11 hours ago Jun 23, 2015 · Few studies have focused on exploring how patient portal use should unfold within the context of the patient-provider interaction, or how it might impact the overall organization and workflow of the health care team including potential liability concerns, reimbursement, and relationships with patients. >> Go To The Portal
Jun 23, 2015 · Few studies have focused on exploring how patient portal use should unfold within the context of the patient-provider interaction, or how it might impact the overall organization and workflow of the health care team including potential liability concerns, reimbursement, and relationships with patients.
Apr 29, 2019 · Workflow Redesign. Adopting an electronic health record (EHR) will change the flow of patients through your organization. Workflow redesign is the process of: Mapping out current workflows and analyzing how your organization gets work done (the current state) Planning for the future by mapping out how EHRs will create new workflow patterns to improve …
Workflow, loosely defined, is the set of tasks—grouped chronologically into processes—and the set of people or resources needed for those tasks, that are necessary to accomplish a given goal. An organization’s workflow is comprised of the set of processes it needs to accomplish, the set of people or other resources available to perform those processes, and the interactions among …
The analysis of clinical workflow usually describes how and by whom tasks are accomplished during the course of a patient's care. ... Citation: Carayon P, Karsh B-T, Cartmill RS, et al. Incorporating Health Information Technology Into Workflow Redesign--Summary Report Appendix F: Tool Compendium. (Prepared by the Center for Quality and ...
Remove chaos from your current workflow. Improve care coordination. Simply put, workflow redesign is important because it helps you get the most value from EHR implementation.
Adopting an electronic health record (EHR) will change the flow of patients through your organization. Workflow redesign is the process of: 1 Mapping out current workflows and analyzing how your organization gets work done (the current state) 2 Planning for the future by mapping out how EHRs will create new workflow patterns to improve your organization’s efficiency and health care quality (the future state)
Initiatives to ensure patient safety. Implementation of changes to make the care team more patient-focused. One important reason that workflow is of pressing concern for today’s clinicians is the introduction of new health care information technology (health IT) into clinical practice.
In health care, as in other industries, some workflows are designed, while others arise organically and evolve. The systems and methods by which organizations accomplish specific goals differ dramatically. Some organizational workflows seem more straightforward than others. Most often, when workflow processes are looked at in isolation, the processes appear quite logical (and even efficient) in acting to accomplish the end goal. It is in the interaction among the processes that complexities arise. Some of these interactions hide conflicts in the priorities of different roles in an organization, for example, what the nursing team is accountable to versus the physician team and its schedule. Organizations also adapt workflows to suit the evolving environment. Over time, reflecting on organizational workflows may show that some processes are no longer necessary, or can be updated and optimized.
Workflow analysis has often been used with the goal of improving efficiency. In response to financial pressure and incentives driving provider organizations, minimizing slack time has become important. Some of the studies discussed below demonstrated the power of analyzing and changing workflow to improve efficiency.
Health IT, used well, can improve efficiency and organizational workflow. In health care, redundant information is often created and stored. As a result, care providers spend a great deal of time reconciling information from various sources. Integrating health IT with the workflow of various departments can help to reduce this redundancy.22However, if workflow is not considered and the technology is not thoughtfully implemented, the benefits cannot truly be achieved. To use technology most effectively, its potential impact to transform care delivery must be realized.36
While it is important to consider workflow when implementing health IT, it does not mean that health IT should leave processes intact. Health IT can bring about positive process change and better workflow. Because IT can consolidate and display information, it can be used as an opportunity to improve upon teamwork and communications.37Understanding existing clinical workflow prior to implementation provides a baseline to redesign systems and develop better processes.38Scharmhorst, Johnson, and Li39emphasized the importance of understanding the system prior to implementing technology, to ensure that technology streamlines nursing workflow, rather than making it more complicated. In a study of mobile cabinets with barcode scanning for medications, Braswell and Duggar40found that, by analyzing workflow ahead of time, both pharmacy and nursing staff reported improvements to existing work processes after implementation. Workflow concerns can lead to failure to adopt new technologies. A study of electronic prescribing systems standards finds that many of the electronic standards are adequate but provider adoption is low because the systems do not fit into workflow.41The evaluators recommend that the standards and systems be revised to accommodate the large role of nurses in electronic prescribing in the office setting.
A common class of problems with information transfer and handoffs includes degradation of information.17If methods of transfer are informal and not documented, patient information may not be passed on when staff members leave a unit. In addition, the lines of responsibility and expectations are not always clear.17Incorporating formalized information transfer tools and protocols into workflow processes may help. Another problem complicating information transfer is interruptions. These interruptions often cause a break in workflow, which can impact what information is documented and passed on.18, 19
These alternate workflows are a cause for concern because these informal, evolutionary systems rely on the clinicians’ memories, and bypass decision-support safeguards that the system may provide. Studies have documented other negative effects,11such as degraded coordination between nurses and physicians, nurses dropping activities during busy periods, and decreased ability to deviate from routine sequences.
