Clinical workflow analysis

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Clinical Workflow Analysis


Introduction:

The term workflow has been variably defined (1). Workflow could be defined as a sequence of cognitive and physical tasks listed chronologically that occur both within and between organizations that are required to accomplish a specific work objective. When applied to the clinical setting the above definition generally holds true, with the work objective being a direct or indirect patient care function. An example of a clinical workflow, seen in the example presentation below, is ordering lab tests on an outpatient during a routine appointment.


Importance of Clinical Workflow to Health IT:

While clinical workflow has always been an essential factor in the delivery of health care it has taken on increased importance with the introduction of digital clinical information systems (CIS), including CPOE and electronic health record systems, over the past few decades. Workflow integration with health IT systems is seen as critical to their successful implementation and end user acceptance (2). Poor CIS integration into clinical workflows are likely to negatively impact efficiency of care delivery, overall quality of care, and provider satisfaction with the work experience, all of which are generally accepted aims of health care delivery organizations (3).


Framework for Clinical Workflow Analysis:

Useful analysis of clinical workflows requires a multidisciplinary approach. In addition to understanding of the specific cognitive and physical tasks required to fulfill the clinical objective under analysis, the workflow is impacted directly by organizational factors and culture, specific technical details of associated information systems, and human cognitive processes (4). End user participation is seen as essential to robust workflow analysis, in the case of clinical workflows this includes those representing physicians/advanced practitioners, nurses, and administrative staff in the analysis depending on the specific workflow under scrutiny.


Tools:

A variety of tools are available to aid in the analysis of clinical workflows. The website of the Agency for Healthcare Research and Quality (AHRQ) contains one repository of tools useful in clinical workflow analysis (5). Some of the tools commonly used in clinical workflow analysis and redesign are:


1) Benchmarking: The process of evaluating best practices of other organizations. This requires communicating with peers in similar organizations that are seen as successful in the objective being analyzed and determining whether these lessons can be applied to the workflow under consideration (6).


2) Check Sheet: A structured form for analyzing data about a specific work process or function (7). It is useful for documenting observational data about specific tasks in a workflow. Referenced is an example of a workflow assessment checklist provided by AHRQ (8).


3) Flowchart or Process Map: Flowcharts visually demonstrate specific steps in a work process arranged in sequential order. This allows understanding of the overall process and where improvement can be made (9). Referenced is an example flowchart of a medication prescribing workflow offered by AHRQ (10).



Example of Clinical Workflow Analysis:

An example of workflow analysis and redesign around implementation of an EHR is offered by ONC (11). This presentation discusses multiple clinical workflows in an outpatient medical practice and provides editable flowcharts for use as templates.


References:

1) Unertl, K et al. J Am Med Inform Assoc. 2010 May-Jun;17(3):265-73

2) Harrington L. Electronic health record workflow: why more work than flow? AACN Adv Crit Care. 2015 Jan-Mar;26(1):5-9.

3) Bowens FM, Frye PA, Jones WA. Health information technology: integration of clinical workflow into meaningful use of electronic health records. Perspect Health Inf Manag. 2010 Oct 1;7:1d.

4) Sheehan, B and Bakken, s. Approaches to workflow analysis in healthcare settings. Nurs Inform. 2012; 2012: 371

5) https://healthit.ahrq.gov/health-it-tools-and-resources/evaluation-resources/workflow-assessment-health-it-toolkit

6) http://asq.org/learn-about-quality/benchmarking/overview/overview.html

7) http://asq.org/learn-about-quality/data-collection-analysis-tools/overview/check-sheet.html

8) https://healthit.ahrq.gov/sites/default/files/docs/workflowtoolkit/Workflow_Assessment_Checklist.pdf

9) http://asq.org/learn-about-quality/process-analysis-tools/overview/flowchart.html

10) https://healthit.ahrq.gov/sites/default/files/docs/workflowtoolkit/In-officePrescribing-PaperSystem.pdf

11) https://www.healthit.gov/sites/default/files/tools/workflow_redesign_templates_v1.pptx



Submitted by Frank Longano.