Re-engineering workflows: Changing the life cycle of an electronic health record system

Abstract

An existing electronic health record (EHR) system was re-engineered with cross-functional workflows to enhance the efficiency and clinical utility of health information technology. The new designs were guided by a systematic review of clinicians' requests, which were garnered by direct interviews. To design cross-functional, patient-centered workflows, several multidisciplinary teams from the health system of hospitals, clinics, and other services participated. We identified gaps and inconsistencies with current care processes and implemented changes that improved workflow for patients and clinicians. Our findings emphasize that, to coordinate care between many providers, process workflow must be standardized within and across settings and focus on patient care processes, not the technology. These new, comprehensive, admission-todischarge workflows replaced the older, functional- and departmental-process flow charts that had fallen short. Our experience led to integrated redesign of the workflows, review prior to implementation and ongoing maintenance of this process knowledge across 37 hospital facilities.