1. Fundamentals of Health Workflow Process Analysis and Redesign
Welcome to the Fundamentals of Health Workflow Process Analysis & Redesign, Clinical Workflow. This is Lecture b.
This component, Fundamentals of Health workflow Process Analysis and Redesign is a necessary component of complete practice automation and includes topics of process validation and change management
This lecture, Clinical Workflow, focuses on the role of the Practice Workflow and Information Management Redesign Specialist in comparison to other ONC defined Health IT roles, and the concepts of processes and thinking of health care in terms of clinical processes. Such understanding provides a foundation for the study if clinical process analysis and redesign.
Clinical Workflow
Lecture b
This material Comp10_Unit1b was developed by Duke University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC

2. Clinical Workflow Learning Objectives
Describe the purpose for process analysis and redesign in the clinical setting (Lectures a, b)
Describe the role of a practice workflow and information management redesign specialist and contrast it with other roles such as technical support and implementation management (Lecture a)
Explain how health care process analysis and redesign and meaningful use are related (Lecture a)
Analyze a health care scenario and identify the components of clinical workflow (Lectures a, b)
Given a scenario of a health care analysis and redesign, analyze the responsibilities of each participant in the process and how the roles complement or overlap with one another (Lecture b)
Describe how the workflow processes used by a health care facility might differ depending on the type of facility (Lecture b)
The objectives for this unit, Clinical Workflow, are to:
Describe the purpose for process analysis and redesign in the clinical setting,
Describe the role of a Practice workflow and information management redesign specialist and contrast it with other roles such as technical support and implementation management,
Explain how health care process analysis and redesign and meaningful use are related,
Analyze a health care scenario and identify the components of clinical workflow,
Given a scenario of health care analysis and redesign, analyze the responsibilities of each participant in the process and how the roles complement or overlap with one another, and finally,
Describe how the workflow processes used by a health care facility might differ depending on the type of facility.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

3. Role of Practice Workflow and Information Management Redesign Specialist
Assist in reorganizing the work of a provider
Take full advantage of health IT
Help practices achieve meaningful use
Ultimately improve health and care
The overarching goal of the role is to assure that the clinical workflow supports the IOM’s requirements of safe, effective, efficient and timely health care that is patient-centered and equitable.
The role of the Practice Workflow and Information Management Redesign Specialist is one of 12 roles defined by the Office of the National Coordinator for Health IT. Workers in this role assist in reorganizing the work of a provider to take full advantage of the features of health IT in pursuit of meaningful use of health IT to improve health and care.
The mission of this role is to support the IOM’s aims defined in Crossing the Quality Chasm (Institute of Medicine, 2001).
As mentioned in the lecture, they are:
Care should be safe, as safe for patients in their health care facilities as in their homes.
The science and evidence behind health care should be applied and served as the standard in the delivery of care.
Care and service should be cost effective and waste should be removed from the system.
Patients should experience no waits or delays in receiving service.
The system of care should revolve around the patient, respect patient preferences, and put the patient in control.
Unequal treatment should be a fact of the past; disparities in care should be eradicated.
Increasing the quality of care is our goal. Implementing technology is a way to achieve this goal.
The description, expected background and competencies for the role are provided in a supplemental handout sheet entitled Health IT Workforce Roles and Competencies: Categories of Health IT Workforce Roles Requiring Short-Term Training.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

4. Types of Roles Roles requiring six month / short-term training
Mobile adoption support positions
Permanent staff of health care delivery and public health sites
Roles requiring university-based training that culminates in a degree (BS, MS, PhD, etc.)
The Office of the National Coordinator for Health IT defined twelve roles needed to achieve national electronic health record and health information interoperability goals. Six roles were designated as requiring six month short term training. The second group of six roles require university-based training at the baccalaureate and post-baccalaureate, including, the post-baccalaureate certificate, masters or doctorate levels. The six short-term training roles include mobile adoption support positions and more permanent staff positions.
Mobile adoption support positions will support implementation at specific locations for a period of time, and when their work is done, will move on to new locations.  Workers in these roles might be employed by regional extension centers, providers, vendors, or state/local public health agencies, and would work together in teams. These multiple employment settings, such as regional extension centers, providers, vendors, or state/local public health agencies, are referred to as “practices” in the ONC documentation. Permanent staff roles are needed for ongoing support of health IT that has been deployed in practices, hospitals, health centers, long-term care facilities, and health information exchange organizations. The description, expected background and competencies for the role are provided in a supplemental handout sheet entitled Health IT Workforce Roles and Competencies: Categories of Health IT Workforce Roles Requiring Short-Term Training.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

