An EHR Workflow Analogy

EHR System Technical Functionality vs. UsabilityIs Your Workflow Just a Product of Your EHR?

William A. Hyman
Professor Emeritus, Biomedical Engineering
Texas A&M University,
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A theme I and others have addressed is the impact of EHRs on workflow, and whether having to adopt the workflow to the EHR is always the optimum thing to do. Associated issues are whether the designers actually knew anything about clinical workflow, and whether if they had such knowledge did they use it well, or at all, in creating the system. Also recently addressed is whether the Meaningful Use imperative is driving bad design. A related issue is did the people who selected the EHR have effective workflow in mind, or did other issues drive their decision. This may be especially relevant in large organizations where the selectors are not the users, yet even in smaller settings users may not know how to adequately analyze a candidate EHR with respect to workflow issues. This by no means suggests that they are “dumb” as I was recently accused of saying in another context. Instead it means that the questions to be asked are not automatic and intuitive but instead requires some training and experience.

Whether optimum or not, once the EHR is in place, there may not be any good choice but to change workflows to meet its design, however less than ideal or even practical it’s design might be. Resisting such change is probably futile at that point, even where the old workflow had actual advantages over the new. Thus, with apologies to my father who was known to say that “Most analogies are odious and that one stinks in particular,” I offer the following EHR workflow/laundry analogy.

When I was looking for a New York apartment one of the many variables to consider was the laundry facilities. Ideal facilitation of personal workflow would be to have a washer/dryer in the apartment, just like we did in our Texas house. Second choice for apartment living would be shared washer/dryers on each floor, a set-up we saw on several occasions. Third was a laundry room somewhere else in the building, typically in the less than pleasant basement. (Having to take the laundry out was not an option we were willing to consider in the life style we aspired to.)

We ended up with an apartment that has the basement solution as a result of other variables outweighing the relative undesirability of that situation. Now that we live in a building with the laundry in the basement, the “ideal” way to do the laundry is for us to take it to the basement. Thus the situation now dictates the workflow rather than the best workflow dictating the situation. Yet it turns out there is also a small upside to the new workflow since we can do multiple loads at once with the many machines available. Thus we have adopted, and found some good in the situation along with the bad.

So, design can drive workflow, and some aspects of the new workflow may be good. But that doesn’t make the new workflow the best workflow other than in the context of it now being the only option.