Incorporating Health Information Technology Into Workflow Redesign

When it comes to improving health care quality and patient safety, health information technology (IT) applications such as electronic medical records or electronic prescribing systems are often considered to be part of the solution. However, evaluations of technology's impact on quality and safety show mixed results, partially because health IT is not always designed to fit the specific context of a given practice or a patient population. Therefore, it is important to identify standard descriptions of care workflow that can help guide providers as they determine where and how to best integrate health IT into their practices.

Drs. Pascale Carayon and Ben-Tzion Karsh led a team at the University of Wisconsin-Madison's Center for Quality and Productivity Improvement that studied the existing research related to the impacts of health IT on workflow in outpatient settings and how health IT can be used to assess workflow in these settings. The information led to the development of a toolkit to help small and medium-sized medical practices assess their workflows before implementing a health IT system. The team gave careful consideration to what "workflow" is and what kinds of measures should be studied. The analysis of clinical workflow usually describes how and by whom tasks are accomplished during the course of a patient's care.

This project gathered information related to workflow changes across a wide variety of types of health IT systems and care settings. A unifying theme was that practices must have a clear understanding of how clinical and administrative tasks are performed and how these processes might change with the introduction of health IT. Among practices that have implemented health IT, some workflow effects seem to be universal, such as an increased workload for physicians. Other effects may be unique to the context of a medical office, particularly when staff is resistant to the new health IT application.

The research findings helped to shape the design and content of a toolkit that includes instruments, methods, and strategies to understand and assess workflow, inform workflow issues, and recognize how workflow can be impacted by implementation and use of health IT. Medical practices that face the daunting challenge of large-scale health IT implementations can benefit from understanding the purpose of each assessment method, how to implement it, the resources needed to do so, and the advantages and disadvantages of each.