5. Related Roles Mobile Adoption Support Positions
Practice Workflow and Information Management Redesign Specialist
Clinician/Practitioner Consultant
Implementation Support Specialist
Implementation Manager
Permanent Staff of Health Care Delivery and Public Health Sites
Technical/Software Support Staff
Trainer
Six roles were designated by the Office of the National Coordinator as requiring six month short-term training. The six roles include both mobile adoption support positions and more permanent staff positions. The mobile adoption support roles include:
The aforementioned Practice Workflow and Information Management Redesign Specialist that assists in reorganizing the work of a provider to take full advantage of the features of health IT
The Clinician/Practitioner Consultant that in addition to the Practice Workflow and Information Management Redesign Specialist set of competencies, brings to bear the background and experience of a professional licensed to provide clinical care or a public health professional.
Implementation Support Specialist that provides on-site user support, above and beyond what is provided by the vendor, for the period of time before and during implementation of health IT systems in clinical and public health settings to be sure the technology functions properly and is configured to meet the needs of the redesigned practice workflow
Implementation Manager that provides on-site management of mobile adoption support teams for the period of time before and during implementation of health IT systems in clinical and public health settings.
The permanent staff roles include:
Technical/software support staff role that supports on an ongoing basis the technology deployed in clinical and public health settings, including maintaining systems, patching and upgrading of software, and providing one-on-one support, in a traditional “help desk” model, to individual users with questions or problems.
Trainer role that designs and delivers training programs, using adult learning principles, to employees in clinical and public health settings.
Preparation for these mobile adoption and permanent staff health IT roles will typically require six months of intense training for individuals with appropriate backgrounds. The description, expected background and competencies for the role are provided in a supplemental handout sheet entitled Health IT Workforce Roles and Competencies: Categories of Health IT Workforce Roles Requiring Short-Term Training. This component is a key component in the training for the Practice Workflow and Information Management Redesign Specialist and Clinician/Practitioner Consultant roles and provides valuable information relevant to the implementation support specialist, implementation manager, technical/software support staff, and trainer roles.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

6. Workflow is a Process Workflow includes: How tasks are accomplished
By whom
Task order
Task priority
Task timing
Choices and decisions
Location
Information needs
The main focus of this Component is workflow. Recall, a workflow is a process, it includes activities, entities (people or things that take part in the activities), and criteria that specify the order, priority and timing of the steps. Choices and decisions as well as the information needs are specified. Often, the physical location where the task occurs or proximity to performance locations of other activities need to be considered. All of these things together comprise workflow.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

7. Clinical Care Activities
Interaction with patients
Physical assessment
Ordering and conducting diagnostic tests
Decision making and diagnosis
Developing a treatment plan
Assessing compliance with treatment regimen
Patient education
Follow-up on test results
Records creation and management
Determination of confidentiality / privacy requirements
As we saw in the example in Unit 1, lecture a, clinical care episodes, for example, a patient visit to a provider’s office, can be broken down into their component processes; these processes are composed of more detailed activities. Examples of these activities in clinical care, listed here, include interaction with patients, physical assessment, ordering tests, making a diagnosis, developing a treatment plan, following-up on test results, etc. Successfully performing workflow analysis and process redesign in health care settings requires familiarity with common clinical activities, processes and how they vary in different clinical settings.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