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.
Summary: Health information technology (IT) systems provide computerized clinical information to clinicians and/or patients and are seen as beneficial to health care quality and patient safety. However, evaluations of the impact of health IT on quality and safety show mixed results. The main reason for unfavorable results seems to be related to difficulty integrating health IT into clinical workflows across organizations (e.g., between a clinic and community pharmacy), within a clinic, during a visit, or into the cognitive work of the clinician. It is clear that health IT must be designed to fit specific contexts if it is to work.
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.
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.
As a secure online website providing patients access to their health information, the portal aims to improve quality of care by engaging patients as active participants in their care. While portal functions vary, most allow patients to view laboratory test results, immunizations, medications, and allergies, as well as to send secure messages to their physician. 14 However, the portal can be difficult to navigate, and patients may struggle to understand their medical information. For instance, in our previous work we found that test result display and graphing were often confusing to patients, and they reported that portals were not user-friendly. 15 A recent systematic review of patient and provider attitudes toward patient portal use found that the most negatively-perceived feature was user-friendliness, making the portal difficult to navigate. 16 Our work exploring patient's experiences using the portal to view test results echoes this finding, as many patients reported having difficulty locating their test results in the portal. 17 When patients interact with their test results, they need to know the purpose of the test, the interpretation of the result, and next steps. 18 Addressing these issues may help improve patient-centered care.
Patient portals are intended to engage patients by giving them access to medical information ; however, if patients are unable to understand the information or the system is not usable, patients will not take advantage of them. Despite several aforementioned drawbacks, apps have used evolving innovative designs to engage consumers and offer unique features and functions that could be translated to patient portal design. For instance, Apple's ResearchKit's Diabetes app pings the user daily to update disease and symptom-related information. Check-in questions or user-friendly alerts in portals could similarly be explored for engaging more patients their health care. Alerts could ask if the patient understands an abnormal result, direct them to helpful resources, and encourage test result follow-up. Finally, test results in the portal need to be easily understood by laypeople or displayed using simplified medical terms. For example, a portal might display elevated cholesterol as "↑LDL cholesterol," or even just display the number without a flag, whereas a health app may label it as “bad cholesterol.”
Although apps might serve a different purpose, patient portals could adopt certain app features that lead to better engagement success with patients. Mobile apps have the capability to record several types of data, such as activity level, nutrition, and sleep, as well as data related to a consumer's condition or disease, such as diabetes or asthma. For instance, Apple's ResearchKit, although not designed as a health tracking application, offers several features that could be useful for health monitoring. It collects data and simultaneously encourages users to track their health by prompting daily health assessments. mHealth apps offer symptom management activities, which are not a standard feature universally available in patient portals.16 For example, LifeMap Solutions (San Jose, CA) has an application for Chronic Obstructive Pulmonary Disease management that provides medication reminders and tracks users’ symptoms to identify abrupt declines in their condition. Sentrian (Aliso Viejo, CA), a patient intelligence company, uses biosensors (i.e., blood glucose biosensor) to detect deteriorating health of patients to prevent avoidable hospitalizations.20 There are also apps that allow users to view their test results, such as Healthvana (Los Angeles, CA) and Labcorp (Research Triangle Park, NC). Healthvana, for instance, provides patients with interpretation of sexually transmitted infection results and follow-up instructions. 21
To improve user experience with future portals, developers could look towards apps in design, function, and user interface. Combining certain high-yield features of mHealth apps with the wealth of provider-generated data available in portals may improve portal use, increase patient engagement, and empower patients to track their health and disease (s). Nevertheless, continued research is necessary to understand how best to combine these features and how data can be used meaningfully by patients to improve outcomes. For further progress, informatics and human factors researchers will need to work in coordination with mHealth vendors, health care delivery organizations, and their data to determine how patients are using these health IT tools and how to make them most useful for patient care. This type of evidence is essential for creating value for patients, clinicians, and health care organizations, as well as for initiating changes to improve the patient portal. Both these health IT tools should be subjected to rigorous evaluation to ensure they meet their potential in improving patient outcomes.
There is growing interest in electronic access to health information and the use of digital data for both disease and health-related tracking. Widespread use of health information technology (IT) could potential ly increase patients’ access to their health information and facilitate future goals of advancing patient-centered care.1 For example, health IT can be used to facilitate information exchange with clinicians and instruct patients when to act upon clinical issues, such as out of range physiologic parameters, follow-up of test results, and complications of medication use. 2 Tools such as personal health records, patient portals, and various mobile health (mHealth) applications (apps) have been developed to help patients engage in their own care. Already, a significant number of patients use health IT; therefore, it is essential that patient-facing health IT be tailored to their needs. In this paper, we discuss two forms of patient-facing health IT tools—patient portals and apps—to highlight how, despite several limitations of each, combining high-yield features of mHealth apps with portals could increase patient engagement and self-management and be more effective than either of them alone. This could potentially improve both patient experience and outcomes related to patient-facing health IT.
