Describing and Modeling Workflow and Information Flow in Chronic Disease Care
Describing and Modeling Workflow and Information Flow in Chronic Disease Care
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DOI：
10.1197/jamia.m3000
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发表时间：
2009-11-01
影响因子：
6.4
通讯作者：
Lorenzi, Nancy M.
中科院分区：
文献类型：
--
作者：
Unertl, Kim M.;Weinger, Matthew B.;Lorenzi, Nancy M.
目的：该研究的目标是深入了解慢性病护理中的工作实践、工作流程和信息流，以促进开发适合具体情况的信息学工具。设计：该研究在三家提供慢性病护理的门诊诊所进行了为期10个月的研究。作者通过直接观察和半结构化访谈反复收集数据。测量：作者在三个不同的慢性病诊所观察了超过150小时的所有方面的护理，包括157个患者-提供者的互动。观察的重点是人员、流程和技术之间的互动。观察数据通过开放编码方法进行分析。然后，作者使用分层任务分析和软系统方法论建立了工作流和信息流的模型。结果：研究有三个主要结果：每个诊所的工作流程模型，每个诊所的信息流模型，以及深入描述工作实践和卫生信息技术(HIT)在诊所中的作用。作者发现了现有HIT功能与慢性病提供者需求之间的差距。结论：根据对工作流程和信息流的分析，作者制定了支持慢性病护理的HIT设计的10个指南，其中包括采用模块化方法进行设计以支持特定疾病需求的建议。本研究论证了评估工作流和信息流在HIT设计和实现中的重要性。J am Med通知Assoc。2009；16：826-836。DOI 10.1197/jamia.M3000。
Objectives: The goal of the study was to develop an in-depth understanding of work practices, workflow, and information flow in chronic disease care, to facilitate development of context-appropriate informatics tools.Design: The study was conducted over a 10-month period in three ambulatory clinics providing chronic disease care. The authors iteratively collected data using direct observation and semi-structured interviews.Measurements: The authors observed all aspects of care in three different chronic disease clinics for over 150 hours, including 157 patient-provider interactions. Observation focused on interactions among people, processes, and technology. Observation data were analyzed through an open coding approach. The authors then developed models of workflow and information flow using Hierarchical Task Analysis and Soft Systems Methodology. The authors also conducted nine semi-structured interviews to confirm and refine the models.Results: The study had three primary outcomes: models of workflow for each clinic, models of information flow for each clinic, and an in-depth description of work practices and the role of health information technology (HIT) in the clinics. The authors identified gaps between the existing HIT functionality and the needs of chronic disease providers.Conclusions: In response to the analysis of workflow and information flow, the authors developed ten guidelines for design of HIT to support chronic disease care, including recommendations to pursue modular approaches to design that would support disease-specific needs. The study demonstrates the importance of evaluating workflow and information flow in HIT design and implementation. J Am Med Inform Assoc. 2009;16:826-836. DOI 10.1197/jamia.M3000.