Five Guest Blog Posts On EHR and HIT Workflow, Usability, Safety, Interoperability and Population Health

@Chuck.. Great start…

Your definition succinctly covers the core elements of workflows.

“Workflow is a series of tasks, consuming resources, achieving goals.”

It tells us there is a natural sequencing (i.e series). It’s not likely there can be 10 best ways to do something.

It tells us that resources will be consumed and, reading between the lines, we can imagine these are scarce resources, so tasks typically need to be prioritized.

Finally, it tells us that there is no merit performing tasks (work) that do not contribute to the advancement of goals.

“Natural, Consistent, Relevant, Supportive and Flexible” is a little vague, but be a little more specific and we will code it for you.

Note that we will assist non-profits and “failed” projects at no charge or reduced rates depending on the scope of issues.

The often missed part of this whole process is to first map out the current processes…whether you are using an EHR or not.

Most private practices have reinvented the wheel, and maybe don’t have the most efficient processes, but they work just fine and they are comfortable with them.

Once an EHR is acquired, the practice sees the EHR vendor has created their own processes, so the practice either changes their processes or goes the customization route.

A lack of desire to change usually steers this route to customization. Once again, mapping out processes become a necessity.

There’s all sorts of tech to help map out processes, but really, what a private practice needs to do is map it out on index cards and lay it all out so they can see how smooth or convoluted things are.

There are multiple limitations including:
1) Programming
2) Organizing
3) Completion of project

Programming: no matter how simple a piece of software is made to be, there will generally need to be a person who is specially training to accomplish the programming

Organizing: until a practice understands the importance of organizing and mapping work flows, it will never get done.

Completion of project: How many websites are started by practices that never get completed? Everyone at a practice is busy, there generally isn’t time for yet another project…such as EHR customization.

All of these items scream for a specialist or consultant to see this type of project through to the end.

Guess who is terrible for this? The EHR vendor (if you care to know why, ask and I’ll tell you tomorrow).

Think about it…using the website analogy: it doesn’t get much easier than WordPress to built a website. Yet, so many offices don’t have someone that can do this. Maybe someone has a cousin who can help, but without any sort of organization to the process, it either looks completely amateur and/or never gets finished.

My overall life has been dedicated to workflow. One of the coolest applications I dealt with was from a Company called Optika, which had a neat workflow design tool that integrated programming and steps to come up with a great flexible solution.

To me workflow in the practice has been optimized over decades around the seeing of patients (Ambulatory Setting). This optimum workflow is achieved and then comes the main problem, EHR software. See the issue is the software is the exact opposite of good workflow, much of it is unusable, and talk about disruptive, have your internet go down and see how well your workflow is going with 40 patients in the lobby and 8 doctors screaming. The issue in workflow is that the software is being designed by developers and often hard coded (alluded to above) and very burdensome to change or use.

To me the issue is the EHR software itself needs to have a much needed change, but in reality with all the new requirements by the Government, really EHR use is anti-workflow at it’s core.

That is not all products, but so many are just copies of another. That being said, the 4GL tools are needed, like Oracles BPM (Business Process Management) tools. Oracle purchased Optika Workflow tools, but a few others obviously exists. For Workflow to be successful in practices BPM type tools will need to be invoked to allow end users control over workflow design changes/requirements for this industry to evolve.

That being said, in the meantime there is a great opportunity for consultants to sell workflow for leading software applications in the EHR space (vertical) that can fit a square peg in a round whole at least to the point that the practice can benefit from what they are required to purchase and use.

Chuck,

Specifically to answer your question:
Do you see any limitations in current abilities to customize EHR workflow?

As stated in post above, now flexibility by technology or consultant to do anything without being in this stiff box the EHR vendor has built. As also noted, technology is often so complex it requires to much time to use.

@ AXEO MED – I’m with you, but before you can program, you have to map out the processes. This is what drives people crazy. In the real world, you can swerve and change and have holes in processes, but still make it happen.

Computers require logic. Holes aren’t allowed. The specificity required to program a simple process (work flow) generally sends folks into a coma.

@ Brendon – like any small business, medical practices have reinvented the wheel many times. One of the draws of a franchise is they have mapped out all the processes for you ahead of time.
Very few medical offices have efficient work flows.
They have flows that work for them, and the people who’ve been with them for years, but they are generally not efficient, but good enough.
I’ve felt, but not proven, that most of the processes that come “stock” with an EHR are optimal in a perfect world. They generally would be good processes if an office was willing to completely change how they function.
Either way