I Found Workflow at National Health IT Week!

I spent the day at the National Health IT Week Second Annual National Health IT Collaborative for the Underserved Conference. As usual I went looking for the workflow angle. :)

And I found it. During the HIT Innovation and Research Panel, which I Periscoped (archived to Katch), Aysha Corbett, MD., Deputy Chief Medical Officer and VP for Quality Improvement, Provider Recruitment/Education at Unity Health here in Washington, discussed the workflow problems they’ve had since they bought one of the most popular EHRs in 2009. You can listen to Dr. Corbett, starting around 30 minutes into the video. Or you can skip to my running paraphrase of her comments, just after the embedded video.

Yes. I know the video turns sideways part way through! :)

  • the emr has brought a lot in safety and getting information out
  • but there’s been a lot of change in our workflow, in our life
  • we’ve have to change the way we do things, because of the way the tool is built instead of the other way around
  • instead of coming to see how we work, and building the tool … [same for patients re portal]
  • a tool that makes daily workflow easier instead of harder is a must
  • people are really burning out, they say they’re glorified data clerks
  • spend so much time with data fields instead of writing coherent notes that make sense to readers
  • the notes are hardly readable, due to their structured data format
  • [please] make our lives easier, not more difficult
  • we’ve become data entry and treasure hunters [info finding-wise]
  • [the EHR] needs to easily adapted to lots of different kinds of providers

If only modern EHRs were built on modern workflow platforms, instead of user interfaces plastered on databases! All of the above could have been easily achieved. By creating user-editable workflow definitions, executed by an EHR workflow engine, if the Dr. Corbett didn’t like the workflows, she and her users could have changed the workflow definitions to fit their own workflows. This is exactly what the first three winners (2003, 2004, 2005) of the HIMSS Davies Award for Ambulatory EHR use did. I know, I helped them edit those workflow definitions. And then help them write all three of their HIMSS Davies Award applications. Feel free to read their original HIMSS Davies applications. They specifically outline that success was due ability to customize EHR workflow to their own needs, instead of having to fit their workflows to the EHR.

After the excellent presentation, Dr. Corbett and I mused about how to fix this unfortunately almost universal experience with that I call “workflow-oblivious” EHRs. I suggested that while EHRs will likely improve somewhat, they’re basic character, that of forcing relatively frozen workflow on clinical users, is unlikely to change much, if it all. Instead, I suggested, there will be a new layer on top of EHRs, which will provide the kind of process-awareness I’ve written about extensively.

I hope you’ll read my most recent posts on the subject, ten in all! There is my 7000-word, five-part series on task and workflow interoperability. And then there is my five-part tutorial series on healthcare workflow technology, usability, patient safety, interoperability, and population health and care coordination.

Lucky for all of us, health IT is indeed becoming more process-aware. This year five percent of 1500 HIMSS Conference exhibitor websites actually mention “workflow engine” someplace on their websites. This statistics doesn’t count the other almost synonyms, such as orchestration engine, or other indicators of a workflow engine under the hood, such as “customizable workflow” or “workflow-driven”. For the last five years I searched every website of every HIMSS conference exhibitor for workflow and workflow technology related material: 2%, 4%, 8%, 16%, and this year more than a third, so much I couldn’t finish what had become my annual survey.

Further, I can no longer count on one hand, or even two hands, fellow workflowistas on Twitter, LinkedIn, and in the bloggosphere. To them, to you, now is not the time to let up on the pressure necessary to move from workflow-oblivious to process aware health IT systems! Viva la workflow! Onward workflowistas!

P.S. Whether to cheer me on, or tell me I’m full it, please join my mid #NHITweek blab today (Wednesday) at 2PM EST!

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