Process Improvement with Electronic Health Records: A Stepwise Approach to Workflow and Process Management, 1st Edition (Paperback) book cover

Process Improvement with Electronic Health Records

A Stepwise Approach to Workflow and Process Management, 1st Edition

By Margret Amatayakul

Productivity Press

279 pages | 109 B/W Illus.

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Although physicians and hospitals are receiving incentives to use electronic health records (EHRs), there is little emphasis on workflow and process improvement by providers or vendors. As a result, many healthcare organizations end up with incomplete product specifications and poor adoption rates.

Process Improvement with Electronic Health Records: A Stepwise Approach to Workflow and Process Management walks you through a ten-step approach for applying workflow and process management principles regardless of what stage your organization is in its EHR journey. Introducing workflow and process mapping as essential elements in healthcare improvement, it includes detailed guidance, helpful tools, and case studies in each chapter. It also:

  • Compares EHR workflow and process management to other continuous quality improvement methodologies
  • Highlights the processes that need to be addressed in EHR workflow and process redesign
  • Describes the level of detail necessary for workflow and process mapping to be effective
  • Explains how to create change agents and offers time-tested change management tools

The book describes the process for getting stakeholders to create, document, and validate new workflows and processes. Using case studies to illustrate the unique requirements of health information technology (HIT) and EHR acquisition, this reference provides you with simple yet powerful tools—along with step-by-step guidance—for the effective use of workflow and process mapping within healthcare.

Table of Contents

Introduction to Workflow and Process Management in Health Care

Context of Workflow and Process Management in Health Care

Workflow and Process Management for Clinical Transformation

Challenges of Workflow and Process Management in Health Care

Workflow and Process Management Defined for Health Care

Case Study 1.1: Workflow for Preventive Screening

Workflows and Processes Performed by Knowledge Workers

Case Study 1.2: Diagnosis-Drug Selection

Challenges and Needs for Workflow and Process Management for Knowledge Workers

Case Study 1.3: Sequencing of Data in an EHR

Key Points


Workflow and Process Management Overview

Definitions of Terms: Workflow and Process Management

Definitions of Terms: Process and Workflow

Case Study 2.1: Poor Dataflow Yields Medical Error

Definitions of Terms: Workflow and Process Mapping

Relationship of Workflow and Process Management for EHR and HIT to Other CQI Methodologies

Health Care Workflow and Process Management Timing

Health Care Workflow and Process Management Stakeholders

Case Study 2.2: Redesigning a Patient Room for a New Hospital

Case Study 2.3: Clinic Staff Mapping the Refill Process

Relationship and Importance of Workflow and Process Management to Change Management

