I recently had the privilege of talking with a national Electronic Health Record (EHR) consultant who works for a major vendor doing hospital implementation of EHR systems. She told me the most important, hardest and trickiest part of her job is helping hospitals understand their workflow. Why? Too much of the workflow in departments and integrated workflows throughout the hospital system remain invisible to the participants. Different departments are isolated from one another and use different tools and workflows. This means there is too much rework and duplication of effort. As she also emphasized, “There is almost always a disconnect between the leaders and those doing the floor work. I call this the gap between what the leaders think should be done and think is being done and the work as it is being done. The floor workers know how the work is being done in day to day operations. Far too many EHR implementations take place without taking the time to get a full understanding of the workflow as it actually happens and/or leaving the floor workers out of the workflow discussions.” As a result too much of the actual workflow remains invisible during the actual EHR rollout resulting in wasted time, confusion, interrupted workflows and comprised patient safety. EHR implementation cannot be done well with a top down approach.
I have been involved in many EHR implementations or conversions and have experienced the above scenario on several occasions. Fortunately, both the EHR consultant and I have successfully used a relatively simple process to make the invisible workflows visible. Create an integrated cross-functional team that is comprised of both the leads and floor workers for different departments. Set up a core team that meets regularly and brings in other members who come and go as needed for workflow information. Make sure this team has set up a “blame free Zone” to ensure that the actual workflow gets documented instead of the workflow that is supposed to be happening. Taking the time to document the pre-implementation workflows accurately saves a great deal of time and heartache during and after implementation, is more cost effective, and safer for patients.