Describing and Modeling Workflow and Information Flow in Chronic Disease Care

Unertl, Kim M.; Weinger, Matthew B.; Johnson, Kevin B.; Lorenzi, Nancy M.

doi:10.1197/jamia.m3000

Cited by 123 publications

(88 citation statements)

References 39 publications

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“…Workflow diagrams have been used to optimize population health management systems 13,14 Unertl and colleagues modeled workflow, information flow, and work practices in side-by-side diagrams representing chronic disease care; they found that clinic staff will create inefficient "work-arounds" to accomplish tasks when the technology does not fit their needs. 15 …”

Section: Workflows To Describe Data Contextmentioning

confidence: 99%

Mapping Multi-Site Clinic Workflows to Design Systems-Enabled Interventions

Coronado¹,

Retecki²,

Petrik³

et al. 2017

eGEMs

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Objective: Variations in processes for different clinics and health systems can dramatically change the way preventive interventions are implemented. We present a method for documenting these variations using workflow diagrams and demonstrate how understanding workflow aided an electronic health record (EHR) embedded colorectal cancer screening intervention. Materials and Methods:We mapped variation in processes for ordering and documenting fecal testing, current colonoscopy, prior colonoscopies, and pathology results. This work was part of a multi-site cluster-randomized pragmatic trial to test a mailed approach to offering fecal testing at 26 safety net clinics (in eight organizations) in Oregon and Northern California. We created clinic-specific workflow diagrams and then distilled them into consolidated diagrams that captured the variations.Results: Clinics had varied practices for storing and using information about colorectal cancer screening. Developing workflow diagrams of key processes enabled clinics to find optimal ways to send fecal test kits to patients due for screening. The workflows informed the rollout of new EHR tools and identified best practices for data capture.Discussion: Diagramming workflows can have great utility when implementing and refining EHR tools for clinical practice, especially when doing so across multiple clinical sites. The process of developing the workflows uncovered successful practice recommendations and revealed limitations and potential effects of a research intervention. Conclusion:Our method of documenting clinical process variation might inform other EHR-powered, multi-site research and can improve data feedback from EHR systems to clinical caregivers.

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Section: Workflows To Describe Data Contextmentioning

confidence: 99%

Mapping Multi-Site Clinic Workflows to Design Systems-Enabled Interventions

Coronado¹,

Retecki²,

Petrik³

et al. 2017

eGEMs

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“…Modelling workflow and information flow is an established methodology for studying medical scenarios, such as chronic patient care (Unertl et al, 2009). This approach is based on the soft systems methodology (Checkland, 2000;Mingers, 2000) which is well documented as a methodology for process innovation (Presley, Sarkis, & Liles, 2000).…”

Section: Design and Flow Of Emergency Response Participationmentioning

confidence: 99%

“…The information system, which integrates patient, physician and EMS participation, advanced matching of prescription medication, and location-based social networking, is being initially focused on anaphylaxis with broad potential for other chronic conditions. The ERC system and anaphylaxis app design emerged by following a soft systems methodology (Checkland, 2000) of modelling workflow and information flow (Durugbo, Tiwari, & Alcock, 2013;Hibberd & Evatt, 2004;Unertl, Weinger, Johnson, & Lorenzi, 2009). To facilitate this process we engaged with a pool of 18 medical professionals across the fields of Emergency Medicine (8), Allergy and Clinical Immunology (4), Pharmacology (4) and Public Health (4).…”

Section: Introductionmentioning

confidence: 99%

Exploring mHealth Participation for Emergency Response Communities

Schwartz

Bellou

Garcı́a-Castrillo

et al. 2017

AJIS

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We explore the challenges of participation by members of emergency response communities who share a similar condition and treatment, and are called upon to participate in emergency events experienced by fellow members. Smartphones and location-based social networking technologies present an opportunity to re-engineer certain aspects of emergency medical response. Life-saving prescription medication extended in an emergency by one individual to another occurs on a micro level, anecdotally documented. We illustrate the issues and our approach through the example of an app to support patients prone to anaphylaxis and prescribed to carry epinephrine auto-injectors. We address unique participation challenges in an mHealth environment in which interventions are primarily short-term interactions which require clear and precise decision-making and constant tracking of potential participants in responding to an emergency medical event. The conflicting effects of diffused responsibility and shared identity are identified as key factors in modelling participation.

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“…To study performance in the process of information exchange, some authors recommend studying the work processes and communication activities associated with information and communication practices (Georgiou, Marks, Braithwaite, & Westbrook, 2013;Unertl, Weinger, Johnson, & Lorenzi, 2009). Work processes or workflow factors include sequences of routine activities and tasks, relationships among activities, roles, and responsibilities and are influenced by internal or external factors (Unertl, Johnson, & Lorenzi, 2012;Unertl et al, 2009).…”

Section: Introductionmentioning

confidence: 99%

“…Work processes or workflow factors include sequences of routine activities and tasks, relationships among activities, roles, and responsibilities and are influenced by internal or external factors (Unertl, Johnson, & Lorenzi, 2012;Unertl et al, 2009). Communication activities or information flow incorporate the transfer of information between individual actors (e.g., registered nurses (RNs) or other healthcare providers) (Unertl et al, 2009). From our perspective, Alter's (2013) work system framework (WSF) is an option for studying workflow and information flow-related aspects of health information-exchange activities in a healthcare setting.…”

Section: Introductionmentioning

confidence: 99%

An Analysis Of The Work System Framework For Examining Information Exchange In A Healthcare Setting

Johnsen

Fruhling²,

Fossum

2016

CAIS

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Abstract:Lack of communication is a leading root cause of sentinel events (any unanticipated event in a healthcare setting resulting in a patient's death or serious physical or psychological injury and not related to the natural course of the patient's illness). Deficits in communication of essential information when patients transfer between different healthcare services can cause interruptions in the continuity of care, inappropriate treatment, and potential harm to the patient. Research has shown that providing the right information about the right patient to healthcare providers at the right time could eliminate up to 18 percent of the general adverse events. In this paper, we assess the applicability of the work system framework (WSF) to evaluate the health information-exchange processes that occur when patients are transferred from home healthcare services and nursing homes to hospitals. From our analysis, we identify possible improvements in both work practices and the flow of health information among healthcare providers. Further, we propose a modified work system snapshot template tailored for evaluating the health information-exchange process. The proposed modifications include changing the WSF terminology to healthcare terms (including patient safety indicators) and adding new performance measurement indicators that are relevant to healthcare.

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Describing and Modeling Workflow and Information Flow in Chronic Disease Care

Cited by 123 publications

References 39 publications

Mapping Multi-Site Clinic Workflows to Design Systems-Enabled Interventions

Mapping Multi-Site Clinic Workflows to Design Systems-Enabled Interventions

Exploring mHealth Participation for Emergency Response Communities

An Analysis Of The Work System Framework For Examining Information Exchange In A Healthcare Setting

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