8. Administrative Activities
Scheduling a patient visit
Registering a patient
Transporting and tracking a patient within a facility
Submitting a claim for reimbursement
Making a referral to a specialist
Sending / receiving health information to / from another provider
Food and laundry service
Clinical care also depends on administrative activities that are necessary for care. They include scheduling, transportation, documentation, billing, food service, laundry, and maintaining an inventory of supplies. These activities that impact the workflow during a clinical encounter, e.g., a visit to a provider’s office, or the flow of the visit from the perspective of the patient or provider are often considered in workflow analysis and process redesign.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

9. Grouped Activities (Tasks)
Admission
Surgery
Specimen collection
Reimbursement
Discharge
Handling of inpatient emergencies
Single activities (also called tasks or steps) are grouped together, “grouped activities” into processes. Some examples of activities grouped into processes include: Patient Admission, surgery, collecting lab specimens, etc.
The point is that steps in a process can be thought of in groups of smaller steps, or as individual steps. The detail level at which one thinks about clinical workflow depends on the detail level that is needed. For example, a professor teaching a new procedure to a resident will describe each single step. However, the medical assistant scheduling the procedure for a patient will think of the procedure as one step, the procedure.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

10. Examples of Roles in Health Care Settings
Providers
Medical Assistants
Phlebotomists
Receptionists
Billing Coordinators
There are several roles that are common to many health care practices. These include providers, (which can be physicians, physician assistants, nurse practitioners, and nurses), and allied health professionals. Allied Health professional roles are those “involved with the delivery of health or related services pertaining to the identification, evaluation and prevention of diseases and disorders; dietary and nutrition services; rehabilitation and health systems management, among others. Allied health professionals, to name a few, include dental hygienists, diagnostic medical sonographers, dietitians, medical technologists, occupational therapists, physical therapists, radiographers, respiratory therapists, and speech language pathologists” (ASAHP, 2011). While the providers are licensed professionals, there can be overlap in the roles. For example, the nurse may weigh the patient and take vital signs and a history, or these tasks may be performed by a medical assistant. Patient education may be provided by any of the providers. Any of the providers or a phlebotomist may draw blood for lab tests. Thus, when analyzing workflow, the role that performs a task must be clear. Clinics that perform outpatient procedures and hospitals tend to have more complex processes that involve even more roles.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

11. Location, Location, Location
Where tasks are performed can be important
Physical layout of a clinic impacts workflow
Patient transportation
Hallway traffic
Distance clinic staff must travel to accomplish tasks
Patient privacy
Where tasks are performed can be important. The physical layout of a clinic can impact workflow. For example, can the patients be weighed on the way to the exam room, or must they go past the exam room, get weighed, then come back, creating more hallway traffic? If patients must walk down the hallway, do they pass other patients, or pass procedure rooms? Do patients have to walk past exam rooms or back through the waiting room to leave the clinic? Are printers and copiers located conveniently for clinic staff who need them?
While changes in the physical layout of a clinic may not be feasible as part of process redesign, layout and its impact on physical workflow must be taken into account.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

12. Information Needs
What information is used and generated in the course of a patient encounter?
Do providers and clinic staff have ready-access to information they need when they need it?
Do patients have access to information about their health before, after and between visits?
Health care is an information-intensive endeavor, and information needs are an important part of workflow. For example, as part of Meaningful use, Eligible Provider Core Objective 5 (Eligible Provider Meaningful Use, 2010) – Maintain active medication list, providers are required to reconcile the information they have about medications a patient is taking at each visit. This requires that the patient knows what medications he takes, and that the provider can both access the records of medications that the patient is on AS WELL AS be able to update that list. This process could potentially be improved by better meeting patient and provider information needs, for example, by providing the patient information before their visit such as, a blank form to complete at home while they have ready access to their medications, or a pre-filled form with their medications that the doctor has on record.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

