Mapping Multi-Site Clinic Workflows to Design Systems-Enabled Interventions

Abstract

Objective:Variations in processes for different clinics and health systems can dramatically change the way preventive interventions are implemented. We present a method for documenting these variations using workflow diagrams and demonstrate how understanding workflow aided an electronic health record (EHR) embedded colorectal cancer screening intervention.Materials and Methods:We mapped variation in processes for ordering and documenting fecal testing, current colonoscopy, prior colonoscopies, and pathology results. This work was part of a multi-site cluster-randomized pragmatic trial to test a mailed approach to offering fecal testing at 26 safety net clinics (in eight organizations) in Oregon and Northern California. We created clinic-specific workflow diagrams and then distilled them into consolidated diagrams that captured the variations.Results:Clinics had varied practices for storing and using information about colorectal cancer screening. Developing workflow diagrams of key processes enabled clinics to find optimal ways to send fecal test kits to patients due for screening. The workflows informed the rollout of new EHR tools and identified best practices for data capture.Discussion:Diagramming workflows can have great utility when implementing and refining EHR tools for clinical practice, especially when doing so across multiple clinical sites. The process of developing the workflows uncovered successful practice recommendations and revealed limitations and potential effects of a research intervention.Conclusion:Our method of documenting clinical process variation might inform other EHR-powered, multi-site research and can improve data feedback from EHR systems to clinical caregivers.

Clinic Factors Associated With Mailed Fecal Immunochemical Test (FIT) Completion: The Difference-Making Role of Support Staff

“…Our approach was theoretically informed by literature on context, 27 constructs from the Consolidated Framework for Implementation Research (CFIR), 28,29 and research defining clinical workflows. 23,30 The Kaiser Permanente Northwest Institutional Review Board (Portland, Oregon) approved PROMPT, with ceding agreements from partnering institutions.…”

Assessment of organizational readiness to implement an electronic health record system in a low-resource settings cancer hospital: A cross-sectional survey

“…they overrun budgets or implementation time, do not provide end user satisfaction, or are completely abandoned [3][4][5][6][7].Implementation of EHRs is difficult because it is not merely a technological change, but rather a socio-technical change process that affect many aspects of the organization [8][9][10]. It often results into changes or disruptions in clinical workflows, introduction of extra tasks, or shifting of tasks from one cadre to another [3][4][5]11,12] e.g. patients entering clinical history via patient portals or medical assistants and front desk refilling prescriptions, a task usually done by physician and pharmacists [13].…”

Standardization and alignment of data capture practices to clinical processes in the evaluation of living kidney donor candidates

“…In the long term, our goal is to foster the practice of documenting PHI at a single designated point to avoid unnecessary data management and reduce errors in data entry. 13 Through thorough analysis of aforementioned data, the CLiKeD database also provides an opportunity for the creation of targeted knowledge translation and patient engagement tools. For instance, reliable in-centre data may be used to develop applicable educational materials on themes relevant to LKD candidates such as "the likelihood of becoming a kidney donor" or "the estimated time to complete an LKD candidate evaluation.…”