1. Make the Complex Simple…
The Healthcare
Knowledge Map
…and Break Down the Silo’s
David Shiple,
Practice Leader, Advisory Services

2. Solving The Healthcare Knowledge Gap
The Problem
» Healthcare professionals often work and think “in silo’s”, but
increasingly need to solve enterprise-wide problems
» Seasoned hospital professionals with a comprehensive
understanding of hospital processes typically acquired this
knowledge after decades of hospital experience
» New professionals coming into the field must quickly gain the
same understanding as industry veterans in a period of hyper-
change, and
› Knowledge of only a single hospital “silo” is no longer an option
› Knowledge and credibility in clinical areas is a critical success factor
› Every process change can have an unintended cascading effect
within a health system

3. Solving The Healthcare Knowledge Gap
The Solution
» How do we quickly help healthcare service professionals
get their arms around the complex flow of a health
system?
» It would be nice if the major health system processes
could be put into one, visually compelling map
» It would be nice… and it’s been done.

4. People Learn Best by Seeing …
We use large graphical models for rapid understanding … and to get everyone on
the same page (i.e. confirming the “current state”)
“… if I can get
everything
onto one
page, I can get
mental control
over it..” -
Workshop
Participant

5. Understanding Correlations Among Workflows
Once people can get the whole problem on a “workbench”, correlating workflows
and planning enterprise-wide changes can begin
“ .. For the first time,
managers from each
discipline felt their
colleagues had a good
understanding of their
business models,
workflow, and issues…”
- Workshop Participant

6. Sample Knowledge Map Sections
Detailed is carefully balanced: enough detail to make information meaningful, but
not too much information that would make the model unusable

7. How is the Knowledge Map Organized?
The data points are color-coded to highlight key workflow steps, technology
enablers, and commentary on current issues of adoption, ROI, etc.
Workflow Step Technology Enabler Commentary
Example from the physician’s workflow:
Technology Enabler Commentary
Workflow Step

8. How is the Knowledge Map Organized? (cont’d)
Pictures, metrics tables, and reference material is embedded into the map to
further drive accelerated understanding of the health system.
Images help students to
develop a rich “mental
Performance Indicators Benchmark
map” of the health system;
LOS for Treat & Release 90 min
the one on the left is from
the O.R. workflow LOS for Admitted Patients 240 min
Left Without Being Seen < 1%
AMA 1%
% of time on Diversion < 1%
Triage Start to Triage End 5-7 min
Triage End to Registration Start < 10 min
The reference section of the model contains commonly used Registration Start to Registration End 3-5 min
statistics, best practices criteria, and other Knowledge Registration End to Placed in Treatment Room < 20 min
information which is commonly accessed by users of the Arrival to First RN Encounter 10 min
model Arrival to First MD Encounter 30 min
First MD Encounter to Disposition Order Written 60 – 75 min
The HIMSS 8-Stage EMR Maturity Model
Disposition Order Written to time Patient Left the ED 15 min (discharged pt)
Stage 7 - Medical records are fully electronic; hospital is able to contribute continuity of care document as 30 min (admitted pt)
byproduct of EMR; data warehousing in use
Stage 6 – Physician documentation in structured templates; full clinical decision support system in use; full
radiologic and PACS in use
Stage 5 – Closed loop medication administration that addresses every step of medication use process Metrics help professionals understand how a given
Stage 4 – Computerized physician order entry system in use; clinical decision support system in use for
clinical protocols workflow is measured and what is seen as important -
Stage 3 – Clinical documentation, clinical decision support system in use for error checking, PACS in use the table above is from the E.R. workflow
outside of radiology
Stage 2 – Clinical data repository, controlled medical vocabulary, clinical decision support system; may have
document imaging
Stage 1 – Ancillaries (lab, radiology, pharmacy) are installed
Stage 0 – None of the ancillaries are installed

9. How is the Knowledge Map Organized? (cont’d)
Physician
The patient experience underlies the entire model
Office
Acute Care Hospital
Nurse
Med/
ICU
Surg Nurse/ Physician
Interaction
Physician
Knowledge Material
Emergency Dept.
36”
Operating Room
Meaningful Use EMR 8-Stage
Revenue Cycle
Criteria Model
Pharmacy
Radiology
Lab
CMS Core Health System
Measures KPIs
• The model prints as a 36” x 48” color poster
• The model contains roughly 200 workflow points
• Other workflow modules are available that can be
48” “swapped in”: Supply Chain, Cardiology, Oncology,
etc.

10. Who Needs the Big Picture?
Health system IT professionals I need to solve
my problem
IT vendor professionals
Board Members
Silo
Quality/ Safety Directors
Marketing Professionals
First year MHA & MPH students
Lean Sigma Practitioners
- OR -
Ancillary Managers
Nurse Managers
Let’s solve our
CMIO’s
problems
Admitting Dept. Managers
Revenue Cycle Managers Health
System
Facilities Managers
Performance Improvement
Professionals

11. Used for Rapid Knowledge Infusion
» Part of on-boarding or level-setting process for
people new to the industry or new to an enterprise-
wide project
» Low-cost, 4-hour course to give participants an
operational/ technology overview of a typical
“ Our managers
healthcare system using the Knowledge Map have dubbed the
» Each student receives a full-sized Knowledge Map program, ‘death
to the silos’…”
to own, and to use during instruction - HR Director
» Short competency exam is given at conclusion of
the course
» “Introduction to Hospital Operations” certification
is given to each passing student
» Students are encouraged to display the Knowledge
Map in their office or hallway and internalize it over
time

12. Used as a Performance Improvement Tool
» Provides a compelling “one-stop-shopping”
visual for illustrating the current and future
states of enterprise improvements, e.g. “ .. People ask what
the future state will
» Reducing average length of stay look like…I say, ‘stop
by my office – it’s
» Increasing patient throughput hanging on my wall’ ”
» Establishing EHR meaningful use - Lean Sigma Project
Manager
» Provides a “workbench” for process change
teams to brainstorm, form cross-silo
correlations, and form a high-level future map
» Maps are easily modified and are inexpensive

13. The Value
» Substitutes for 100’s of pages of text or slides (that never gets
read and does not lend itself to building an integrated mental
map)
» Provides a map that can be gradually internalized on the wall
of an office or cube
» Helps bridges the communication gap between the various
actors in the operation of a hospital – in days or weeks, not
months and years
» Gives all players in the healthcare system an appreciation for
the complexity of care delivery and challenges facing each
player
» Visually compelling - people are drawn to large diagrams
describing their line of work

14. Making a Difference in Healthcare
» A Knowledge Map that includes the full workflow scope of
the acute care hospital and physician office setting has not
existed until now
» Legions of people work in the “ecosystem” of healthcare –
can we afford each to have only a piecemeal understanding?
» The Knowledge Map can be easily customized for:
» A specific hospital or health system
» A set of technologies specific to a vendor
» Emphasis on particular workflows (e.g. revenue cycle and supply
chain)
» The Knowledge Map is a powerful tool used during on-
boarding, weekend workshops, certification programs,
retreats, and performance improvement projects

15. Healthcare Knowledge Map 2.0
DIVURGENT has begun integrating the knowledge content into a
leading workflow tool to create a “living model”
» Filter slide control gradually move user from high-level to
detailed views
» Zoom in and out of model for greater/ lesser detail
» Workflows can be added/ changed easily
» Workflow widgets (IT enablers, actors, illustrations) can be
picked from palettes
» Mouse-over workflow item to display IT enablers, metrics,
issues, etc
» Healthcare Knowledge Map 2.0 is planned for early 2012