QA Process Often Relies on Ingenious Work-Arounds

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Karen Utterback By Karen Utterback 
Former Vice President, Product Marketing and Strategy, McKesson (Retired)

Home Health DocumentationMonique Lambert gets paid to study people. And she’s discovered that QA staff at agencies spend an inordinate amount of time trying to complete home health documentation.

Lambert is a medical ethnographer and investigator with the David Druker Center for Health Systems Innovation at the Palo Alto Medical Foundation. She previously worked at Intel, including five years in the company’s digital health group. In that capacity, she collaborated with McKesson on inpatient nursing initiatives.

When we were looking for someone to study impact that the new clinical management functionality of McKesson Homecare™ home health software could have on agencies who implement it, we chose Lambert to help us examine the QA processes.

“An ethnographer is someone who studies people and practices in their natural context from a holistic point of view,” explains Lambert. “We go where they go and observe directly.”

She has conducted baseline studies of the QA process, studying the habits of QA workers at two agencies before they implemented McKesson Homecare v13.0. A later study will compare the baseline post-implementation.

Lambert found that creating the Medical Plan of Treatment (485) documentation often required a flurry of emails and texts back and forth between QA and field staff to answer questions and fill gaps in the care plan. She also found that turnaround time for texts between QA and field staff was faster than with email.

“On the QA side, the most significant thing I’ve observed is a lot of dependence on external email systems,” Lambert says. “QA staff that I’ve observed have devised some amazing ‘home-grown’ work processes. In the current work practice, however, there’s often a lot of manual checking and other workflow processes that create room for inadvertent errors, omissions and schedule oversights.”

Next up: A look at field staff.

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