Component 10:

Fundamentals of Health
Workflow Process
Analysis & Redesin
!nstructor "anual
#ersion $%0&'prin (01(
)otes to !nstructors
This Instructor Manual is a resource for instructors using this component. Each
component is broken down into units, which include the following elements:
Learning objectives
uggested student readings, te!ts, reference links to supplement the
narrated "ower"oint slides
Lectures #voiceover "ower"oint in $lash format%& "ower"oint slides
#Microsoft "ower"oint format%, lecture transcripts #Microsoft 'ord format%&
and audio files #M"( format% for each lecture
elf)assessment *uestions reflecting +nit ,bjectives with answer ke-s
and.or e!pected outcomes
/pplication /ctivities #e.g., discussion *uestions, assignments, projects%
with instructor guidelines, answer ke-s and.or e!pected outcomes
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow 2
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
Contents
7otes to Instructors............................................................................................................2
8isclaimer..........................................................................................................................9
1omponent 65.+nit 6.........................................................................................................:
1omponent 65.+nit 2.......................................................................................................6;
1omponent 65.+nit (.......................................................................................................6:
1omponent 65.+nit <.......................................................................................................2;
1omponent 65.+nit ;.......................................................................................................2:
1omponent 65.+nit =.......................................................................................................((
1omponent 65.+nit >.......................................................................................................<5
1omponent 65.+nit 9.......................................................................................................<2
1omponent 65.+nit :.......................................................................................................<=
1omponent 65.+nit 65.....................................................................................................<:
1omponent 65.+nit 66.....................................................................................................;6
1omponent /cron-m ?lossar-........................................................................................;;
1reative 1ommons /ttribution)7on1ommercial)hare/like (.5 +nported.....................==
/ppendi! 6: 7arrative 1linical 'orkflow cenarios........................................................=>
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow (
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
Component *+er+iew
This component covers fundamentals of health workflow process anal-sis and redesign
as a necessar- component of complete practice automation. "rocess validation and
change management are also covered.
Component *,-ecti+es
/t the completion of this component, the student will be able to:
Identif- the elements involved in providing patient care within a comple! health
care setting that must be taken into consideration when e!amining and proposing
changes in workflow processes.
1reate diagram of processes in the healthcare setting that support workflow
anal-sis and re)design.
1riticall- anal-@e the workflow processes in a selected health care setting to
determine their effectiveness from the perspective of those being served #i.e.,
patients%, those providing the services #i.e., professional and non)professional
staff%, and the organi@ationAs leadership #i.e., decision makers%.
"ropose wa-s in which *ualit- improvement methods, tools and health IT can be
applied within a healthcare setting to improve workflow processes.
uggest approaches that would ensure the success of workflow re)design from
development and presentation of the implementation plan, to facilitation of
decision making meetings, implementation of the changes, evaluation of the new
processes, sustainabilit- of new workflow processes, and continuous *ualit-
improvement efforts to achieve meaningful use.
/ppl- to these activities an understanding of health IT, meaningful use, and the
challenges practice settings will encounter in achieving meaningful use.
Each Learning +nit includes 6)< contact #or instructional% hours and an additional ()62
hours of independent or team work on the part of the student. Each unit contains more
material than would likel- be used in an- one teaching so that the instructor can pick
and choose material most applicable to local workforce needs.
+nit 6 1oncepts of "rocesses and "rocess /nal-sis
+nit 2 "rocess Mapping Theor- and 3ationale
+nit ( Interpreting and 1reating "rocess 8iagrams
+nit < /c*uiring 1linical "rocess Bnowledge
+nit ; "rocess /nal-sis
+nit = "rocess 3e)design
+nit > $acilitating Meetings for Implementation 8ecisions
+nit 9 Cualit- Improvement Methods
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow <
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
+nit : Leading and $acilitating 1hange
+nit 65 "rocess 1hange Implementation and Evaluation
+nit 66 Maintaining and Enhancing the Improvements
This entire 1omponent #units 6)66% is estimated to provide 25 total contact. instructional
hours plus <5)=5 additional hours of independent or team work, depending on the
learning activities and assessments used within each unit.
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow ;
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
Component Authors
Assined !nstitution
8uke +niversit-, 8urham, 71
.eam /ead
Meredith 7ahm, "h8
8uke +niversit-, 8urham, 71
Primary Contri,utin Authors
Meredith 7ahm, "h8
8uke +niversit-, 8urham, 71
Ba-e $endt, M"0
3owan) 1abarrus 1ommunit- 1ollege, 71
/ecture )arration&'ound 0nineer
3aland Technologies LL1
6(9> $airport 3oad
uite 65;5 $airport, 7D 6<<;5
http:..www.raland.com.
