Process Modelling of a large Family Medicine Teaching Facility

In previously reported work, the Health Informatics for Research, Education and Service (HiRES) team at St. Mary's Hospital Center (SMHC) presented the design for an electronic medical record (EMR) that would address the unsatisfied needs of the teaching, research and service mandates of the post graduate residency program. The design takes an existing commercial EMR product and adapts it to the needs of SMHC. The technology, in the context of a research project, is being developed through the integration of medical practice expertise and systems engineering methodologies. The first step in this integration involved the development of a formal process model of the Hospital’s Family Medicine Centre (FMC) within McGill University’s Family Medicine, using the US Air Force IDEF0 methodology. The process modelling was undertaken to establish the baseline set of processes by which the FMC services the community, teaches its residents and medical students and researches into primary care as required by SMHC’s ‘université affilié’ status. Detailed interviews were conducted with a cross section of medical, nursing and support staff in key positions. The information gathered was then compiled into a collection of over forty models dealing with the entire breadth of activities of the FMC. The models were validated through follow-up interviews and presentation to the FMC at large during Grand Rounds. The collection of models (the Model), is the first known example of the processes of a Canadian family medicine unit being represented in a systems engineering form. The Model has provided the team with a benchmark metric for evaluating the relative merits of various process optimization proposals. Using the Model, it is possible to determine the effect any given optimization or group of optimizations would have on operational parameters including staffing, patient interaction time (support staff versus actual treatment) and information flow. The Model will play a key role in characterizing, both qualitatively and quantitatively, the environment in which a ‘computable’ patient record (CPR) is to be implemented. This is the next step in the HiRES team’s investigation of the three mandates of the clinical teaching