View source for Describing and Modeling Workflow and Information Flow in Chronic Disease Care


== Background ==
The purpose of this study was to follow three outpatient clinics who served patients with chronic diseases.  It was conducted over 10 months to understand the [[methods to capture workflow]] and practices of these clinics in order to develop useful tools for documenting to increase efficiency and improve patient safety and outcomes. <ref name="Describing and Modeling Workflow">Unertl, 2009. Describing and Modeling Workflow and Information Flow in Chronic Disease Care http://www.ncbi.nlm.nih.gov/pubmed/19717802</ref>

== Methods ==
Data was obtained via direct observation, interviews, and workflow models of the clinics.  Clinics selected in the study included: multiple sclerosis(MS), cystic fibrosis(CF), and diabetes mellitus(DM).  Direct observation and interviews included watching computer use, and comments from clinical and non- clinical staff using the [[EMR|EHR]].  Some of the activities observed included:  patient check in, diagnostic tests, prescribing, handoffs, patient check outs, and examinations.

== Results ==
Based on the analysis of observation data and interviews of workflow, information flow, and patient/provider interactions, researchers were able to develop a protocol for HIT development for care of patients with chronic diseases. The following guidelines were recommended:
* Applications should be designed to support shared needs and behaviors in chronic disease care.
* Applications should be designed to allow for customization for disease-specific needs.
* Applications should allow customization to support the needs of different types of users.
* New approaches for information input into the EHR should be explored.
* Efficient transfer of data from medical devices into the EHR should be supported.
* Information scanned into the system should be searchable, quickly viewable, and more accessible.
* The EHR should be designed so that users are able to search through the EHR quickly and easily to filter out important information.
* Alternate methods of displaying the longitudinal data for individual patients should be investigated to determine if they assist in the cognitive processing of electronic data.
* New tools and processes should be as efficient as existing approaches or yield significant benefits to users to promote adoption.
* The reasons behind organizational and personal resistance to technology should be addressed to promote adoption.

== Conclusion ==
This study used direct observation, interviews, workflow, and information flow of three outpatient clinics caring for patients with chronic conditions.  Both clinical and non-clinical personnel were studied.  This study resulted in the development of HIT guidelines for EHR documentation for patients with chronic diseases.  

== Comments ==
The guidelines developed are important for an effective flow of patient care in chronic care clinics and HIT design for clinical documentation.  I believe that observation and interviews are vital in really seeing what the clinicians and support staff have to do to provide patient care in an efficient, caring, and complete manner.

== References ==
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[[Category: Reviews]]
[[Category: Workflow]]