As you may have noticed, I have been posting less frequently than usual over the last few months. The simplest explanation for the lack of posts? The human condition or stated differently, “everyday brings enough trouble of its own.” Now that things have sorted themselves out, I look forward to posting more regularly.
Clinical Workflow Center
When I set up Clinical Workflow Center (CWC) in January, the expectation was that it would provide new content at least twice per month and no less than monthly. Obviously, that has not happened, which is very disappointing. The delay has not been entirely fruitless, however. I have used the time to revise the plan for the site and to select new content categories.
One area that has grabbed my attention is the interplay between clinical work, clinical workflow modeling and aspects of cognitive work analysis, task analysis, business process analysis, and software design. Clinical work and clinical workflow are now being studied by informaticists, software designers, human factors professionals, and business analysts. All presume to do the same thing – understand the key aspects of clinical work in relation to software systems – yet each group has its own jargon, concepts, and methods. Even so, there is significant overlap among these groups in how they approach clinical work analyses. At some point, each group uses interviews, written protocol reviews, observation, and some diagramming method (usually flowcharts and/or swim lanes) to capture their findings.
With the exception of clinical informatics, these domains are not focused specifically on health care. Yet, those professionals from each domain who are working to improve clinical software are working on the same problem. Progress in solving problems of usability, safety, CDS, etc. requires a common set of concepts, terms, and methods.
My workflow journey started with trying to understand how to encode flexible workflow models in an EHR. I never solved that problem, but van der Aalst and his group at Eindhoven did. Other aspects of clinical system design have been addressed through human factors, software engineering, and informatics. With this in mind, I intend to add materials from human factors and software engineering to CWC as complements to the clinical workflow and patterns and Petri nets resource pages. In addition, anyone who wishes to submit articles from these fields may do so (more about this in a later post). Of course, my work on clinical work modeling will be present as well.
Trying to determine what to add in terms of non-resources pages has been a challenge. Originally, the goal was to provide a forum, resource pages, and regular long-form articles (2500-4000 words) on important clinical workflow topics. The human condition and my exploration of human factors literature changed those plans—in a positive way. For one, they made me reconsider what CWC should be and how it might best support the development of clinical work analysis/modeling as its own domain. This, in turn, led me to change the content profile for long-form content. Happily, there is now a revised editorial plan and the final draft (I hope) for a book on clinical workflow. Current plans call for a book of 24 chapters with the first four being published on CWC as an article series starting in late summer or early autumn. In addition, two academic articles are in the works that I think will be a useful contribution to the informatics literature.
Mathematics and Clinical Care
Math posts have been a topic area on EHR Science for a while. I have now arrived at the point where its time to put all of the math ideas, in expanded form, into a single publication. This publication will also contain my musings on clinical systems theory and clinical work models. Obviously, I am not a mathematician, so technical reviewers will be welcome. At present, I have one technical review commitment, and it would be nice to have two more reviewers who have backgrounds in computer science and/or discrete mathematics. Beyond the initial work, I am also interested in collaborations.
As it is, the resource pages contain article citations from gleaned from three sources: PubMed, IEEE Xplore, and the ACM Digital Library. During the monthly reviews of each database, I try to keep a list of articles that would be generally interesting to anyone focused on the design, implementation, and use of clinical systems. In the past, after reading and annotating them for my use, I listed these papers in the “Key Articles” section of each resource page in concert with using them as post subjects. This approach has not worked out. Last time I checked, there were about 35 in the queue, but I have only used a few in posts. With the writing projects outlined above, it is very unlikely all 35 will make it to a post. Further, I add a few each month, so the list is growing.
As a result of the backlog, I have decided to try a different approach. Twice each week I will tweet reviewed articles from the queue and add them to the Key Articles sections during regular monthly updates. Tweets will begin on May 13th.
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