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Workflow and Process Mapping

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Workflow and Process Mapping


General

(from Inpatient Computerized Provider Order Entry (CPOE): Findings from the AHRQ Portfolio)[1]

 

Understanding workflows and redesigning inefficient processes are critical steps to ensuring successful adoption of CPOE. CPOE is a disruptive technology that fundamentally changes the processes used to place, review, authorize, and carry out orders. Researchers and practitioners have written extensively about the importance of workflow redesign when implementing CPOE.  Grantees heeded the advice in this body of literature, and they invested heavily in process redesign when planning for their CPOE implementations.

 

Before selecting a CPOE solution, there is no substitute for conducting a needs assessment and gathering requirements to determine product and workflow needs. CPOE efforts should not be initiated in a “product selection” mode. Rather, CPOE should be viewed as a solution to a recurring patient safety problem.

 

Projects mapped existing processes to “future state” ones to better understand the impact of changes on their systems. Although they required a significant investment of time during the early stages of planning, process redesign efforts enabled projects to identify and correct weaknesses in existing information processes. This enabled them to integrate electronic ordering effectively into their clinical workflow. Decisionmakers in the redesign process included “on-the-ground” clinicians, clinical managers, organization executives, and other staff.

 

Some grantees used manual techniques (e.g., pencil and paper) to diagram their workflows. Others used mapping software (e.g., Microsoft® Visio®) to outline existing processes and  recommended changes. Mapping software can help end users and project implementation teams to visually represent workflow needs during system design and training. Diagramming the full cycle of how an order is tracked through a system, from inception to completion and notification, is critical to showing how existing and redesigned processes impact system performance.

 

For instance, grantees indicated that the use of a CPOE system significantly impacted the workflow of unit clerks, a finding that must be considered in the redesign process. When using a paper-based system, unit clerks are able to track and manage the ordering process. For example, a unit clerk may be able to intercept a duplicate, paper-based test order. In an electronic order environment, the unit clerk may not be able to review orders before they are delivered to their recipient (e.g., the laboratory). This has the potential to impact negatively the workflow of other hospital departments.

 

Several grantees emphasized the need for CPOE implementation to involve representatives from many areas of hospital operations in discussions of how CPOE implementation will affect their department’s workflow and its interaction with other departments or units. Implementers should recognize that some tasks will be reassigned to different personnel, others will be eliminated, and some new tasks will be added. Another lesson from grantees is that it is important to avoid automating an inefficient manual process from the paper world.

 

 

Tools

 

Example of a CPOE Workflow process map:

Workflow process map example

Workflow Redesign in Support of the Use of Information Technology Within Healthcare

Footnotes

  1. Dixon BE, Zafar A. Inpatient Computerized Provider Order Entry (CPOE): Findings from the AHRQ Portfolio (Prepared by the AHRQ National Resource Center for Health IT under Contract No. 290-04-0016). AHRQ Publication No. 09-0031-EF. Rockville, MD: Agency for Healthcare Research and Quality. January 2009.