As promised, Version 1.0 of the Clinical Workflow Resources page is now available. Pulling this page together required more effort than expected. Because the workflow literature is extensive, especially outside of health care, deciding what to include was a challenge. Those who have been following the blog for a while might recall that workflow issues have been an abiding interest of mine for years. Consequently, my research interests are the main inclusion criteria used to select materials for the page.
In Clinical Workflow Analysis: Next Steps, I stated that there is a need for a unified framework for clinical workflow representation that would provide a single paradigm for the following activities:
- Capturing clinical processes in their original form
- Generating and refining software requirements
- Mapping workflow needs directly to software designs
- Designing usability studies
- Setting feature requirements for user interface configuration modules
- Configuring programmable WF engines
Creating such a framework is my long-term goal. Since starting EHR Science, I have become better acquainted with mathematical approaches to workflow such as Petri nets, which I find compelling for describing clinical workflows. Thus, areas of discrete mathematics that are pertinent to Petri nets (graph theory) as well as sets, relations, and functions will also be included in the resources page. There are five workflow challenges/issues that have been the focus of my activities, and all materials are related to one or more of them.
- Defining and mapping the clinical work processes of healthcare professionals
- Determining how HIT affects clinical work processes
- Determining how to represent clinical work processes in a manner that permits their use for domain analysis and designing process-aware clinical systems
- Representing clinical work processes using formal mathematical methods
- Cross-referencing patient care data with process data as a means of studying the relationships between interventions, processes, and outcomes
I have tried to separate out materials that are specific to workflow/processes and their capture, analysis and representation from closely-related topics such as decision support and usability. For this reason, decision support-related resources are included only if they are specifically evaluated as adjustments to workflows/processes. Usability has its own page.
Here are a few general observations about workflow practices in health care based on the materials reviewed:
- Workflow representations in clinical journals tend to rely on flow charts and swim lane diagrams for mapping more often than notation systems with stricter semantics such as business process management notation (BPMN), UML tools (e.g. activity diagrams), and Petri nets.
- There are no agreed upon names or representations for clinical workflow tasks.
- Use of WF engine technology in HIT appears to be rare. (See this post by Chuck Webster for his take on why WF technology is not widely used).
Organizing content when so many domains are involved has been problematic. Materials will be presented by major topic area (e.g., clinical workflow, workflow management systems, Petri nets, etc.). Clinical workflow issues such as mapping, analysis, and HIT effects are the focus of Version 1.0. The remaining topics will be added (as time permits) over the next few months. If things go as planned, eventually there will be six main topic areas.
The workflow page will contain the usual assortment of resources—websites, reports, white papers, software, and literature citations–seen on other resource pages. One significant difference, however, will be the inclusion of citations from computer science (ACM Digital Library) and engineering journals and conferences (IEEE Xplore).
All resource pages are updated on a monthly cycle with updates occurring on the same date each month. The Clinical Workflow Resources page will be updated on the 26th of each month.
Well, that’s all for now. If there are resources that you would like to share, please send links using the contact form. As always, I would love to hear your comments and suggestions.