Different Versus Same Person Versus Time EHR Workflow: Process-Aware HIT

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The following four categories of EHR workflow (Table 1) are useful in broadly construing EHR workflow ca- pabilities. First there is different person/different time workflow. This is the classic workflow that most people think of as workflow. The nurse enters vitals information, which is forwarded to the physician who reviews it and other data, and then delegates tasks back the nurse.

Then there is different person/same time workflow. The workflow management system workflow engine “knows” what activity started where and for how long, as well as who is responsible, and this information can be fed into not just worklists but onto a universally available status screen. Everyone can see which patient is waiting where, for what task, for how long and who is responsible. This screen functions much like the radar screen in an aircraft control tower, only it is patients and tasks being are tracked, not airplanes. By continually updating a universally accessible display of system state—a universal worklist tagged with information about location, time, and responsibility—all EHR users can maintain a shared mental model, and, more important, they can act with respect to that model under the assumption that others have the same mental model of what needs to be done, where, and who is responsible. (This does sound complicated, but reflect on how much judg- ment often depends on one person knowing that another person knows something, or even each person knowing that other people know that he or she knows something.)

person-vs-time-workflow

Not only can a user send information or a delegate task to another user, a user can do so to themself, much as people sometimes send an email to themselves or leave a message on their own answering machine. This is same person/different time workflow.

Finally, there is same person/same time workflow. This kind of workflow does not come as naturally to mind as the classic different person/different time workflow, but it can be critically important in a “user friendly” EHR. Just as process definitions can be used to forward tasks from person to person, they can also be used to drive the individual screens that a single user interacts with during the accomplishment of a series of related activities. Instead of having to navigate through thickets of menu hierarchy or drilling down through complicated dialog boxes or scrolling through long lists, the information that has been gathered or deduced so far (what is the en- counter type, who is logged in, what is the next step in the process definition) determines the right screen, in- cludes the right content (data, orders) on that screen, and displays the content in the most appropriate format (such as a list sorted by category or alphabet, based on the user’s preference).


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Take me to the next blog post in this series! Multi-Specialty, Multi-Site, Multi-Encounter Workflow Management: Process-Aware HIT.


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