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Meaningful use EHR certification criteria for 2014 "providers to be forced to use a given workflow/form/template to achieve MU that is not consistent with optimal workflow/usability" page 152 < this is the problem
"Activity based costing is painfully difficult to implement – essentially someone has to stand around with a stopwatch and do 'time and motion' studies ... requires process maps for each activity that will be assessed" < need BPM and process mining
Using EHRs to Improve Quality & Efficiency: Hospital "Software developers must continue to work to develop systems that fit into clinicians’ workflow, minimizing administrative work & automating tasks as much as possible"
"A traditional EMR has structured template-driven forms with complicated, inflexible, time-consuming, distracting (from the patient) drop-down menus, check boxes, radio buttons that require massive change to physician workflow"
Activity-Based Computing for Medical Work "Activity-Based Computing. A computing infrastructure, which supports users to create, save, manage, suspend, resume, move, share, and discover computational activities."
"Most of the older EMR’s on the market cannot adapt, most are having to come out with new solutions, some of the vendors that came out a little later and employed [BPM] were smart and will have a great marketplace in the future"
" Complex Event Processing (CEP) is about identifying an issue caused by multiple process events, analysing its impact, and kicking off a new process to resolve the issue" < relevant to EHR workflow systems
HIMSS CBI Committee "Clinical Business Intelligence solutions extract data from [HIT] systems into a centralized, secure, historical repository, for the purpose of making better clinical decisions within and across healthcare settings"
“With an entire body at your command, do you seriously think the Future Of Interaction should be a single finger?” < proctology? seriously, Buxton chapter 15 Norman & Draper 1986 User-Centered System Design made same point
EHRs need similar:"do-it-yourself workflow application builder…drag and drop…no coding required [Users] can build solutions in hours or days…fraction of cost of traditional [SW] development…Reduce dependence on IT, optimize workflow & increase ROI"
Chief Optimist - Workflow Issue - Healthcare
"What should be a robust market for reducing administrative costs, the authors write, has been skewed a bit by poor planning in the rush to meet federal meaningful use deadlines, resulting in the need for repeated investment in software tweaks and workflow burdens for some doctors and nurses."
Using a "'workflow engine', which can complete the actions explained in a workflow, in the order and with the derivation rules specified in it, workflows can be employed by people who are not experts in programming for the health area"
"Workflow engines specialize in executing a business process, not just decisions made at a discrete point in time. The technology can assist greatly in clinical decision-making by not only presenting clinicians with alerts and reminders, like a rules engine, but also by encouraging teamwork in clinical decisions, assisting with the time management and task allocation in process delivery, stating changes in patient or operational conditions, and creating behind-the-scenes automation of process steps"
Improved EHR usability requires a new look at how these systems work "NIST offers some valuable ideas on a technical level, but it does not address the main reasons why many physicians still find EHRs unusable or less usable than they should be"
Do EHR Investments Lead to Lower Staffing Levels? "Hospitals with a greater number of EHR applications in use do not appear to realize significant gains in labor efficiency" < my opinion? need true process automation
What is a Business Process? "activity or set of activities that will accomplish a specific organizational goal" < therefore a Clinical Process = "activity or set of activities that will accomplish a specific clinical goal"
" skills-based routing and queuing enables a virtual workflow that closely maps to and improves the physical workflow healthcare providers are currently engaged in today. This allows for easier adoption"
Artificial Intelligence Command & Control System “continuously optimizes operational schedules available resources taking into account real-time variability of procedures & changing inpatient & emergency room demands”
Identification of Newborns
"recurring issue of concern for healthcare professionals is the steep EHR learning curve (often caused by their abysmal design) and the dip in healthcare facility productivity that a move to EHRs creates"
Work-Centered Support Systems "work management support aiding the metacognitive activities entailed in prioritizing and managing multiple intertwined work activities (such as requirements for attention shift and remembering the number and state of tasks in process)"
"Workflow engines in healthcare aren’t heard of too often...pushes alerts for activities to be completed...interacts with connected infrastructure to perform actions and events based on a set of programmable rules" < vendor
Intelligent Patient Management "modeling of patient flow in hospital and the healthcare system in general, the modeling of healthcare interventions, and the management of patient care, the allocation of resources, healthcare expenditure and performance"
Cross Enterprise Workflow - IHE Wiki "manage and track the tasks related to patient-centric workflows as the systems hosting workflow management applications coordinate their activities for the health professionals and patients they support"
Healthcare providers are using BPM for comprehensive case management that improves treatment outcomes, increases staff collaboration and productivity and delivers innovative yet cost-effective new services.
Giving Office-Based Physicians Electronic Access To Patients’ Prior Imaging And Lab Results Did Not Deter Ordering Of Tests « did not reduce costs « need process and cost systems to systematically improve
Workflow usability! "EHR makes every aspect of the work involved with patient care take MUCH longer than it did before. It simply takes a long time to click a template multiple times, switch between screens multiple times. In my opinion the EHR reduces productivity"
Evolution from Transaction-Oriented to Intelligence-Oriented EHRs "clinical decision support and workflow management are key to drive data presentation based on the context of provider type and care setting in conjunction with sophisticated analytics" < sounds like BPM!
LEAN Strategies & Rapid Response Workflow Improve Patient Safety < "innovative use of healthcare information technology (HIT) and Business Process Management (BPM) software to automate the process of care"
Context-Aware EHRs (relevant to) "Context is any information that can be used to characterize the situation of an entity. An entity is a person, place, or object that is considered relevant to the interaction between a user and an application, including the user and applications themselves"
Changing Patient Workflow can Make Using an EMR Fun "downside to my new workflow is that I’ve got to hold everything in memory between the time my patient leaves my office and when she is ready in the exam roo "
Healthcare workflow automation vendor "Workflow is simply the process of completing a series of tasks. A workflow can be very simple and include one person, or it could be a complex and dynamic series of processes among many people, groups or departments"
"Widespread adoption of an EMR (or multiple compatible EMRs) that is intuitive and easy to use, that empowers the end user and patients, and that actually helps to make the healthcare system more efficient would be a good thing" ...but...
Adapting Office Workflows to the EMR "I’ve got to hold everything in memory between the time my patient leaves my office and when she is ready in the exam room, during which I may have seen another patient"
Team Creative Processes: Importance of Complementary & Shared Mental Models < complementary "knowledge structures held by team members that have unique role-specific task-relevant content" relevant to EHR BPM systems
A Challenge For Healthcare Web Applications - From Data- To Process-Orientation "New process-oriented technologies like business process management systems...tools for process design, execution, administration & integration & guarantee performance & scalability"
"average nursing home resident has… one primary disease & eight secondary diseases… 70% of rehospitalizations… are due to the progression of secondary disease and/or the onset of new disease" < role for clinical intelligence