13. Unique Aspects of Health Care
System of “experts”
Physicians and physician extenders are ultimately ethically, morally and legally responsible for everything that happens to a patient
Physicians have taken an oath to “above all, do no harm”
Health care usually involves personal contact
Decisions impact patient’s health and well being
Patient care involves teams of people working in information-intense situations
Patterns of fundamental clinical routines are the product of years and decades of evolution
Conducting workflow analysis and process redesign in health care is different than working in other settings because of the unique aspects of health care.
You will be working within a “System of ‘experts’” and a culture in which
Physicians and physician extenders are ultimately ethically, morally and legally responsible for everything that happens to a patient, and in which
Physicians have taken an oath to “above all, do no harm”
Health care involves one-on-one contact with people
Decisions sometimes make the difference between “life or death”, or have the potential to seriously impact a person’s health
Patient care involves teams of people that depend on minute to minute communication and large amounts of information, and
Patterns of fundamental clinical routines are the product of years and decades of evolution. This evolution involves complex interactions between members of the health care team, technology, information, external forces and organizational factors. Sometimes the result of this evolution is a process that operates optimally. Other times, processes are the relic of compromises or constraints that are no longer important. Only careful analysis can differentiate the two.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

14. Complexities of Health Care
Each situation is unique
Involve multiple people and organizations
Many opportunities for delays and variability
Must take patient preference into account
Continually changing priorities
Many interruptions, options and exceptions
Have overlapping roles and responsibilities
Involves Humans and organizations
Vary from practice to practice
Subject to time and resource pressures
Other unique aspects of health care and clinical workflows that make workflow analysis and process redesign complex include the fact that clinical workflows:
Vary from practice to practice,
Involve multiple people and organizations, thus there are many opportunities for delays and variability,
Must take patient preference into account,
Have many interruptions,
Have many options and exceptions,
Have overlapping roles and responsibilities, and
Involves humans, organizations, information, and technology.
Because of the need to contain costs, health care today is subject to considerable time and resource pressure.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

15. Complexities of Health Care
Pause the slides and view the videos below about health care complexity
This slide provides links to short videos about the complexity in health care today. Pause the slides now and watch the videos, they are one and two minutes in length.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

16. Pulling it all Together
Clinical Workflow Impacts Patients
Problems, errors and delays are not just aggravating, inefficient or even infuriating
In medicine, more than in other fields, problems, errors and delays can cause serious harm
There are many factors that differentiate health care from other industries. One looms larger than all the rest. Health Care is about life and death. Care, including preventative care directly impacts an individuals health and wellness. Many decisions and actions taken in the course of health care involve intervening with someone’s physical or mental functioning. Things that impact the care process directly impact patients.
Problems, errors and delays are not just aggravating, inefficient or even infuriating.
Problems, errors and delays can cause serious harm.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

17. Common Processes in Physician Practices
Appointment scheduling
New patient intake
Existing patient intake
Exam and patient assessment
Ordering labs/receiving & communicating results
Prescriptions
Referrals out/in
Diagnostic testing
Billing
Now that we have talked about unique aspects of health care settings, let’s return to common clinical processes. Common processes in physician practices include:
Appointment scheduling,
New patient intake,
Existing patient intake,
Exam and Patient Assessment,
Ordering Labs, and receiving and communicating results,
Prescriptions,
Referrals both out and in,
Diagnostic testing, and
Billing.
On the next slide, you will have the opportunity to watch some videos and identify clinical processes mentioned.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

18. Common Health Care Processes
Electronic Medical Record (EMR/EHR) Videos, Parts 1-3:
To participate in improving processes in the clinical setting, we must first understand them. Pause the slides and view the three videos. As you watch the videos, make a list of the processes that the doctor in the video mentions. Each of these processes is a common process in primary care. Restart the slides after you view the videos and make your lists. Pause the slides and watch the videos now.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

19. Video Part I Processes Referral Following up on lab tests Billing
Obtaining insurance pre-approval
Monitoring patient outcomes
Reporting performance measures
Clinical processes mentioned in the Part I video include:
Referral,
Following up on lab tests,
Billing,
Obtaining insurance pre-approval for procedures, tests, or specialist referrals,
Monitoring patient outcomes, e.g.,
HbA1c
Cancer screening: colonoscopy, mammogram, PAP smear, and
Reporting performance measures.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

