Describing and Modeling Workflow and Information Flow in Chronic Disease Care

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The purpose of this study was to follow three outpatient clinics who served patients with chronic diseases. It was conducted over 10 months to understand the methods to capture workflow and practices of these clinics in order to develop useful tools for documenting to increase efficiency and improve patient safety and outcomes. [1]


Data was obtained via direct observation, interviews, and workflow models of the clinics. Clinics selected in the study included: multiple sclerosis(MS), cystic fibrosis(CF), and diabetes mellitus(DM). Direct observation and interviews included watching computer use, and comments from clinical and non- clinical staff using the EHR. Some of the activities observed included: patient check in, diagnostic tests, prescribing, handoffs, patient check outs, and examinations.


Based on the analysis of observation data and interviews of workflow, information flow, and patient/provider interactions, researchers were able to develop a protocol for HIT development for care of patients with chronic diseases. The following guidelines were recommended:

  • Applications should be designed to support shared needs and behaviors in chronic disease care.
  • Applications should be designed to allow for customization for disease-specific needs.
  • Applications should allow customization to support the needs of different types of users.
  • New approaches for information input into the EHR should be explored.
  • Efficient transfer of data from medical devices into the EHR should be supported.
  • Information scanned into the system should be searchable, quickly viewable, and more accessible.
  • The EHR should be designed so that users are able to search through the EHR quickly and easily to filter out important information.
  • Alternate methods of displaying the longitudinal data for individual patients should be investigated to determine if they assist in the cognitive processing of electronic data.
  • New tools and processes should be as efficient as existing approaches or yield significant benefits to users to promote adoption.
  • The reasons behind organizational and personal resistance to technology should be addressed to promote adoption.


This study used direct observation, interviews, workflow, and information flow of three outpatient clinics caring for patients with chronic conditions. Both clinical and non-clinical personnel were studied. This study resulted in the development of HIT guidelines for EHR documentation for patients with chronic diseases.


The guidelines developed are important for an effective flow of patient care in chronic care clinics and HIT design for clinical documentation. I believe that observation and interviews are vital in really seeing what the clinicians and support staff have to do to provide patient care in an efficient, caring, and complete manner.


  1. Unertl, 2009. Describing and Modeling Workflow and Information Flow in Chronic Disease Care