10 - Fundamentals of Health Workflow Process Analysis and Redesign - Unit 6 - Process Redesign - Lecture B

Fundamentals of Health Workflow
Process Analysis and Redesign

Process Redesign
Lecture b
This material Comp10_Unit6b 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 IU24OC000024.
Process Redesign
Learning Objectives
2
1. Identify the factors that optimize workflow processes in health care
settings (Lecture a)
2. Describe how information technology can be used to increase the
efficiency of workflow in health care settings (Lectures a, b)
3. Identify aspects of clinical workflow that are improved by EHR
(Lecture b)
4. Propose ways in which the workflow processes in health care
settings can be re-designed to ensure patient safety and increase
efficiency in such settings (Lecture c)
5. Use knowledge of common software functionality and meaningful
use objectives to inform a process redesign for a given clinic
scenario (Lectures c, d, e)

Health IT Workforce Curriculum
Version 3.0/Spring 2012
Fundamentals of Health Workflow Process Analysis & Redesign
Process Redesign
Lecture b
Process Redesign
Topics Lecture b
Describe how information technology can
be used to increase the efficiency of
workflow in health care settings
Identify aspects of clinical workflow that
are improved by EHR

3
Process Redesign
Lecture b
Human-Centered Design (HCD)
HCD is an approach to systems design and
development that aims to make interactive
systems more usable by focusing on the use
of the system and applying human factors/
ergonomics and usability knowledge and
techniques.

(ISO, 2010)

4
Process Redesign
Lecture b
Big D and Little d
For large software systems such as
electronic health records, we distinguish two
types of design:

D design of the software itself
d configuration of the system to make it work
for a particular clinics processes

Decisions about how electronic health record software is used in the clinic
workflow heavily impacts how clinic providers and staff interact with the system.

5
Process Redesign
Lecture b
Human-Centered Design Principles
ISO 9241-210
a) The design is based upon an explicit
understanding of users, tasks and environments
b) Users are involved throughout design and
development
c) The design is driven and refined by user-
centered evaluation
d) The process is iterative
e) The design addresses the whole user experience
f) The design team includes multidisciplinary skills
and perspectives

6
Process Redesign
Lecture b
ISO HCD Framework
7
Process Redesign
Lecture b
ISO. This material is reproduced from ISO 9241-210:2010 with permission of the American National
Standards Institute (ANSI) on behalf of the International Organization for Standardization (ISO).
Integrating Process & Information Design
8
Process Redesign
Lecture b
Technology-centered design
As-is care
process
model
Information
architectures
Improved
process
models
Sensitivity
analysis
S/W
implement
ation
models
Trade-off
analysis
Better care
process
Cost-effective
HIT system
Information usage
Risk & cost
Value to care
Care-centered design
LEAN
Source: Figure from Butler 2011, used with permission
Design Solutions
Consider:
Sources of ideas
Using and further developing other designs
Logical progression from previous designs
Innovative creativity
Perspectives
Alignment

9
Process Redesign
Lecture b
Design Methods
Leveraging and further developing other designs
Design guidelines and standards
Best practices from other industries
Other clinics which have implemented EHR
Other clinics which have a proven process that
doesnt depend on EHR
Prior quality improvement projects at your clinic
Problems with current clinic workflows

10
Process Redesign
Lecture b
Design Methods cont.
Logical progression from previous designs
Gap Analysis between as-is and clinics ideal
Leveraging technology, i.e., automation
Workflow diagram analysis

11
Process Redesign
Lecture b
Design Methods cont.
Innovative creativity
Brainstorming
Parallel Design
Storyboarding
Affinity Diagrams
Organizational Prototyping

12
Process Redesign
Lecture b
Design Perspectives
Patient
Clinic providers and staff

13
Process Redesign
Lecture b
Design Alignment
Organizational structures
i.e., Roles, responsibilities, authority
Available talent
Physical layout
Information flow
Information use
Regulatory requirements
Accreditation and Meaningful Use

14
Process Redesign
Lecture b
Three Key Considerations
Key considerations in process redesign:
Clinical decision support
Other Meaningful Use objectives
Physical layout
System interfaces

15
Process Redesign
Lecture b
Impact of CDSS on Workflow
Information must be available when providers
and staff need it
i.e., At the point of decision making
Are they logged into the system?
Do they need to be or will they be in front of a computer to
get the alert?
Do they need to be with the patient?
Do they have what they need to act on the alert?
Decision must be supported
Representation
Information
Right place, right time, right resources

16
Process Redesign
Lecture b
Impact of Physical Location on
Workflow
Location of computers
Other office hardware
Office layout:
Patient, provider and staff flow
Traffic congestion
Number of steps
Standing or sitting

17
Process Redesign
Lecture b
Impact of System Interfaces on
Workflow
Common interfaces
Practice Management System for billing
Local lab systems
Imaging
Local hospital
Local Health Information Exchange
Interfaces impact what information will be
available electronically and when

18
Process Redesign
Lecture b
Review of New Process
Providers and Staff look for:
Points of failure
Potential confusion
Bottlenecks
Design Team considerations
Technology Vendors determinations:
Technology Leveraged
Pot holes

19
Process Redesign
Lecture b
Process Redesign
Summary Lecture b

20
Human-Centered Process Design
Impact on workflow of:
Clinical decision support
Physical layout
System interfaces

Process Redesign
Lecture b
Process Redesign
References Lecture b
References
Butler, K., Bahrami ,A., Esposito, C,, Hebron, A. (2000). Conceptual models for coordinating the design of user work
with the design of information systems. . Data & Knowledge Engineering, 33(2), 191-198.
Butler A. (2011, May). Human Center for Design & Engineering, University of Washington, MATH Method & Tools for
Evidence-based Health IT, Presentation at Duke University, Durham, NC.
ISO 9241-210:2010(E) Ergonomics of humansystem interaction Part 210:Human-centred design for interactive
systems. Retrieved from
http://www.iso.org/iso/iso_catalogue/catalogue_ics/catalogue_detail_ics.htm?csnumber=52075
Mansar, S. L., & Reijers, H. A. (2005). Best practices in business process redesign: validation of a redesign
framework. Computers in Industry, 56, 457-471. Retrieved from
http://is.tm.tue.nl/staff/hreijers/H.A.%20Reijers%20Bestanden/Mansar_2005_Computers-in-Industry.pdf
Images
Slide 7: ISO HCD Framework. ISO 9241-210:2010(E) Ergonomics of humansystem interaction Part 210:Human-
centred design for interactive systems. Retrieved from
http://www.iso.org/iso/iso_catalogue/catalogue_ics/catalogue_detail_ics.htm?csnumber=52075
Slide 8: Integrating Process and information. Image used with permission. Butler et al. (2000)

21
Process Redesign
Lecture b

10 - Fundamentals of Health Workflow Process Analysis and Redesign - Unit 6 - Process Redesign - Lecture B

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