Case report: activity diagrams for integrating electronic prescribing tools into clinical workflow

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Increasing Adoption of E-prescribing Through Integration In to Clinical Workflow

E-prescribing is used to improve patient safety, increase clinical workflow efficiency, and reduce the overall cost of healthcare delivery. Although there are huge benefits cited, there are a number of studies which document issues related to clinical workflow disruption resulting in decreased adoption of the electronic prescribing. To facilitate the future implementation of an e- prescribing system, researchers in Tennessee developed activity diagrams to represent sequence of steps to complete a prescription after interviewing a convenience sample of 19 providers (nurses and MD’s) with questions focusing on who performed what aspects of prescribing, how often, in what context and in what order. The diagrams covered only outpatient prescribing for patients during a clinic visit and between clinic visits. With the aid of these diagrams, the e-prescribing development team at Tennessee fundamentally changed its prototypic application to better reflect (and support) workflows discovered for paper- based prescribing. The activity diagrams also provided the researchers with unexpected answers to some questions that had arisen early in the e- prescription application development phase.

Comments: Before such an application can have a great impact, it must be integrated with the electronic medical record so as to allow the medical history information available from EHR system to be readily available in the course of performing routine clinical activity. To be successful, e-prescribing must be integrated into the clinical workflow of a physician’s practice or the failure to recognize the realities of the manual process could drastically compromise the adoption when the system is implemented. Implementing an e-prescribing solution can also be viewed as an opportunity for process re-engineering. As a pre-requisite for successful e-prescribing implementation, organizations should analyze their existing workflows .During this process, each component of e-prescribing should be categorized as either a value-added task (e.g., a physician choosing appropriate medication) or a non-value-added task (e.g., faxing a script to the pharmacy). As suggested by the authors, these diagrams can also be used as templates upon which other functional capabilities can be modeled. Purvi Mehta