8avid $lass E "roject Manager
.eam "em,ers
Frian 3e-nolds, "h8
1linical "roject Leader
8uke +niversit-, 8urham, 71
1harmaine mith, M/
Cualit- 1ontrol
3owan) 1abarrus 1ommunit- 1ollege, 71
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow =
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
1isclaimer
These materials were prepared under the sponsorship of an a!ency of the United
States 'overnment& Neither the United States 'overnment nor any a!ency thereof, nor
any of their employees, makes any warranty, e(press or implied, or assumes any le!al
liability or responsibility for the accuracy, completeness, or usefulness of any
information, apparatus, product, or process disclosed, or represents that its use would
not infrin!e privately owned ri!hts& )eference herein to any specific commercial
product, process, or service by trade name, trademark, manufacturer, or otherwise does
not necessarily constitute or imply its endorsement, recommendation, or favorin! by the
United States 'overnment or any a!ency thereof& The views and opinions of authors
e(pressed herein do not necessarily state or reflect those of the United States
'overnment or any a!ency thereof&

*ikewise, the above also applies to the Curriculum Development Centers +includin!
Columbia University, Duke University, ,ohns Hopkins University, Ore!on Health -
Science University, University of "labama at .irmin!ham, and their affiliated entities/&
The information contained in the Health T 0orkforce Curriculum materials is intended
to be accessible to all& To help make this possible, the materials are provided in a
variety of file formats& Some people may not find the 1lash video and &S01 files
accessible and should instead utili2e the 3ower3oint slides to!ether with the &mp4
audio file and5or 0ord transcript to access the lectures& 1or more information, please
visit the website of the National Trainin! and Dissemination Center at http655www&onc7
ntdc&or! or http655www&onc7ntdc&info to set up a profile and view the full accessibility
statement&
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow >
"rocess /nal-sis and 3edesign
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Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
Component 10&2nit 1
2nit .itle
Concepts of Processes and Process Analysis
2nit 1escription
This unit focuses on the si! aims for health care process improvement. In this unit,
students are helped to understand the concepts of s-stems, s-stems thinking and
health care processes. uch understanding provides a foundation for the stud- of
clinical process anal-sis and redesign.
2nit *,-ecti+es
F- the end of this unit the student will be able to:
6. 8escribe the purpose for process anal-sis and redesign in the clinical
setting
2. 8escribe the role of a "ractice workflow and information management
redesign specialist and contrast it with other roles such as technical
support and implementation management
(. E!plain how health care process anal-sis and redesign and meaningful
use are related
<. /nal-@e a health care scenario and identif- the components of clinical
workflow.
;. ?iven a scenario of a health care anal-sis and redesign, anal-@e the
responsibilities of each participant in the process and how the roles
complement or overlap with one another
=. 8escribe how the workflow processes used b- a health care facilit- might
differ depending on the t-pe of facilit-
2nit .opics & /ecture .itles
6a The 1oncepts of 0ealth 1are "rocesses and "rocess /nal-sis
6b 1linical 'orkflow
2nit References
#/ll links accessible as of 6.2=.2562%
/ecture 1a
6. /nal-sis. 2566. In Merriam)'ebster.com. 3etrieved 8ecember 26, 2566. from
http:..www.merriam)webster.com.dictionar-.anal-sis
2. 1ommittee on Engaging the 1omputer cience 3esearch 1ommunit- in 0ealth
1are Informatics, 7ational 3esearch 1ouncil. #255:%. 1omputational technolog-
for effective health care: immediate steps and strategic directions. #'. tead, G
0. . Lin, Eds.% 1ambridge: 7ational /cademies "ress.
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow 9
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
(. 1ommittee on Cualit- of 0ealth 1are in /merica and Institute of Medicine.
#2556%. 1rossing the *ualit- chasm: / new health s-stem for the 26st centur-
2556. 'ashington: 7ational /cademies "ress.
<. 1ommittee on Cualit- of 0ealth 1are in /merica& Institute of Medicine. #2555%. To
err is human: building a safer health s-stem. #L. T. Bohn, H. M. 1orrigan, G M. .
8onaldson, Eds.% 'ashington: 7ational /cademies "ress.
