Configuring Electronic Health Records Patient Care Clinical Workflow

Configuring Electronic Health Records Patient Care Clinical Workflow; Multiple Perspectives of Patient Care This material (Comp 11 Unit 2) was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 90 WT 0001. This work is licensed under the Creative Commons Attribution-Non. Commercial-Share. Alike 4. 0 International License. To view a copy of this license, visit http: //creativecommons. org/licenses/by-nc-sa/4. 0/.

Patient Care Clinical Workflow; Multiple Perspectives of Patient Care Learning Objectives - 1 • Enter a progress note as a Physician in a Vist. A simulation EHR environment. (Lab Exercise 1) • Enter nursing notes and implement physician orders as a Registered Nurse in a Vist. A simulation EHR environment. (Lab Exercise 2) 2

Patient Care Clinical Workflow; Multiple Perspectives of Patient Care Learning Objectives - 2 • Understand the importance of clinical workflows in the functioning of EHRs. (Lecture, Lab Exercises 1 and 2) 3

What is A Workflow And Why Are They Useful? • • • Sequence of events Series of tasks that produce an outcome Establish a procedure or process Delineate flow of activities Improve efficiency of work activities – Optimize system efficiency – Improve patient care – Enhance patient safety – Recoup measurable cost savings 4

Workflows In The Clinical Environment • Typically clinicians do not think of the workflow as they are taking care of patients • Clinical workflows are often complex • Clinical workflows are dependent on the setting, on the clinician as well as the patient 5

Examples Of Clinical Workflows • Clinical workflows may be very different in different settings – In a doctor’s office: Patient greeted at front desk and registered o Taken to exam room by MA o Seen by physician o – In an ED: Patient may have little time to register if very ill, usually greeted at front desk and triaged o Taken back into ED room and rapidly assessed by RN o Seen by physician o 6

How Does the EHR Affect Clinical Workflows? • EHR affects information gathering and processing • EHR changes the way clinicians obtain information of past history • CPOE influences clinical decision making • CDS such as reminders, clinical guidelines and “hard stops” change workflows • Imaging visualization workflows are altered by the EHR PACS versus film 7

Conceptual Versus Actual Workflow 3. 1 Figure: (Cheng et al. , 2003) 8

Analyzing Workflows - 1 • Implementing EHR requires analysis and modification of workflows • Transition from current state to future state • Observation of workflows allows modifications during EHR implementation 9

Analyzing Workflows - 2 • One method for analyzing workflows: – What are the tasks? – Who is performing them? – How are the tasks performed? – What is the sequence of events? – What are the critical steps? – What is the priority of the workflow and processes within the workflow? 10

Patient Care Clinical Workflow; Multiple Perspectives of Patient Care Summary - 1 • Defined workflows • Examined the importance of clinical workflows in health care systems • Looked at how electronic health records modify these workflows 11

Patient Care Clinical Workflow; Multiple Perspectives of Patient Care Summary - 2 • Looked at multiple examples of clinical workflows from different perspectives • Studied the differences between conceptualized and actual workflows • Underscored the importance of observational studies and workflow analysis. 12

Patient Care Clinical Workflow; Multiple Perspectives of Patient Care References - 1 References Aarts J, Ash J, Berg M. Extending the understanding of computerized physician order entry: implications for professional collaboration, workflow and quality of care. Int J Med Inform. 2007 Jun; 76 Suppl 1: S 4 -13. Epub 2006 Jun 23. Damiani G, Pinnarelli L, Colosimo SC, Almiento R, Sicuro L, Galasso R, Sommella L, Ricciardi W. The effectiveness of computerized clinical guidelines in the process of care: a systematic review. BMC Health Serv Res. 2010 Jan 4; 10: 2. Review. Gooch P, Roudasri A. Computerization of workflows, guidelines, and care pathways: a review of implementation challenges for process-oriented health information systems J Am Med Inform Assoc 2011; 18: 738 -748 Niazkhani Z, Pirnejad H, Berg M, Aarts J. Review Paper: The Impact of Computerized Provider Order Entry Systems on Inpatient Clinical Workflow: A Literature Review. J Am Med Inform Assoc 2009; 16: 539 -549 Wetterneck TB, Lapin JA, Krueger DJ, Holman GTBeasley JW, Karsh B-T. Development of a primary care physician task list to evaluate clinic visit workflow BMJQS 2012; 21: 47 -53 13

Patient Care Clinical Workflow; Multiple Perspectives of Patient Care References - 2 References Zheng K, Haftel HL, Hirschl RB, O"Reilly M, Hanauer DA. Quantifying the impact of health IT implementations on clinical workflow: a new methodological perspective J Am Med Inform Assoc 2010; 17: 454 -461 Tables, Charts and Figures 3. 1 Figure: Cheng CH, Goldstein MK, Geller E, Levitt RE. The Effects of CPOE on ICU workflow: an observational study. AMIA Annu Symp Proc. 2003: 150 -4. 14

Configuring Electronic Health Records Patient Care Clinical Workflow; Multiple Perspectives of Patient Care This material was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 90 WT 0001. 15