Improving Clinical Workflow in Ambulatory Care: Implemented Recommendations in an Innovation Prototype for the Veteran’s Health Administration Article Swipe
Emily S. Patterson
,
Svetlana Z. Lowry
,
Mala Ramaiah
,
Michael Gibbons
,
David Brick
,
Robert Calco
,
Greg Matton
,
Anne Miller
,
Ellen Makar
,
Jorge A. Ferrer
·
YOU?
·
· 2015
· Open Access
·
· DOI: https://doi.org/10.13063/2327-9214.1149
YOU?
·
· 2015
· Open Access
·
· DOI: https://doi.org/10.13063/2327-9214.1149
Introduction: Human factors workflow analyses in healthcare settings prior to technology implemented are recommended to improve workflow in ambulatory care settings. In this paper we describe how insights from a workflow analysis conducted by NIST were implemented in a software prototype developed for a Veteran’s Health Administration (VHA) VAi2 innovation project and associated lessons learned.Methods: We organize the original recommendations and associated stages and steps visualized in process maps from NIST and the VA’s lessons learned from implementing the recommendations in the VAi2 prototype according to four stages: 1) before the patient visit, 2) during the visit, 3) discharge, and 4) visit documentation. NIST recommendations to improve workflow in ambulatory care (outpatient) settings and process map representations were based on reflective statements collected during one-hour discussions with three physicians. The development of the VAi2 prototype was conducted initially independently from the NIST recommendations, but at a midpoint in the process development, all of the implementation elements were compared with the NIST recommendations and lessons learned were documented.Findings: Story-based displays and templates with default preliminary order sets were used to support scheduling, time-critical notifications, drafting medication orders, and supporting a diagnosis-based workflow. These templates enabled customization to the level of diagnostic uncertainty. Functionality was designed to support cooperative work across interdisciplinary team members, including shared documentation sessions with tracking of text modifications, medication lists, and patient education features. Displays were customized to the role and included access for consultants and site-defined educator teams.Discussion: Workflow, usability, and patient safety can be enhanced through clinician-centered design of electronic health records. The lessons learned from implementing NIST recommendations to improve workflow in ambulatory care using an EHR provide a first step in moving from a billing-centered perspective on how to maintain accurate, comprehensive, and up-to-date information about a group of patients to a clinician-centered perspective. These recommendations point the way towards a “patient visit management system,” which incorporates broader notions of supporting workload management, supporting flexible flow of patients and tasks, enabling accountable distributed work across members of the clinical team, and supporting dynamic tracking of steps in tasks that have longer time distributions.
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- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.13063/2327-9214.1149
- http://egems.academyhealth.org/articles/10.13063/2327-9214.1149/galley/121/download/
- OA Status
- diamond
- Cited By
- 15
- References
- 18
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W1714012894
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W1714012894Canonical identifier for this work in OpenAlex
- DOI
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https://doi.org/10.13063/2327-9214.1149Digital Object Identifier
- Title
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Improving Clinical Workflow in Ambulatory Care: Implemented Recommendations in an Innovation Prototype for the Veteran’s Health AdministrationWork title
- Type
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articleOpenAlex work type
- Language
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enPrimary language
- Publication year
-
2015Year of publication
- Publication date
-
2015-07-09Full publication date if available
- Authors
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Emily S. Patterson, Svetlana Z. Lowry, Mala Ramaiah, Michael Gibbons, David Brick, Robert Calco, Greg Matton, Anne Miller, Ellen Makar, Jorge A. FerrerList of authors in order
- Landing page
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https://doi.org/10.13063/2327-9214.1149Publisher landing page
- PDF URL
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https://egems.academyhealth.org/articles/10.13063/2327-9214.1149/galley/121/download/Direct link to full text PDF
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YesWhether a free full text is available
- OA status
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diamondOpen access status per OpenAlex
- OA URL
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https://egems.academyhealth.org/articles/10.13063/2327-9214.1149/galley/121/download/Direct OA link when available
- Concepts
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Workflow, Administration (probate law), Ambulatory, Health care, Medical emergency, Medicine, Process management, Business, Nursing, Computer science, Political science, Database, Law, Internal medicineTop concepts (fields/topics) attached by OpenAlex
- Cited by
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15Total citation count in OpenAlex
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2024: 1, 2023: 1, 2022: 1, 2021: 1, 2020: 2Per-year citation counts (last 5 years)
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18Number of works referenced by this work
- Related works (count)
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10Other works algorithmically related by OpenAlex
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