Workflow analysis a critical but hidden step to EHRs

Despite the information-sharing benefits of an EHR, many physicians are reluctant to invest in this technology.


Despite the information-sharing benefits of an EHR, many physicians are reluctant to invest in this technology. Adopting EHRs requires significant human and capital resources. Compounding the decision is that physicians often do not have the technical background to assess the myriad of ambulatory EHRs and know what they're buying.

Another barrier to implementation isn't as obvious, but can be the most critical. Before implementing an EHR, the physician should analyze the business and clinical operations currently in place. This pre-analysis activity goes by several names, including “workflow analysis,” “current state analysis” or “process mapping.”

Some EHR vendors conduct workflow analysis as part of the implementation process. But it is in the practice's best interest to perform the pre-analysis beforehand. It's important to thoroughly understand how the practice operates in order to:

  • identify areas where the practice operates well and poorly,
  • guide the design of the future “ideal” practice,
  • provide the requirements for candidate EHRs, and
  • reduce risks in the selection and implementation process.

Practices are often not sure how to start the pre-analysis process. Two guidelines are “use what you have” and “engage all levels of staff.”

“Use what you have” includes any written guidelines already in place. These could be as simple as checklists, log books, sign-in sheets and message logs. Analyzing these tools will often lead to the development of rules to complete a particular task, such as prescription renewals, managing patient calls or writing referrals.

Engaging all level of staff is one key to successful workflow analysis. In a small practice, it is important to look at cross-trained personnel to capture any variation in how tasks are completed. In larger practices, focus should be on the actual staff performing a set of tasks. Consulting solely with a practice manager or supervisor often fails to provide the step-by-step detail that becomes transparent when interviewing the person who actually does the work. Also, gathering input from the entire staff fosters a team mentality that will be important for future phases of the EHR adoption process.

Understanding how a practice runs is an important step—the first one—to take in the EHR adoption process. Physicians who invest in this step will gain the greatest benefit from an EHR implementation. For more information on EHR adoption and workflow analysis, please visit here.