2006 EHR WfMS Tutorial Slides 60-63: Eliminating EMR EHR Non-Value Added Workflow Steps

(Take me to the beginning of these slides!)

From EHR Workflow Management Systems: Essentials, History, Healthcare, TEPR Conference, May 19, 2004, Fort Lauderdale.

Value-added activities are typically those that someone will pay for. To use a manufacturing example, an automobile buyer may willingly pay for a leather interior but will be loath to pay for fixing a defect that shouldn’t be there in the first place. Encounter length is determined by a combination of value-added and non-value-added EHR activities. EHR value-added activities include entering data that may be used in a future decision or making a decision that affects the welfare of the patient. Non-value-added activities include navigation from screen to screen and searching for the next person to handover the next activity in the encounter. If these non-value-added activities, and the time required to accomplish them, can be eliminated, encounter length can be reduced.

Process definitions can be used by the workflow engine to accomplish exactly this. Instead of users having to proceed through multiple clicks to search for the next data or order entry screen, the workflow can be controlled by the process definition and the user merely needs to click ‘Next’, ‘Next’, ‘Next’…. (Of course, a user always has the option of jumping out of an executing definition to manually access a different screen than the one presented. Over time, with process definition refinement, this usually happens less and less.) Similarly, instead of a user having to find the next user to hand off the next activity, the workflow engine can do this instead, perhaps by forwarding items into a user’s To-Do list or onto a generally available status screen of pending tasks.

A general strategic principle is to shift as many value-added, and non-value-added activies from the manual to the automated category, while preserving and enhancing value-added manual activies that increase effectiveness, efficiency, and (user and patient) satisfaction.

wfms-usability-ehr-015

Here is a generic representation of a workflow or process. Tasks/activities are the circles and arrows combos. Processes are networks (in this case a very simple network) of interconnected activities. Roles are kinds of resources required to accomplish each step. There are different kinds of resources, some human and some automated. The role is a container and that person (or other resource) must fit, but as long as a resource fits it is interchangeable with other resources.

By the way, this is my own dead-simple notation, intended to convey basic ideas about EHR workflow. Business process management, research and industry, is full of notations (such as Petri nets and BPM Notation) and machine readable formats. My purpose and method here is to emphasize relevance to EHR usability and eschew methodological complexity. This is what I call my cat-dog-tree approach: what are the simplest ideas expressed most simply that only combine in one simple manner.

Suppose step two is navigating from screen to screen or searching for the next person required to complete the process or an opportunity to acomplish the task automatically without relying on expensive manual human labor.

wfms-usability-ehr-022

Now the following is a little complicated. I included a number of animations in the original EHR Workflow Management Systems: Key to Usability PowerPoint slides. It was easy to trigger the animations and talk about them. It’s a little different here on the Web. There are ways to include embed animations in web pages. I’ve done elsewhere on this blog. However, I’ve found, these are not usually very cross-platform friendly, and especially so with advent of smartphones. So I decided to screen-capture intermediate animation states and publish a series of screen captures from the original slides.

screen-shot-2012-10-22-at-123412-pm

The slide generically shows customer value incrementally growing during execution of workflow. I’ve only labeled the three steps from the previous slide. Steps 1, 3, and (implied) 5 are value-added so their execution moves graphed customer value up and to the right. Steps 2 and (implied) 4 (in green) consume resources and, especially, time, but do not contribute to accumulated customer value.

wfms-usability-ehr-023

This is just a visual representation of the previous paragraph. The phrase “Value-Added” points to steps 1, 3, and 5. The phrase “Non-Value-Added” points to steps 2 and 4. (If this slide reminds you of Value Stream Mapping. It should.)

screen-shot-2012-10-22-at-123441-pm

In the original slide animation steps 2 and 4 disappeared and steps 3 and 5 slipped to the left. The result is a graph that shows steadily increasing accumulated EHR value during execution of workflow and a new, shorter, cycle time (length of patient encounter).

The following slides depict intermediate animation states showing essentially the same idea as above: elimination of non-value added EHR steps results in a shorter patient encounter. The slides look different because I took them from the 2004 tutorial slides.

051-1-fewer-nonvalue-added-activities-shorter-encounter-animation

Animation Step 1

052-2-fewer-nonvalue-added-activities-shorter-encounter-animation

Animation Step 2

053-3-fewer-nonvalue-added-activities-shorter-encounter-animation

Animation Step 3

054-4-fewer-nonvalue-added-activities-shorter-encounter-animation

Animation Step 4

055-5-fewer-nonvalue-added-activities-shorter-encounter-animation

Animation Step 5

056-6-fewer-nonvalue-added-activities-shorter-encounter-animation

Animation Step 6

057-7-fewer-nonvalue-added-activities-shorter-encounter-animation

Animation Step 7

(Take me to the beginning of these slides!)

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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