As news unfolded last week about the ongoing fight against Ebola in Texas, many of us began to hear a new word in the conversation: “workflow.” We don’t see this term often in the health policy community, but it’s well-known to frontline providers and critical to improving both our public health and care delivery efforts.
So what is workflow?
Workflow refers to the steps that a provider takes to care for a patient, but it can also refer to how and when a provider sees critical information about a patient. There are many pieces that determine the latter: office care protocols, evidence-based medicine guidelines, and patient record information, to name a few.
In the context of health information technology, workflow is the actionable information that physicians or nurses can see within an electronic health record (EHR) that helps them determine what patient information to collect and what medical services to provide. And as we almost saw in Texas, it can be the lynchpin in modern care management, since providers can’t act upon information they can't easily see.
Relevant alerts and clinical reminders are extremely valuable in hospitals or physician offices, where efficiency is key and a doctor may have only a few minutes with each patient. Some of these alerts are built into an EHR by the vendor, but many are the result of third-party applications. These applications, such as data analytics, reconcile a patient’s EHR data using sophisticated algorithms and return actionable information to the patient’s record, essentially feeding “intelligence” into a provider’s workflow.
Sounds easy, right? This process was one of the basic functions that providers envisioned when they talked about the ability of IT innovation to drive high-quality, low-cost health care.
But in reality, the process of analyzing information and pushing it back into an EHR workflow is quite complicated, and it depends on the EHR and application’s ability to “talk” to each other. This leads us to another policy buzzword: “interoperability.”
What is interoperability?
Chances are you have heard about ongoing efforts to improve interoperability, as it’s the next step in maximizing investments in EHRs. To put it simply, interoperability is the extent to which two or more systems can exchange and interpret information.
The Office of the National Coordinator at HHS is undertaking a comprehensive effort to explore all the possible options for ensuring that health information sources can appropriately share data in an efficient and affordable manner while protecting the privacy of patients. And members of Congress are taking a closer look, too, as they seek to better understand how they can maximize the ROI associated with widespread EHR adoption. All of these efforts are much-needed and well-timed as providers and patients alike figure out how better access to information can improve individual, population, and public health.
Related: How an EMR changed my patient experience
There is no doubt that the current barriers to interoperability—such as technical challenges, restrictive vendor behavior, high transaction costs, and a steep learning curve—threaten to slow our progress. But the increasing emphasis on new payment and care delivery models that drive improvements in quality and cost offers a renewed opportunity to advance interoperability because it places a premium on actionable information. To achieve population health goals, providers need to extract data from EHRs for use by platforms and systems such as mobile devices, disease registries, patient portals, analytics tools, and clinical decision support algorithms.
Because most major health systems and ACOs face the challenge of extracting and integrating data from multiple EHRs, achieving an industry-wide standard of interoperability is critical to scalability. While the circumstances driving the sudden focus on workflow are unfortunate, we should seize the opportunity to expand the interoperability of data sources and improve care from the perspective of providers, patients, and the public.
Electronic Medical Records Strategy,
Cost and Productivity,
Metrics and Analytics,