2006 EHR WfMS Tutorial Slides 42-47: EMR EHR Usability Principles and Workflow: Supportiveness

(Take me to the beginning of these slides!)

From Chapter 7: Natural Language Processing, Business Process Management, and Adaptive Case Management in Healthcare in How Knowledge Workers Get Things Done: Real-World Adaptive Case Management:

I’m not talking about calling technical support here. I’m talking about cognitive support. You’ve got a set of tasks waiting for you. Patient A (“belonging” to physi-cian B) has been waiting ten minutes in Exam Room C for task D usually performed by staff E. Can you look and see those tasks? Can you see their state? What’s waiting for whom and for how long? For routine activities, such as all those 30-seconds to diagnosis simple earaches and prescribe standard antibiotics, workflow rules help move things along (automatically print educational materials, send e-prescriptions to preferred pharmacies, etc.).

For less routine, more complicated cases it’s impossible to predict workflow in advance (“I’ve never seen this before: What should I read? Who should I call?”). Adaptive case management systems don’t have rules controlling what gets done when and by whom. They say: “These are the goals that need to be done” and “This one is 50 percent done and that one’s been completed and the other one has been languishing.” That’s support in a cognitive sense. Ideally, EHRs should combine aspects of both structured BPM and unstructured case management.


Support Definitions

  • “give aid”
  • “supply what is necessary”
  • “hold up”
  • “aid in the support of a mission”
  • “establish or strengthen as with new evdience or facts”
  • “to provide documentation”
  • “corroborate: make more certain or confirm”
  • “provide a foundation”


Bicycle Seat: Supportiveness
Supports what needs to be supported and otherwise does not get in the way


Clippie’s “Supportiveness”
I know, I know, folks hated Clippie, that’s why there are scare quotes around “Supportiveness”


EMR EHR Supportiveness

  • Are user options reduced to manageable sets
  • Is help available for beginning users, but not obtrusive to expert users
  • Do visual cues impart system state?
    • Color coded displays
    • Real time updates (if appropriate)
    • Geographic metaphors (if appropriate)


Supportive Workflow

  • Degree enough information is provided to a user to accomplish tasks
  • Shared mental model of system state allows users to coordinate their activities
  • Workflow engine knows who, what, why, when, where, and how (long)
  • Can drive real-time display to support team shared mental models


In “Shared Mental Models and Shared Displays: An Emprical Evaluation of Team Performance” Bolstad and Endsley summarize:

“Overall, we found that effective team performance could be enhanced by providing teams with sufficient information to build a shared mental model of each other’s tasks and goals, either through direct instruction, or through provision of shared displays. It is believed that the shared displays helped to build shared mental models which boosted later task performance”

[need to find and link to reference]

(Take me to the beginning of these slides!)

Related links:

EHR/EMR Usability: Natural, Consistent, Relevant, Supportive, Flexible Workflow

TEPR 2004 EHR Workflow Management System Slides

Based on the slide deck used for three-hour tutorial at the 2004 TEPR conference in Fort Lauderdale.

TEPR 2006 EHR Workflow Management Systems Slides

Based on the slide deck used for three-hour tutorial at the 2006 TEPR Conference in Baltimore.

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