;. 8eMarco, T. #6:>:%. tructured anal-sis and s-stem specification. 7ew Herse- :
Dourdon "ress, "rentice)0all.
=. 8eming, '. E. #6:92%. ,ut of crises. 1ambridge: MIT "ress.
>. 8epartment of 0ealth and 0uman ervices& 1enters for Medicare G Medicaid
ervices. #2565, 8ecember 2:%. Medicare and Medicaid programs) electronic
health record incentive program. 3etrieved from
http:..edocket.access.gpo.gov.2565.pdf.2565)(29=6.pdf
9. 8epartment of 0ealth and 0uman ervices& 1enters for Medicare G Medicaid
ervices. #2565, Hul- 29%. Medicare and Medicaid programs) electronic health
record incentive program. 3etrieved from
http:..edocket.access.gpo.gov.2565.pdf.2565)6>25>.pdf
:. Eligible professional meaningful use core measures measure 6 of 6; )stage 6.
#2565, 7ovember >%. 3etrieved 8ecember 26, 2566, from
http:..www.cms.gov.E03Incentive"rograms.8ownloads.6I1",EIforIMedication
I,rders.pdf
65. Eligible professional meaningful use core measures measure ( of 6; )stage 6.
#2565, 7ovember >%. 3etrieved 8ecember 26, 2566, from
http:..www.cms.gov.E03Incentive"rograms.8ownloads.(IMaintainI"roblemILis
tE".pdf
66. "rocedure. 2566. /merican ociet- for Cualit- ?lossar-. 3etrieved 8ecember 26,
2566, from http:..as*.org.glossar-.p.html
62. "rocess improvement. 2566. In /merican ociet- for Cualit- ?lossar-. 3etrieved
8ecember 26, 2566, from http:..as*.org.glossar-.p.html.
6(. "rocess re)engineering. 2566. In /merican ociet- for Cualit- ?lossar-.
3etrieved 8ecember 26, 2566, from http:..as*.org.glossar-.p.html
6<. "rocess. 2566. In /merican ociet- for Cualit- ?lossar-. 3etrieved 8ecember
26, 2566, from http:..as*.org.glossar-.p.html
6;. "rocess. 2566. In Merriam)'ebster.com. 3etrieved 8ecember 26, 2566, from
http:..www.merriam)webster.com.dictionar-.process
6=. 3edesign. 2566. In Merriam)'ebster.com 3etrieved 8ecember 26, 2566, from
http:..www.merriam)webster.com.dictionar-.redesign
6>. 'hite, . /., G Miers, 8. #2559%. F"M7 modeling and reference guide.
Lighthouse "t: $uture trategies, Inc
69. 'orkflow. In 'ikipedia. 3etrieved 8ecember 26, 2566, from
http:..en.wikipedia.org.wiki.'orkflow
6:. 'orkflow. 2566. In 1oncise ,!ford English 8ictionar-. 3etrieved 8ecember 26,
2566, from http:..www.wordreference.com.definition.workflow
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow :
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
/ecture 1a Charts3 .a,les and Fiures
6.6 $igure: Meaningful +se 1riteria. J"ublic domainK 3etrieved from
https:..www.cms.gov
/ecture 1a !maes
lide 65: Fart Everson, photographer. 2566. 8octorAs ,ffice J"ublic 8omainK, 3etrieved
from: http:..commons.wikimedia.org.wiki.$ile:8octorL2>sI,fficeIinI7ewI,rleans.jpg
lide 69: 7ational /cadem- "ress. 2555. To Err is 0uman book cover. J"ublic 8omainK,
3etrieved from: http:..www.nap.edu.catalog.phpMrecordIidN:>29
lide 69: 7ational /cadem- "ress. 2556. 1rossing Cualit- 1hasm book cover. J"ublic
8omainK. 3etrieved from: http:..www.nap.edu.catalog.phpMrecordIidN6552>
lide 69: 7ational /cadem- "ress. 255:. 1omputational Technolog- for Effective 0ealth
care. J"ublic 8omainK. 3etrieved from: http:..www.nap.edu.catalog.phpM
recordIidN62;>2
lide 6:: 7ational /cadem- "ress. 2556. 1rossing Cualit- 1hasm book cover. J"ublic
8omainK. 3etrieved from: http:..www.nap.edu.catalog.phpMrecordIidN6552>
/ecture 1,
6. /llied health professionals. #n.d.%. 3etrieved 8ecember 2:, 2566, from
/ssociation of chools of /llied 0ealth "rofessions:
http:..www.asahp.org.definition.htm
2. 1ommittee on Cualit- of 0ealth 1are in /merica and Institute of Medicine.
