'Context is key' - 10 tips to improve clinical workflow analysis

10 tips to improve clinical workflow analysis
By Richard Pizzi
05:54 PM
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A pressing need exists for an evidence-based interdisciplinary approach to the role of clinical informaticist at U.S. healthcare organizations, says Matthew Burton, MD, a clinical informaticist on the heath systems engineering team at the Mayo Clinic Center for the Science of Health Care Delivery.

Burton, who like all clinical informaticists was trained in clinical care as well as healthcare IT, said effectively implementing IT-related changes in healthcare today requires a solid understanding of clinical workflows. But to adequately comprehend such workflows, the informatics team must remain open to best practices, theories, perspectives, methods, tools and findings from various disciplines.

Burton spoke here Sunday at the 2013 HIMSS Annual Conference & Exhibition. His workshop panel, titled "Best Practice (Methods and Tools) for Clinical Workflow Analysis," included Todd Rowland, MD, director of medical informatics at IU Health Bloomington (Ind.) Hospital, and Tony LeCount, a clinical informatics consultant at MMY Consulting.

Burton's team at Mayo Clinic developed a sophisticated, team-based approach to workflow analysis that drew on the skills of medical informaticists, industrial engineers and cognitive scientists, in addition to healthcare IT professionals. He said this broad-based team, as well as an appreciation for the latest workflow analysis studies from industry, allows Mayo to better understand the actual use of healthcare IT tools within the context of clinical workflow.

"Context is key. Any information that describes the current situation of an entity adds to context," he said. "And a lack of understanding context is what hinders successful analysis."

Based on his studies of clinical workflow at Mayo, Burton created a list of the following 10 "expert practitioner insights" that healthcare informatics teams should draw on when undertaking workflow analyses:

  1. Analyses must include direct observation.
  2. Don't forget the clinical dimension.
  3. Re-purpose data that is currently in the clinical environment.
  4. Consider multiple methods. No single method accomplishes everything.
  5. Focus on time or resource-consuming tasks.
  6. Don't miss rare or critical events, interruptions, workarounds or delays.
  7. Simulations force detailed descriptions of work and are good for communicating with subjects and testing interventions or scenarios.
  8. Consider all systems, their respective lifecycle states, and contextual factors.
  9. Take a systematic, interdisciplinary approach to studying workflow and endorse a National Working Group to facilitate its development.
  10. Engage leaders and stakeholders in your healthcare organization.