Skip Navigation Archive: U.S. Department of Health and Human Services U.S. Department of Health and Human Services
Archive: Agency for Healthcare Research Quality
Archival print banner

This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: Let us know the nature of the problem, the Web address of what you want, and your contact information.

Please go to for current information.

Workflow Assessment for Health IT (Text Version)

Slide presentation from the AHRQ 2011 conference.

On September 19, 2011, Pascale Carayon made this presentation at the 2011 Annual Conference. Select to access the PowerPoint® presentation (1.2 MB).

Slide 1

Workflow Assessment for Health Information Technology (Health IT)

Pascale Carayon and WITH IT Research Team
Department of Industrial and Systems Engineering
Center for Quality and Productivity Improvement
University of Wisconsin-Madison

Slide 2


Slide 3

What is Workflow?

Slide 4

Defining Workflow

  • Workflow:
    • Who, what, where, when and how things get done in your healthcare organization.
    • Both clinical and administrative work.

SEIPS [Systems Engineering Initiative for Patient Safety] Model of Work System and Patient Safety (Carayon et al., 2006).

Slide 5

Examples of clinic workflows

  • Answering phones:
    • Flows for different types of phone calls.
  • Appointment system:
    • Flows for new vs. existing vs. continued vs. non-continued care patients.
  • Messaging:
    • To different types of staff and for different reasons.
  • Order diagnostic testing:
    • Flows for different kinds of tests.
  • Reporting diagnostic test results:
    • Flows for different kinds of tests or normal vs. abnormal.
  • Ordering medications, including:
    • Prescription renewal.
  • Making referrals.
  • Billing and coding.
  • New patient work-ups.
  • Chronic disease management.
  • Receiving and processing patient information from outside providers.
  • Confirming insurance or pay status.

Slide 6

Detailed Flowcharts

  • Two flow charts of the workflow of "patient check-in".
  • Both figures are accurate descriptions of the same process at a particular clinic.
  • But only the figure on the right (2) shows the details of what the workflow really is.

Images: Two flowcharts are shown.

Slide 7

Is Workflow Just the Sequence of Steps of a Process?

  • Not exactly.
  • Workflow is the sequence of:
    • Physical and/or mental tasks performed by various people.
    • Over time and through space:
      • It can occur sequentially and/or simultaneously.
      • It can occur at different and/or multiple levels.

Slide 8

Workflow at Different Levels

  1. Inter-organizational workflow.
  2. Clinic-level workflow.
  3. Intra-visit workflow.
  4. Cognitive workflow.

Slide 9

Workflow at Different Levels (continued)

  1. Inter-organizational workflow:
    • Between a primary care physician and a community pharmacy, or.
    • Between an emergency department physician and a primary care physician to share information about a patient.
  2. Clinic-level workflow.
  3. Intra-visit workflow.
  4. Cognitive workflow.

Slide 10

Workflow at Different Levels (continued)

  1. Inter-organizational workflow:
  2. Clinic-level workflow:
    • Workflow of a physician, nurse or patient through physical space, or.
    • Flow of information, in paper or electronic formats, among people at a practice or clinic.
  3. Intra-visit workflow.
  4. Cognitive workflow.

Slide 11

Workflow at Different Levels (continued)

  1. Inter-organizational workflow.
  2. Clinic-level workflow.
  3. Intra-visit workflow:
    • Workflow during a patient visit:
      • E.g. start by asking for a problem list, then do history and physical, then prescribe treatment.
  4. Cognitive workflow.

Slide 12

Workflow at Different Levels (continued)

  1. Inter-organizational workflow.
  2. Clinic-level workflow.
  3. Intra-visit workflow.
  4. Cognitive workflow—the workflow in the mind:
    • Sensation, perception, decisionmaking, and response execution.
    • A clinician might be thinking: "listen for any significant acute problems and deal with those first. Also, investigate my concern about spousal abuse. If I don't hear any, focus on the chronic problems."
    • This is unlikely to be observable.

Slide 13

A More Detailed Example: Medication Orders

  • Consider the workflow of ordering a medication.
  • Without e-prescribing, the workflow might involve a provider with prescribing privileges writing a prescription on a prescription pad, signing it, and handing it to the patient.

Slide 14

Medication Orders: E-Prescribing

  • Implementing e-prescribing changes the mental and physical steps of the process, as well as the order of steps and the organizations involved.
    • Providers have to log into the system, remembering a password.
    • They have to access the record of the particular patient, which involves a series of physical steps using the mouse and/or keyboard.
      • They have to execute mental steps of searching for the correct information and locating the correct medications and pharmacy.
      • Both the provider and patient need to know the pharmacy where the patient will pick up the medication.

Slide 15

Why Is It Important to Understand Your Workflow When Planning, Implementing, and Using Health IT?

Slide 16

Answer #1: To Avoid Pain and Suffering

  • Many clinics have implemented health IT only to find that they did not anticipate how much an EHR, clinical decision support or other technologies can change clinical and administrative workflows.
  • Suddenly the way things have to get done becomes very different:
    • The unanticipated changes cause considerable pain during and after implementation for the clinic staff.
    • Significant disruptions in patient care, billing, communication, etc...

Slide 17

Answer #2: To Assist in Vendor Selection

  • Workflow analysis can:
    • Identify efficient and productive workflows that you would like to keep and inefficient ones that you would like to change.
    • Determine how your workflows are likely to change after implementing the technology.
  • With that information, you can ask each potential vendor about how their technology will affect different workflows.
  • This way, you can select the vendor that best fits your practice.

Slide 18

Answer #3: To Better Prepare and Train Staff

  • Every time you make a change to your practice, especially when implementing health IT, your clinical and practice management workflow will change.
  • These changes may affect some staff members more than others.
  • You need to train staff for the changes that will affect them.

Slide 19

Answer #4: To Plan Ahead

  • Although technology implementation may seem like a simple change, it is likely to be much more complex and challenging than you anticipate.
  • By identifying how workflows will change, you can make better decisions.

Slide 20

How to Evaluate Workflow?

Slide 21

Toolkit on Workflow Assessment for Health IT

  • The Toolkit is a comprehensive compendium of information that includes:
    • Information on how to analyze workflow.
    • Tools to analyze workflow.
    • Examples of workflow analysis and redesign.
    • Others' experiences with health IT and workflow.
    • Research on health IT and workflow.

Slide 22

Demonstration of Toolkit

Image: A screen shot of the AHRQ Web site is shown.

Slide 23

Workflow Assessment for Health IT Toolkit

Image: The Workflow Assessment for Health IT Toolkit is shown.

Page last reviewed October 2014
Internet Citation: Workflow Assessment for Health IT (Text Version). October 2014. Agency for Healthcare Research and Quality, Rockville, MD.


The information on this page is archived and provided for reference purposes only.


AHRQ Advancing Excellence in Health Care