20. Video Part II Processes Include
Prescription refills
Billing
Following-up appointment no-shows
Scheduling same-day appointments
Tracking accounts receivable and resubmission of unpaid claims
Scanning old charts, i.e., getting old data into the new EHR system
Referrals
Clinical processes mentioned in the Part II video included:
Prescription refills,
Billing,
Following-up appointment no-shows,
Scheduling same-day appointments,
Tracking accounts receivable and resubmission of unpaid claims,
Scanning old charts, i.e., getting old data into the new EHR system, and
Referrals.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

21. Video Part III Clinical Processes
Receiving and reviewing electronically acquired data
Patient exam
Posting payments
Viewing practice financials
Answering call
Clinical processes mentioned in the Part III video included:
Receiving and reviewing electronically acquired data, e.g., EKGs,
Patient exam,
Posting payments,
Viewing practice financials, and
Answering call, e.g., questions from an emergency department physician.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

22. Lab Process Example
Locate the Ordering Lab Results -Using an EMR scenario in your course materials (Appendix of the Instructor’s Manual).
Your course materials include a written scenario about lab tests ordering.
Read the scenario.
As you read it, write down or highlight the following things :
Activities or steps in the process and their order,
Roles or people that take part in the process,
Where the steps are performed,
Choices or decisions, and
Information needs.
After you do this, restart the slides and we will talk through the results. Pause the slides now.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

23. Activities Patient arrives Patient checks in Patient pays co-pay
Patient called back to exam room
Nurse asks reason for visit
Nurse takes vital signs
Nurse locates electronic chart
Nurse confirms medications
Patient removes shoe and sock
Doctor examines patient
Doctor makes working diagnosis
We will go over the list of activities first.
Patient arrives,
Patient checks in,
Patient pays co-pay,
Patient called back to exam room,
Nurse asks reason for visit,
Nurse takes vital signs,
Nurse locates electronic chart,
Nurse confirms medications,
Patient removes shoe and sock,
Doctor examines patient, and
Doctor makes working diagnosis.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

24. Activities cont. Doctor describes treatment options and requirements
Patient chooses course of action
Doctor orders lab tests
Nurse obtains lab supplies
Nurse completes lab requisition form
Nurse labels tubes
Nurse draws blood
Nurse immediately centrifuges and refrigerates samples
Nurse provides patient education
Courier picks tubes up and takes to lab
Doctor describes treatment options and requirements,
Patient chooses course of action,
Doctor orders lab tests,
Nurse obtains lab supplies,
Nurse completes lab requisition form,
Nurse labels tubes,
Nurse draws blood,
Nurse immediately centrifuges and refrigerates samples,
Nurse provides patient education, and
Courier picks tubes up and takes to lab.
You may have left some off, for example, the activity of “patient arrives” or “making a co-pay” may not be germane to ordering lab tests. Some people might not include activities that are not relevant to the process of interest, and that is ok, and often necessary to focus attention on the main activities. If you left these activities off, it is ok. If you missed some main activities that were part of actual test ordering, read back through the scenario.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

25. Locations & Roles Locations Reception area Exam room Phlebotomy room
Patient
Receptionist
Nurse
Doctor
Courier
The locations include the reception area, exam room, and phlebotomy room; and the roles include the patient, receptionist, nurse, doctor, and courier.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

26. Choices and Decisions Working diagnosis (Doctor)
Patient preparation for Doctor (Nurse decides based on chief complaint)
Which treatment option (Patient decision)
Required tests (determined for each treatment option by clinical guidelines)
What tests or treatments to order and when (Doctor based on clinical guidelines)
The choices and decisions included:
Making a working diagnosis (the Doctor),
Patient preparation for Doctor (the Nurse decides what clothing needs to be removed based on chief complaint),
Which treatment option (Patient decision),
Required tests (determined for each treatment option by clinical guidelines), and
What tests or treatments to order and when (Doctor based on clinical guidelines).
Like activities, you may elect to include or exclude some decisions. For example, if you are interested in physical process steps, you might exclude mental decisions that do not impact physical actions. Or, if you are only interested in how information flows, you might exclude physical steps that do not impact information and decisions.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

