Typically, ambulatory care organizations don’t do workflow studies, as leaders assume they have neither the time nor the data available to make it happen.
They may have more options than they think, however. A group of researchers has concluded that timestamp data found in their EHR can be used to predict ambulatory workflow.
The research article, which appears in the Journal of the American Medical Informatics Association, notes that workflow studies typically require large amounts of timing data which are too expensive to collect through observation or tracking devices. Historically, ambulatory care organizations have had to make do with observation and intuition rather than sophisticated interventions.
In fact, the relationship between health IT and ambulatory care workflow redesign hasn’t been a friendly one. A 2015 study by the Agency for Healthcare Research and Quality concluded that health IT implementations could make a mess of existing workflows. Problems included “a redistribution of clinicians’ and clinic staff’s time on different clinical tasks, repurposed usage of workspace, increased level of interruptions, multitasking, and off-hours work activities.”
According to the current group of researchers, however, these organizations may have the data they need at their fingertips. The study, which used EHR timestamp data to predict ambulatory workflow timings, suggests that this approach is valid.
To conduct the study, the researchers studied the workflow at four outpatient ophthalmology clinics associated with the Oregon Health and Science University, observing their workflows and timing each workflow step. They then mapped the EHR timestamps to workflow steps to see how they compared.
They found that workflow times generated by EHR timestamp analysis were within three minutes of observed times for greater than 80% of the appointments. What variance they did observe between observed times and timestamps seems to have been due to EHR use patterns.
Even giving these variances, ambulatory care organizations can get a lot of value out of EHR timestamp data, researchers said. “EHR timestamps…can be used to create simulation models, analyze HR use, and quantify the impact of trainees on workflow,” they concluded.
Even given this option, few ambulatory care organizations are likely to conduct formal workflow studies unless they’re backed by a deep-pocketed health system. Most medical practices have their hands full collecting what they’re owed by health plans and managing operations on a day-to-day basis.
This isn’t to suggest that they are unsophisticated, but rather, that workflow studies may require a level of time, commitment and resources that smaller practices simply don’t have. Most U.S. medical practices are small businesses.
Still, it’s good to know that if they choose, medical groups can use data already available in their EHR to make meaningful workflow improvements. Perhaps it’s time for vendors to step forward and support the use of EHRs for this purpose.