Steps in Workflow and Process Management

Key Points


Step 1: Assess Readiness for Workflow and Process Management

Understand Organizational Culture for Change

Case Study 3.1: The Itinerant C Suite

Change an Organization’s Culture

Assess End-User Readiness for the Clinical Transformation That EHR

and HIT Represent

Educate Stakeholders about EHR and HIT

Set S.M.A.R.T. Goals

Case Study 3.2: On-board and Overboard with Goal Setting

Workflow and Process Management Governance

Key Points


Step 2: Compile Process Inventory

Process Inventory Description and Purpose

Process Inventory Worksheet

Case Study 4.1: Clinic Processes

Case Study 4.2: Hospital Processes

Generic Lists of Processes

Compiling the Process Inventory

Managing the Process Inventory

Process Inventory Database

Key Points


Step 3: Select Tools and Train Team

Workflow and Process Mapping Tool Selection

Workflow and Process Mapping Tools

Case Study 5.1: Nurse Travel Time in a New Hospital

Case Study 5.2: Downstream Time Savings Saves the Day

Selecting the Right Tool(s) and Following Tool Conventions

Level of Detail

Training the Workforce to Perform Workflow and Process Mapping

Key Points


Step 4: Map Current Workflows and Processes

Documenting While Doing

Case Study 6.1: Mini-EHR Serves a Dual Purpose

Documenting Current Processes

Documenting Boundaries

Documenting Current Operations

Case Study 6.2: Credentials Make a Difference

Documenting Variations in Operations

Case Study 6.3: Process Variation

Documenting Appropriate Operational Detail

Case Study 6.4: Too Little Detail

Case Study 6.5: Too Much Detail

Documenting Decision Making

Clinical Decision Support

Documenting Decisions in a Process Map

Annotating Frequency of Decision Making, Operations, and Boundaries

Documenting Flow

Flowcharting Conventions

Special Symbols

Flowcharting Software Support

Subsidiary Documents

Process Mapping Template

Key Points


Step 5: Obtain Baseline Data

Purposes and Uses of Baseline Data Collection in Workflow and Process Management

Types of Benefits Studies

Risks and Benefits of Baseline Data Collection

Metrics for Benefits Data

Case Study 7.1: Why Does it Take Twice as Long to Document?

Case Study 7.2: Dismayed Physician Resolves to Acquire EHR

Strategies for Conducting Benefits Realization Studies

Data Collection Tools

Case Study 7.3: Patient Perspective Survey

Sampling Methodology

Communications Surrounding Baseline Data Collection and Benefits

Realization Studies

Key Points


Step 6: Validate Workflow and Process Maps

Need for Validation


Case Study 8.1: Obscure Terminology

Issues in "As-Is" Maps are Common

Seven Deadly Sins of Workflow and Process Mapping and Their Salvations

Taking a Validation Timeout

Key Points


Step 7: Identify Process Redesign Opportunities

The Process of Redesign

Case Study 9.1: Contrarian Contributions to Process Redesign

Key Characteristics for Redesign

Case Study 9.2: Clinically Relevant Duplication

Case Study 9.3: Was the Task Performed, or Is Socialization Needed?

Case Study 9.4: Reorganize the Environment to Improve the Use of EHR

Case Study 9.5: Beating the System

Documenting the Redesigned Workflows and Processes

Validating the Redesigned Process

Key Points


Step 8: Conduct Root Cause Analysis to Redesign Workflows and Processes

Cause and Effect

Case Study 10.1: Causality of Noncompliance with BC-MAR System

Weighing Potential Solutions

Requirement for Root Cause Analysis

Tools and Techniques to Aid Root Cause Analysis

Case Study 10.2: New Workflow Results in Construction Project

Key Points


Step 9: Implement Redesigned Workflows and Processes

Implementing Redesigned Workflows and Processes

Case Study 11.1: Consequences of Training Without Workflow and Process Management

Making Change Management a Priority

Creating Change Agents

Case Study 11.2: Grime Scene Investigators Focus on the Hand Hygiene Process

Change Management Tools

Case Study 11.3: Forces Impacting EHR Adoption

Case Study 11.4: Physician Strategy Impacts All

Key Points


Step 10: Monitor Goal Achievement with Redesigned Workflows

Monitoring Goal Achievement

Measuring Results

Planning for Monitoring and Measuring

Celebrating Success

Case Study 12.1: Celebration Gone Awry

Case Study 12.2: A True Celebration for Learning

Correcting Course




About the Author

Margret Amatayakul is a health information management professional with a passion for automating medical records since her first professional job included creating a retinal disease registry on punch cards! She is currently president of Margret\A Consulting, LLC. The firm provides integrated delivery systems, hospitals, physician practices, vendors, health plans, their business associates, and the legal and investment communities with consulting, freelance technical writing, and educational programming to improve quality and cost-effectiveness of the strategic business of health care through IT. Margret is also adjunct professor in the health information and informatics management master’s program at the College of St. Scholastica; and co-founder and member of the board of examiners of Health IT Certification, LLC. Margret has formerly held positions as the associate executive director of the American Health Information Management Association (AHIMA), associate professor at the University of Illinois Medical Center, and director of the medical record department at the Illinois Eye and Ear Infirmary. She is the author of numerous books, textbook chapters, and articles on electronic health records and HIPAA/HITECH privacy and security compliance. She has served on the board of directors of the Healthcare Information Management and Systems Society (HIMSS) and is active in several other professional health informatics organizations.

Subject Categories

BISAC Subject Codes/Headings:
BUSINESS & ECONOMICS / Quality Control
BUSINESS & ECONOMICS / Industries / Service Industries
COMPUTERS / Information Technology
MEDICAL / Administration