27. Information Needs Co-pay amount
Existing medications for medication reconciliation
Treatment options for working diagnosis
Required tests / follow-up for treatment options
Patient and provider identifiers for lab test requisition
The information needs in the scenario include:
Co-pay amount,
Existing medications for medication reconciliation,
Treatment options for working diagnosis,
Required tests / follow-up for treatment options, and
Patient and provider identifiers for lab test requisition.
This concludes this exercise with the Lab Tests Ordering Scenario. If you missed any items, go back through the scenario and make sure you understand why. The ability to identify activities, roles, locations, decisions, and information needs is critical to process analysis. This skill must be mastered prior to the next unit. Your instructor may provide additional scenarios and practice exercises with them so that you can practice analyzing clinical scenarios in this way.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

28. Confusion about Workflow
Most people are not accustomed to thinking of what they do everyday in terms of workflow
Terms used in health care that may be confused with workflow or process analysis:
Regimented care
Clinical pathways, clinical guidelines
Accreditation and audit
Most people are not accustomed to thinking of what they do everyday in terms of workflow – that is why we need people trained as process analysts, to facilitate this process and to help practices accurately describe and analyze their processes.
Several terms used in health care that may be confused with workflow or process analysis are:
Regimented care,
Clinical pathways, clinical guidelines, and
Accreditation and audit.
On your own, look each of these terms up and think about the similarities and differences with process analysis. If you don’t normally think of things in terms of workflow, select a day, tomorrow maybe, and at each location you visit, identify three processes. Then, for each of these processes, list out the process steps that you witnessed, and those that you may not have witnessed but assumed to have happened so that you have a complete process described. Consider steps, their order and timing, decisions, locations, information needs, etc. This is an easy way to practice thinking in terms of workflow.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

29. Workflow Changes Must first, do no harm Must improve processes
Increase efficiency
Decrease delays and cost
Increase quality and safety
Improve the work environment
Improve ability to care for patients
Create a better overall patient experience
Workflow changes in the clinical setting, like physicians, “must first, do no harm,” and secondly must improve the following processes. Processes can be improved by:
Increasing efficiency,
Decreasing delays, errors, and cost,
Increasing quality and safety,
Improving the work environment,
Improving ability to care for patients, and
Creating a better overall patient experience.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

30. Fundamentals of Health Workflow Process Analysis & Redesign Summary
What a Practice Workflow and Information Management Redesign Specialist Does
Document context and process so that it can be analyzed
Analyze process
Recommend redesign options
Implement redesign
Evaluate, adjust and maintain changes
This concludes Fundamentals of Health Workflow Process Analysis & Redesign. This unit consisted of 2 lectures, lecture a,
Concepts of Health Care Processes and Process Analysis and lecture b, Clinical Workflow.
In summary, the purpose of Clinical Process Redesign is to improve the safety, efficiency and overall quality of health care. Meaningful use of Health IT can help do this. The Practice Workflow and Information Management Redesign Specialist role helps practices improve the safety, efficiency and overall quality of care by leveraging Health IT. The Practice Workflow and Information Management Redesign Specialist role:
Documents context and process so that it can be analyzed,
Analyzes process,
Recommends redesign options, including opportunities to leverage Health IT,
Works with practices to implement redesigned processes, and
Evaluates, adjusts and maintains changes.
The Specialist may do these things himself, or may teach groups of practices and facilitate groups to do the analysis and redesign themselves.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow Lecture b

31. Clinical Workflow References – Lecture b
Allied health professionals. (n.d.). Retrieved December 29, 2011, from Association of Schools of Allied Health Professions:
Committee on Quality of Health Care in America and Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century Washington: National Academies Press.
Eligible provider meaningful use meaningful use core measures measure 5of 15 -Stage 1. (2010, November 7). Retrieved December 29, 2011, from
No audio.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Fundamentals of Health Workflow Process Analysis and Redesign Clinical Workflow
Lecture b