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Managing Patient Communications with Workflow Technology, Part IV: Conducting The Workflow Analysis
Jerome Carter, MD December 14, 2016
A workflow analysis is an objective way to find out why a process works the way it does. In order to be useful, a workflow analysis must capture detailed information. Workflow information comes from so many different sources that gathering it can be time-consuming and overwhelming, unless a structured process is used. In my experience, the best approach is to start with written documents (e.g., policy and procedure manual) then move on to interviews, and repeat as needed until done. In addition, it is best to start with a high-level view, then gradually drill down to fine details (More..)
Managing Patient Communications with Workflow Technology, Part III: The Properties of "Good" Clinical Processes
Jerome Carter, MD October 31, 2016
Managing Patient Communications with Workflow Technology, Part II: Signs and Symptoms of Process Problems
Jerome Carter, MD October 18, 2016
Managing Patient Communications with Workflow Technology, Part I
Jerome Carter, MD October 10, 2016
Bridging the Gap: Bringing BPM to Clinical Care
Jerome Carter, MD June 20, 2016
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Modeling Clinical Workflows with BPMN 2.0: Analytic Level Tasks and Gateways
Jerome Carter, MD July 6, 2016
Well, we have reached the final installment of the introductory BPMN modeling tutorial. While this series has focused on BPMN, the underlying goal was looking at clinical work modeling challenges. With this in mind, only BPMN elements most helpful in modeling clinical work have been used.
Send and Receive tasks make their first appearance in Level 2 BPMN 2.0. Send tasks make it possible to create explicit messages within a process flow and attach conditions; something events cannot do. Send tasks may have boundary events (e.g., an error), which is not possible with message events. In clinical settings, this comes in handy. The definition of what constitutes an error within a process is up to the modeler. There are many times when a communication MUST happen, and one needs a way to react if the message is not sent. For example, one could have a Send task that represents STAT lab results, and failure to send the results (for whatever reason) would result in an error. In executable BPMN 2.0, a Send task is equated with an automated action (e.g., web service). (More...)
Modeling Clinical Workflows with BPMN 2.0: Analytic Level Events
Jerome Carter, MD June 28, 2016
Modeling Clinical Workflows with BPMN 2.0: Ordering a Medication
Jerome Carter, MD April 18, 2016
Modeling Clinical Workflows with BPMN 2.0: A Closer Look at Events and Subprocesses
Jerome Carter, MD March 28, 2016
Modeling Clinical Workflows with BPMN 2.0: Tasks, Roles, and Data
Jerome Carter, MD March 21, 2016
Modeling Clinical Workflows with BPMN 2.0: Terminology and Symbols
Jerome Carter, MD March 14, 2016
Modeling Clinical Workflows with BPMN 2.0: An Overview of BPMN
Jerome Carter, MD March 7, 2016
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___________________________________________________________________________________________________________Jerome Carter, MD April 25, 2016
I have just finished reviewing workflow-focused reports from NIST and AHRQ. Some things I love and some simply leave me scratching my head. First, here is the list of reports:
AHRQ
- Carayon P, Karsh B-T, Cartmill RS, et al. Incorporating Health Information Technology Into Workflow Redesign--Summary Report. (Prepared by the Center for Quality and Productivity Improvement, University of Wisconsin–Madison, under Contract No. HHSA 290-2008-10036C). AHRQ Publication No. 10-0098-EF. Rockville, MD: Agency for Healthcare Research and Quality. October 2010.
- Zheng K, Ciemins E, Lanham H, Lindberg C. Examining the Relationship Between Health IT and Ambulatory Care Workflow Redesign. (Prepared by Billings Clinic under Contract No. 290- 2010-0019I-1). AHRQ Publication No. 15-0058-EF. Rockville, MD: Agency for Healthcare Research and Quality. July 2015.
NIST
- Lowry, Svetlana Z., et al. Integrating Electronic Health Records into Clinical Workflow: An Application of Human Factors Modeling Methods to Ambulatory Care. NISTIR7988 Gaithersburg, MD (2014).
Workflow, as these reports attest, is a highly elastic concept in health care. There are no standard task/activity lists, process lists, or ways of modeling workflow that are widely accepted within health care. Naturally, this makes for a mess when trying to compare the methods and outcomes of one group of researchers to another. Sharing process maps and task definitions between healthcare entities is equally problematic. These reports provide an excellent analysis of where we are now and point out in detail the many workflow issues that arise in clinical care as a result of HIT. (More...)
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