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What is Workflow

Workflow refers to the flow of work through space and time, encompassing activities, tools, and processes necessary for producing or modifying work, particularly in healthcare settings. It includes both clinical and administrative tasks and can occur at various levels, such as inter-organizational or intra-visit workflows. Understanding the details of workflows is essential for effective implementation of health IT systems.

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0 views

What is Workflow

Workflow refers to the flow of work through space and time, encompassing activities, tools, and processes necessary for producing or modifying work, particularly in healthcare settings. It includes both clinical and administrative tasks and can occur at various levels, such as inter-organizational or intra-visit workflows. Understanding the details of workflows is essential for effective implementation of health IT systems.

Uploaded by

beth hamill
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPT, PDF, TXT or read online on Scribd
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What is Workflow?

Defining workflow
• Definitions of workflow vary. Here are a
couple:
– The flow of work through space and time, where work
is comprised of three components: inputs are
transformed into outputs.[1]
– The activities, tools, and processes needed to
produce or modify work, products, or services. More
specifically, clinical workflow encompasses all of the
1) activities, 2) technologies, 3) environments, 4)
people, and 5) organizations engaged in providing
and promoting health care.[2]
What does that really mean?
• That means that workflow is the who,
what, where, when and how things get
done in your clinic. This includes both
clinical and administrative work.

• Doing a poor job analyzing your workflows


can lead to misleading conclusions.
Examples of clinic workflows
Those with * come from: http://healthit.ahrq.gov/portal/server.pt/document/897942/tool_-_know_your_processes_pdf

• Answering Phones*
– Flows for different types of phone calls
• Appointment System*
– Flows for new vs. existing vs. continuity vs. non-continuity patients
• Messaging*
– To different types of staff and for different reasons
• Scheduling Procedures*
– Flows for new vs. existing vs. continuity vs. non-continuity patients
• Order Diagnostic Testing*
– Flows for different kinds of tests
• Reporting Diagnostic Test Results*
– Flows for different kinds of tests or normal vs. abnormal
• Ordering medications, including
– Prescription Renewal*
• Making Referrals*
• Billing/Coding*
• New Patient Work-ups*
• Chronic Disease Management*
• Receiving and processing patient information from outside providers
• Confirming insurance or pay status
2
Detailed 1

flowcharts
• Here are two flow charts
showing the workflow of
“patient check-in”.
• Both figures are accurate
descriptions of the same
process at a particular clinic.
• But, only the figure on the
right (2) shows the details of
what the workflow really is.
• It is the details that will
change when you implement
health IT.
• If you don’t understand the
details, you cannot plan for
the changes that will come.
Is workflow just the sequence of
steps of a process?
• Not exactly.

• Workflow is the sequence of:


– physical and/or
– mental tasks performed by various people
– over time and through space.
• It can occur at different and/or multiple levels (e.g., one
person, between people, across organizations)
• It can occur sequentially and/or simultaneously
Work flows in different ways
• Inter-organizational workflow:
– Workflow between a primary care physician and a
community pharmacy, or
– between an emergency department physician and a
primary care physician to share information about a
patient.

• Clinic-level workflow:
– Flow of a physician, nurse or patient through physical
space, and
– the flow of information, in paper or electronic formats,
among people at a practice or clinic.
Work flows in different ways
• Intra-visit workflow:
– Workflow during a patient visit, which involves the
workflow of the visit (e.g. start by asking for a problem
list, then do history and physical, then prescribe
treatment)

• Cognitive workflow – the workflow in the mind:


– Sensation, perception, decisionmaking, and response
execution
– A clinician might be thinking: “listen for any significant
acute problems and deal with those first. Also,
investigate my concern about spousal abuse. If I don’t
hear any, focus on the chronic problems.”
– This is unlikely to be observable.
A more detailed example:
Medication orders
• Consider the workflow of ordering a medication.
• Without e-prescribing, the workflow might involve a
provider with prescribing privileges writing a prescription
on a prescription pad, signing it, and handing it to the
patient.
Medication orders:
e-Prescribing
• Implementing e-prescribing changes the mental and physical steps
of the process, as well as the order of steps and the organizations
involved.
– Providers have to log into the system, remembering a password.
– They have to access the record of the particular patient, which
involves a series of physical steps using the mouse and/or
keyboard.
– They have to execute mental steps
of searching for the correct
information and locating the correct
medications and pharmacy.
– Both the provider and patient need
to know the pharmacy where the
patient will pick up the medication.
Workflow: simple and complex
• As you can see, what seems like a simple
workflow for “ordering a medication,” in
fact involves
– multiple physical and mental steps, and
– several people working in different locations.

• These are the details you will need to


consider when implementing health IT.
To summarize:
• Workflow is
– People flowing through space and time.
– Information flowing through space and time in
paper and electronic formats.
– Objects, such as medications, flowing through
space and time.

• The flow of all of these information,


people, and products are necessary to
consider when designing health IT to
support workflow.
References
1. Carayon P, Karsh, BT. Workflow toolkit and
lessons in user-centered design. Paper presented
at the AHRQ Annual Health IT Grantee and
Contractor Meeting; 2010 June 2-4; Washington,
DC.
2. Niazkhani Z, van der Sijs H, Pirnejad H, Redekop
W, Aarts J. Same system, different outcomes:
Comparing the transitions from two paper-based
systems to the same computerized physician
order entry system. International Journal of
Medical Informatics 2009; 78(3): 170-181.

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