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Emerging Provider Challenges EHR Workflow April 19 th , 2013 David Brick, MD, FACC, FAAP

Emerging Provider Challenges EHR Workflow April 19 th , 2013 David Brick, MD, FACC, FAAP. 1) Order a CBC 2) Review results. Order a CBC. 1) Order a CBC on one end 2) Results come out the other. 2. 1. Time delay/Pause in workflow. Task-Order a CBC. 20. ……. 4. 17.

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Emerging Provider Challenges EHR Workflow April 19 th , 2013 David Brick, MD, FACC, FAAP

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  1. Emerging Provider ChallengesEHR WorkflowApril 19th, 2013David Brick, MD, FACC, FAAP

  2. 1) Order a CBC 2) Review results

  3. Order a CBC 1) Order a CBC on one end 2) Results come out the other 2 1 Time delay/Pause in workflow

  4. Task-Order a CBC 20 …… 4 17 19 18 3 2 1 • History, Physical, Review Test • Research, consult, discuss • Pick a Diagnosis • Decide on Task- Lab test/Radiology/ Consult • Select the exact test from list • Choose laboratory among allowed choices • Determine if test is ordered correctly • Press “order” button • Get approval from insurance company • Send order to lab • Schedule patient • Patient goes to lab • Patient has test • Test is run • Test is interpreted • Test results are sent to doctor • Prelim, then intermediate, then final data sent • Comes into EHR by fax, scan, html , pdf , structured data • Review for critical value • Review lab in context of initial issue

  5. CBC Each part may be done by a different person

  6. CBC Interpreting doctor may be different than ordering doctor

  7. Tasks • Workup Fever (Fever “project”), many tasks • Labs • CBC • Blood Culture • Urine culture • Imaging • CXR • Consults • Pulmonary consult • Miscellaneous • Review Family history

  8. Patient with respiratory distress-5 potential tasks BMP CXR Pulmonary consult CBC ESR

  9. CBC Redundant entry of labs into the EHR ESR BMP CBC Consult CXR BMP ESR CXR

  10. CBC ESR BMP CBC Consult CXR BMP ESR CXR

  11. CBC ESR BMP CBC Consult CXR BMP ESR CXR

  12. Tasks can have different steps, and occur over different time periods.

  13. As tasks are complete new tasks are ordered creating a task tree

  14. CBC

  15. BMP

  16. Alert- due to reagent error, we recommend repeating the test BMP

  17. Projects/Activities • Workup Fever • Multiple tasks-multiple results • Workup hypertension • Multiple tasks-multiple results • Workup Diabetes • Multiple tasks-multiple results • Respiratory Distress • Multiple tasks-multiple results Complexity Grows Geometrical

  18. Summary • Each task has many steps • Steps are completed over time, with interruptions and delays • Different team members work on the same task and finish tasks others start • Redundant lab results have negative impact • Complexity grows geometrically as more “projects” are added • Not safe to rely on Doctors memory

  19. Design Opportunities • Have flexible workflow with complex branches for contingencies • Provide context for why lab ordered (stickies) • Group related/redundant lab values • Support annotations for data • Support communication embedded in regular workflow • Support secure informal communication

  20. The End

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