Health Informatics Workflow Management: A Case Study

Introduction

A major focus area in healthcare settings over the past several years has been the support of data collection and transmission of patient information through computer-based workflow systems. This case study analyzes the deployment of a commercially available healthcare workflow system in a hospital setting. Research findings show that workflow organizational support as a strategic solution—and the use of an implementation team with members having varying functional roles—were critical elements not just for success, but also for creating a comprehension of data flow into and through the system, given the complex and challenging nature of healthcare work processes. It is important to understand workflow management system maturity, the organizational effect of workflow, and human participation and interaction specific to workflow contexts.

Workflow entails the automation of business processes. It is designed to offer support for business activity coordination in order to attain organizational goals. An integral element of workflow is collaboration—it involves the interaction of people and computer-based processes to facilitate the movement of work from user to user, or department to department, within a healthcare setting. Workflow systems ensure that work is routed in the correct sequence, provide document and data access to workers, and track the execution of work processes. They offer information flow support for health information management based on business processes such as deficiency processing and management, analysis of patient charts, patient admission, patient discharge, utilization review, patient billing, and record completion.

The health information management (HIM) department is where most workflow processes begin. Patient billing, medical records, and other hospital resource processes that require detailed patient information are automated through workflow systems. Collaborative computing efforts have been attributed to workflow technology; however, the emergence of workflow and collaborative computing has been slow. Despite the importance of workflow systems in hospital settings, their development is not only sensitive to the particular tools utilized, but is also largely unstructured.

Workflow systems are ineffective at attaining optimal productivity when their development and implementation challenges are not completely analyzed and addressed. Lack of access to workflow systems in real-world settings has been identified as one of the primary challenges hindering analysis of such systems. Although healthcare institutions that have implemented workflow systems have experienced or are expected to experience tremendous growth in the next decade, they still face evolving challenges in expertise and knowledge. Healthcare institutions rarely share their workflow system designs, whether they consider them a success or a failure. Workflow technology implementations are time-consuming and complex, which complicates data collection processes.

Avenue Healthcare is experiencing problems mapping data flow between its two facilities and its data center facility, as well as with other external systems. This paper studies a workflow management system that can help overcome these workflow issues—specifically, the challenge of mapping information flow between different facilities owned by a single institution and their main data center. As the Informatics Project Manager, the proposed solution is a workflow management software called TAG DOC, designed to address these issues. The manager's primary role entails overseeing the new software's implementation and maintenance through structured project management (Aalst & Hee, 2004).

The Current State of Avenue Healthcare

Avenue Healthcare is a clinic located in the northeastern part of the United States. The institution is an advanced acute care facility that operates on two independent campuses, each situated in a separate area of the city. The total number of patient beds across both campuses is 800. On average, the facility handles approximately 42,000 inpatient admissions per year, 400,000 outpatient diagnostic procedures, and 73,000 emergency department visits. The facility serves as a regional resource for cardiovascular medicine, cancer treatment, surgical services, burn treatment, and kidney transplantation, and also operates a regional trauma center.

Health Information Management (HIM) resources are accessible on both campuses. However, the primary HIM department is based in a separate facility that also hosts the Information Systems (IS) department and the data center. The three facilities are connected via a high-speed network. The principal workflow challenge experienced by Avenue Healthcare is mapping information flow across these three separate facilities. The primary information handled involves patient data relating to diagnoses, prescriptions, admissions, discharges, and similar records. The main system users include nurses, system administrators, pharmacists, and physicians. Physicians are responsible for treating patients; nurses deliver healthcare to patients undergoing treatment, including drug administration; pharmacists provide prescriptions through the healthcare pharmacy; and administrators manage and monitor the system to ensure it operates as expected at all times (eHealth Conference et al., 2011).

System Issues and Problems

Avenue Healthcare has workflow issues mapping information transfer between its two facilities and the data center facility. As a result, the hospital experiences delays, interruptions, pauses, reworks, established workarounds, gaps caused by omission of critical steps, and physicians perceiving processes as illogical. These problems lead to slower progress, decreased job satisfaction, and ultimately lower quality of patient care. Because the hospital handles large volumes of patient data, poor workflows result in the loss of valuable information, which in turn impedes coordination and communication between nurses and physicians, further increasing workflow interruptions.

The deficient workflow system also leads to a decreased ability to deviate from routine sequences when necessary, and nurses dropping tasks during busy periods. The large volumes of patient data being transferred and the frequency of handoffs contribute to information degradation. Interruptions break the workflow cycle, determining what information is recorded and passed on to the next user. Due to these systemic issues, it is important that Avenue Healthcare adopt a new workflow management system capable of overcoming these challenges (In Berner, 2013).

Proposed Innovation: TAG DOC

The workflow innovation proposed for Avenue Healthcare is a commercially available product created by a Fortune 100 Healthcare Information Systems vendor. It is an imaging and information management system based on client/server technology—TAG DOC—which integrates and supplements existing healthcare applications. The system's technological foundation allows for electronic capture, indexing, storage, and retrieval of processed data stored across various media and electronic platforms from a centralized location. An online patient chart is created through the consolidation of primary patient information systems data with supplementary information. An EPRS database also interfaces with the workflow system to help track document routing, patient data queries, and real-time capture of patient information feeds.

The innovation's workflow features allow for automation and customization of information flow within the system. Work objects, connected to one another to develop information flow throughout the work process, are used to construct workflow threads. Fourteen workflow objects are available for this purpose.

Business processes supportable through the development of workflow threads include deficiency processing and management, patient chart analysis, utilization review, record completion, patient admission, and patient discharge. Release of information requests and patient accounting for billing are additional processes that can be supported by the proposed innovation. Workflow map processing is controlled by a build-time agent. The processing of the workflow map occurs in a cyclical manner: the workflow agent executes work objects in a pre-determined order by object type, processing the object links defined in work threads. The execution cycle restarts after all links have been processed and continues until the workflow agent is terminated. The agent is scheduled to operate continuously and is only stopped when system backups are required.

In general, all system users have access to information stored in the centralized system via the internet, with system security provided through an SSL protocol. This simplifies the workflow process, eliminating the mapping issues that previously existed between the two campus facilities and the data center facility (Trotter & Uhlman, 2011).

References

Aalst, W., & Hee, K. (2004). Workflow management: Models, methods and systems. Cambridge, MA: MIT Press.

Barker, S., & Cole, R. (2012). Brilliant project management: What the best project managers know, do and say.

eHealth Conference, Szomszor, M., & Kostkova, P. (2011). Electronic healthcare: Third international conference, eHealth 2010, Casablanca, Morocco, December 13–15, 2010: Revised selected papers. Berlin: Springer.

Harvard Business Review Press. (2013). HBR's guide to project management.

In Berner, E. S. (2013). Informatics education in healthcare: Lessons learned.

Trotter, F., & Uhlman, D. (2011). Meaningful use and beyond. Sebastopol, CA: O'Reilly.