Patient-facing health IT should be simply designed to encourage and sustain use and engage patients at various levels of health literacy. 3 Patients increasingly express interest in being involved in medical decision-making and desire access to their health information.4 Despite having increased access to their health data, patients do not always understand this information or its implications, and digital health data can be difficult to navigate when displayed in a small-format, complex interface. For example, test results are not always displayed in a way that is easy for the patient to understand (e.g., with normal ranges clearly shown, along with implications of abnormal results). There is also little evidence that patient portal design addresses patients’ needs outside of meeting the “meaningful use” patient engagement criteria. 5 It is imperative to keep patients’ needs in mind because patient-facing health IT users in the long run will not be just the early adopter health and technology "enthusiasts," but regular people in need of better disease control and management. 6
Widespread use of health information technology (IT) could potentially increase patients’ access to their health information and facilitate future goals of advancing patient-centered care. Despite having increased access to their health data, patients do not always understand this information or its implications, ...
A workflow is a set of tasks that are completed to accomplish a goal. Your workflow should be defined with chronological processes, depicted typically through the sequential use of forms for documentation within an electronic medical record, and identified by the set of people or other resources available to perform those processes and the interactions among them. Providing this process-driven approach for yourself and to your employees can maximize the department’s efficiencies and patient throughput and ensure you have completed the necessary quality and patient safety documentation during the patient’s course of care.
Further clinical factors for wound and skin assessment include understanding the physical findings of the wound and skin, the evaluation of the patient’s laboratory values and diagnostic tests, nutrition needs, and management modalities, such as topical dressings, drugs, support surface products, and off-loading devices.
Clinical order sets (basically, predefined templates) are one way to ensure patient safety and reduce risk. Creating order sets for the wound types seen in your department provides a common platform and support for clinical decisions related to a specific condition or medical procedure. Further, creating wound-specific laboratory values assists with the consistency of ordering and care.
improve the quality of patient care, promote patient safety, reduce healthcare costs, and
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and become a better nurse and person. There is no doubt that without his continued love,
One found that overall, CDS can improve clinical practice37 and the features that increased the likelihood of success were automatic provision of support as part of workflow, provision of recommendations and not just assessments, provision of support at the time and location of decisionmaking, and computer decision support.37 The other review showed that the majority of studies that reported on clinician outcomes showed improvements (e.g., faster time to diagnosis, increased compliance with screening guidelines, or more disease management practices), but few of the studies that reported patient outcomes showed improvements.61 Having CDS that automatically prompted use and systems that were developed by the authors reporting the study both predicted success on clinician outcomes.61 Research is also starting to uncover patient and practice factors in ambulatory care that predict acceptance of CDS automation. For example, one study found that female and less experienced primary care physicians had more favorable perceptions of CDS automation than male or more experienced physicians.126 Perhaps most interestingly was the finding that physicians reported they were more likely to accept alerts for elderly patients, those on more than five medications, and those with more than five chronic conditions. 126
Research shows that automation is able to improve the quality and safety of care delivered by health care facilities. Recent advances in automation have the potential to improve all aspects of health care delivery, from diagnosis and treatment to administration and billing. Diagnostics have improved with the introduction of higher resolution functional magnetic resonance imaging (fMRI), positron emission tomography (PET), and computed tomography (CT) scans, not to mention advances in laboratory medicine technology for superior analysis of blood, urine, and cultures. Automation used for treatment spans the gamut—from new infusion devices such as smart IV pumps to surgical technologies such as endoscopic surgical tools, improved lasers, and even surgery assisting robots (e.g., da VinciTM).
The fields of computer supported collaborative work (CSCW),64, 185 teamwork,111, 140, 186-192 and distributed cognition110, 113, 193, 194 may also provide insights into how to study and conceptualize the workflow in ambulatory health care delivery for better CDS design and integration with workflow. CSCW research focuses on how people collaborate and how technology can mediate that collaboration effectively. In ambulatory settings—from primary care clinics to surgery-centers to emergency departments—a wide variety of people (clinicians, patients, and administrative staff) collaborate to achieve high quality and safe care.195 When CDS automation is present, it may mediate or moderate the interactions of the individuals who must collaborate, and depending on how well the CDS automation meets the challenge, the interaction may be improved or degraded by the automation.
These frameworks come from research on (1) decision support systems (DSS) outside of health care, (2) human-automation interactions, (3) teams, collaborative work and distributive cognition, and (4) sociotechnical systems approaches to health information technology acceptance and use. All four contribute to an understanding of what CDS automation should be designed to accomplish and what it means to design and implement it effectively to achieve desired outcomes.