#2556%. 1rossing the *ualit- chasm: / new health s-stem for the 26st centur-
2556. 'ashington: 7ational /cademies "ress.
(. Eligible provider meaningful use meaningful use core measures measure ( of 6;
)tage 6. #2565, 7ovember >%. 3etrieved 8ecember 2:, 2566, from
www.cms.gov.E03Incentive"rograms.8ownloads.;I/ctiveIMedicationIList.pdf
/ecture 1, Charts3 .a,les and Fiures
#7one in this unit%
/ecture 1, !maes
#7one in this unit%
2nit Re4uired Readins
#7one in this unit%
2nit 'uested Readins
6. Institute of Medicine. 1rossing the *ualit- chasm: / new health s-stem for the
26st centur-, JInternetK. 2556. /vailable from: http:..www.nap.edu.openbook.phpM
recordIidN6552>GpageN36
2. Hust Enough tructured /nal-sis #1hapter 6% JInternetK. /vailable from:
http:..-ourdon.com.strucanal-sis.wiki. inde! .phpMtitleN1hapterI6
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow 65
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
(. Hust Enough tructured /nal-sis #1hapter 2% JInternetK. /vailable from:
http:..-ourdon.com.strucanal-sis.wiki.inde!.phpMtitleN1hapterI2
<. 0ood , Mcintosh E. 1linical workflow ke-s, Eclips-s "ractice 7ewsletter
JInternetK. 7o date. Jcited 2565 /ug <K.&2#2% /vailable from:
http:[email protected]!
'tudent Application Acti+ities
comp65Iunit6Iactivit-.doc
comp65Iunit6Iactivit-Ike-.doc
comp65Iunit6IselfIassess.doc
comp65Iunit6IselfIassessIke-.doc
05ternal Resources
0ow Life hould Fe /fter DouAve Implemented Electronic Medical 3ecords
$ilmed visit scheduling and patient encounter scenario in small pediatric practice with
technolog- assisted workflow. "roduced b- a commercial sponsor& > minutes and6=
seconds long.
http:..www.-outube.com.watchMvN:>v;p:7k2IIGfeatureNrelated
Te!as 0ealth 0eart /ttack Transfer
This video shows a cardiac transfer protocol from a communit- hospital to a large
tertiar- care center. The scenario demonstrates an optimi@ed clinical workflow, and
illustrates the positive impact on saving lives. The video is produced b- Te!as 0ealth
3esources a non)profit organi@ation. The video is 2 minutes and ;2 seconds long.
http:..www.-outube.com.watchMvN0E/LT0 1/3EM1*I;-lh:4/
http:..www.-outube.com.watchMvN5b"HsIsgb=s
If /ir Travel 'orked like 0ealth care
This video presents a not)so)funn- comical scenario about a man tr-ing to purchase
airline tickets to fl- across the countr-. 0e runs into problems faced b- patients in health
care toda-. "roduced b- individuals, sponsorship not disclosed, seven minutes and 6
second in length.
http:..www.-outube.com.watchMvN;H=>!HBpF=c
'hat if There 'as 7o Technolog-
This video presents a comical series of vignettes demonstrating what the DM1/ would
be like with no information technolog-. ponsorship not disclosed. The video is (
minutes and 9 seconds in length.
http:..www.-outube.com.watchMvNf/;9C00'OfkGfeatureNchannel

The EM3 E!perience: 4isiting "aperless "h-sicianAs ,ffices
$ilm of providers and practice staff in practices post)implementation of electronic
medical records. "resents their actual e!periences with implementation and use.
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow 66
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4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
"roduced b- 0awaii Independent "h-sicianAs /ssociation& : minutes and 26 seconds
long.
http:..www.-outube.com.watchMvN(sFe(rdis3oGfeatureNrelated
7ew England 'omenAs 1linic "arts 6)<:
This two part video features 8r. "ablo 3odrigue@, 1E, of 'omenAs 1are, one of the
largest womenAs health care practices in southern 7ew England. /t a recent event for
area ph-sicians, he shared his e!perience with his recent E03 implementation and his
insight on how his colleagues can take full advantage of the incentives available through
The /merican 3ecover- and 3einvestment /ct #/33/% and meaningful use. The video
was produced b- a commercial sponsor& the videos are from ;)= minutes long each.
