.

The most cost- and time-efficient solution to automate the conversion was to use scripting. We tested a couple of different scripting tools to download, clean and move the data from each of the individual hospitals, and selected a tool from MicroScript, which was shortly updated to its current form, Boston WorkStation—and we succeeded. The script enabled us to move one hospital’s 10,000 complete demographic profiles in only two days. The script was able to create those patients’ medical record numbers to MEDITECH without errors in about a half an hour. Following on this great success, we continued to find opportunities to use scripting in a number of ways.

Lean Is a Mindset
Once Avera Health became involved with the lean initiative, we realized that Boston WorkStation would be a key component for our success. Across the hospital, the potential to save time and eliminate waste with scripting was enormous. For example, every year the hospital must discharge recurring accounts in order to balance the books. On a patient-by-patient basis we manually discharge these 1,200 to 1,300 recurring accounts, so that the series patients they refer to don’t hold up billing.

The process used to take upward of 16 man-hours, but with scripting, we can do it in one hour. Similarly, we use scripting to manage our daily 835 batches that come through from Medicare. An 835 is the electronic version of remittance advice from Medicare, and we can use scripting to electronically post those payments and adjustments. By automating this process with Boston WorkStation, keying errors go away. What used to be a 4- to 8-hour process now takes minutes.

Just as the lean initiative spans the hospital, we have used Boston WorkStation to facilitate our “lean project” project throughout all facets of the hospital. It operates with all of our systems, not just with MEDITECH, but also with Misys, and Windows-based and Web-based programs. We currently have projects underway in our labs, the ER, housekeeping, surgery, pharmacy and radiology.

In terms of managing patient records in our Health Information Management (HIM) department, we have seen a 28 percent improvement in the speed of filing loose reports, an 88 percent improvement in getting inpatient charts down to HIM from the clinical practices, and a 90 percent improvement in chart teardown and transport through HIM. These numbers are significant because the HIM department can’t assemble a chart until all these pieces are in place. This means that billing is slowed down. Our use of Boston WorkStation has decreased turnaround in coding for the outpatient area from 25 days to seven days, with our ultimate goal being five days. This gets bills out the door faster, which is an enormous improvement as speeding the revenue cycle is an ever-present challenge for our hospital.

Also, we have recently embarked on a major, 5-year project with Boston WorkStation, converting 26 hospitals and 60 clinics from the MEDITECH’s Magic platform onto the MEDITECH Client/Server platform for all facilities. This project incorporates the implementation of LSS data systems. While MEDITECH handles a lot of the converting, we also will rely on Boston WorkStation to fill in the gaps.

Essentially, lean thinking has permeated our organization, and the IT department can use scripting technology to support many other departments that participate in lean management. Here in the IT department, we don’t always have a good sense of the daily processes in any given hospital department. This is why we rely on the staff in those departments to come to us once they realize what scripting can do and how they can use it. The expanse of our lean project is limited only by the imagination of our staff.

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Ross Stolle (left) is an integration engineer, and David Parrott is a project leader, at Avera Health, headquartered in Sioux Falls, S.D.