Health Information Technology’s “Workflow Wall”: Patient Experience

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We have invested tens of billions of dollars in health information technology and electronic health records over the last several decades. I believe that we have hit what I call the workflow “wall”. The workflow wall is the invisible workflows, that is, you can’t see task status, you don’t know what’s going on, all these black boxes around us.

The inflexible workflows, you can’t change them, because they’re hard coded into the software. They’re ineffective, they’re not achieving the goals we need them to achieve. They are inefficient workflows, that is, they consume too many resources when they are executed.

This has created what I call workflow discontents. If you go to a healthcare industry, or particularly a health IT industry conference, you may see people talking about workflow, it may be in some abstracts. For sure, when you walk down the hall, you will hear the word workflow, it’s like a cocktail party effect, where you hear someone mention your name across the room. You walk down the hall, and every thirty seconds you’ll hear “Workflow, workflow, workflow.”

Let’s say you have a problem, pollution, you have a pollution problem. Guess what, then you have pollution technology. Well, healthcare has a workflow problem, so we need to use workflow technology. In the academic research realm, the folks who study workflow technology, call these “process-aware information systems”. Process aware means that there’s some kind of model of the process or workflow, and aware basically means, not that the software has consciousness, but that it can inspect that model, and it can refer to that model, and it can reason with that model in order to facilitate, and make these invisible workflows visible, flexible, effective and efficient. Structured messaging is an example of workflow technology and process aware information systems.

This is the only slide that’s full of statistics, and it’s really to drive home the point, that this is an important problem, and there’s a way to characterize it.

First of all, fifty percent of all healthcare errors are due to slips and lapses, such as not executing some intended or an interrupted action. This is called perspective memory. Perspective memory is when you say, “I need to do something next, or eventually, and you intend to do it. Then later, you remember that you intend to do it, and then you do it. Obviously, if you forget to do it, that can be a problem.

Almost fifty percent of interruptions affect direct care tasks. About fifty percent of pages to physicians interrupt direct patient care, and almost fifty percent of pages are non-urgent. You’ve got almost fifty percent of pages, non-urgent, and they are causing interruptions, which can lead to healthcare errors. These errors may be serious, in terms of outcomes, but they also have dramatic impact on patient experience. “They forgot me,” or, “They forgot about this,” or, “This took too long.” Those affect patient experience, and that’s the system behind the smiles.

Take me to the next post in this series: The Workflow Technology Prescription: Patient Experience.

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