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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. - PowerPoint PPT Presentation
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Emerging Provider ChallengesEHR WorkflowApril 19th, 2013
David Brick, MD, FACC, FAAP
4/19/2013
1) Order a CBC 2) Review results
4/19/2013
Order a CBC1) Order a CBC on one end 2) Results come out the other
1 2
Time delay/Pause in workflow
4/19/2013
Task-Order a CBC4 18 1917 201 2 3
4/19/2013
CBC
Each part may be done by a different person
4/19/2013
CBC
Interpreting doctor may be different than ordering doctor
4/19/2013
Tasks• Workup Fever (Fever “project”), many tasks
– Labs• CBC• Blood Culture• Urine culture
– Imaging• CXR
– Consults• Pulmonary consult
– Miscellaneous• Review Family history
4/19/2013
Pulmonary consult
BMP
CBC
CXR
Patient with respiratory distress-5 potential tasks
ESR
4/19/2013
ESR
BMP
CBC
CXR
CBC
BMPESR
CXR
Redundant entry of labs into the EHR
Consult
4/19/2013
ESR
BMP
CBC
CXR
CBC
BMPESR
CXR
Consult
4/19/2013
ESR
BMP
CBC
CXR
CBC
BMPESR
CXR
Consult
4/19/2013
Tasks can have different steps, and occur over different time periods.
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As tasks are complete new tasks are ordered creating a task tree
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4/19/2013
CBC
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BMP
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BMP
4/19/2013
Alert- due to reagent error, we recommend repeating the test
4/19/2013
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
ComplexityGrowsGeometrical
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Summary1) Each task has many steps2) Steps are completed over time, with interruptions
and delays3) Different team members work on the same task
and finish tasks others start4) Redundant lab results have negative impact5) Complexity grows geometrically as more
“projects” are added6) Not safe to rely on Doctors memory
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Design Opportunities1) Have flexible workflow with complex
branches for contingencies2) Provide context for why lab ordered (stickies)3) Group related/redundant lab values4) Support annotations for data5) Support communication embedded in
regular workflow6) Support secure informal communication
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