"art 6: http:..www.-outube.com.watchMvNfHpCImE4j5+GfeatureNchannel
"art 2: http:..www.-outube.com.watchMvNEee9w:4trmEGfeatureNchannel
"art (: http:..www.-outube.com.watchMvNCDOC3/(@g*MGfeatureNchannel
"art <: http:..www.-outube.com.watchMvN)ne7DD8"6o<GfeatureNrelated
"roject +"T/3T
This is an educational video about "roject +"T/3T )The +tili@ation of "rocedural
tandardi@ation to 3educe 3ecognition to 3eperfusion Time in TEMI
#www.projectupstart.com%. The video shows the operations of data collection for a
*ualit- improvement project within the 0ealth care setting. The video is produced b- a
non)profit organi@ation and is 9 minutes and <2 seconds in length.
http:..www.-outube.com.watchMvN64*28)+2r+GfeatureNrelated
7,4E "F documentar-: 8octorAs 8iaries
This is a documentar- that follows seven medical students through medical school and
the first two decades of their careers. 'hile it does not provide a lot of information
about clinical workflows, viewing the two hour documentar- ma- provide conte!t for
students about what ph-sicians do, and how ph-sicians think. This two part 2 hour
documentar- is produced b- a non)profit organi@ation, 7,4/ "F. It is available free
on the web at http:..www.pbs.org.wgbh.nova.doctors.
"atient 1are 3e*uires Teamwork
This short >6 second video clip discusses some of the factors that make the clinical
environment comple!. The video was produced b- a non)profit organi@ation called afer
0ealth care. It is available free at http:..www.-outube.com.watchMvN<k'<bIrD*"D
"harmac- Medication Error
This short two and a half minute video clip e!emplifies comple!ities in an emergenc-
department. The clip is a headshot of a nurse describing the genesis and resolution of
a medication error. The video was produced b- a non)profit organi@ation called afer
0ealth 1are. It is available free at http:..www.-outube.com.profileMuserNaferhealth
carePp.u.<.jmh<$'apa95
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow 62
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This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
3ural 0ealth IT /doption Toolbo!
This website compiles information about 0ealth IT adoption with a focus on rural
settings. This is a government website that is sponsored and maintained b- the +..
8epartment of 0ealth and 0uman ervices #00% 0ealth 3esources and ervices
/dministration #03/%.
http:..www.hrsa.gov.healthit.toolbo!.3ural0ealthITtoolbo!.
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow 6(
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
Component 10&2nit (
2nit .itle
Process "appin .heory and Rationale
2nit 1escription
In two parts, $undamentals of 0ealth 'orkflow "rocess /nal-sis and 3edesign:
"rocess Mapping Theor- and 3ationale, Lecture a, and "rocess Mapping 8iagramming
Tools, Lecture b, covers the background necessar- for graphicall- representing
processes. It uses flowcharts and basic flowchart s-mbols to provide an introduction to
graphical process representation, also called process diagramming. eparate units
cover complete s-mbol sets and conventions for different t-pes of process diagrams.
2nit *,-ecti+es
F- the end of this unit the student will be able to:
6. /rticulate the value of process mapping.
2. 8escribe standard process mapping s-mbols and conventions.
(. /nal-@e an e!isting workflow process chart in terms of the information that
could be generated, and the se*uence of steps that are being
communicated.
<. 1hoose the correct scope and detail level for a process map.
;. 1hoose an appropriate process mapping methodolog-.
=. 1reate a process map for a health care s-stem #or s-stem component%
using correct s-mbols and conventions.
2nit .opics & /ecture .itles
2a "rocess Mapping Theor- and 3ationale
2b "rocess Mapping 8iagramming Tools
2nit References
#/ll links accessible as of (.5<.62%
/ecture (a
6. Q$lowchart.Q Merriam)'ebster ,nline 8ictionar-. 2565. Merriam)'ebster ,nline.
2( Hune 2565
http:..www.merriam)webster.com.dictionar-.flowchart
2. ?all, H. #6:>9%. Systematics6 how systems work and especially how they fail&
London: 'ildwood 0ouse Ltd.
(. I,./7I ;95> Information processing ) 8ocumentation s-mbols and
conventions for data, program and s-stem flowcharts, program network charts
and s-stem resources charts. 6:9;.
<. Huran Hoseph M, ?r-na $rank M. #eds.% HuranAs Cualit- 1ontrol 0andbook. 6:99
Mc?raw)0ill, Inc. 7ew Dork.
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow 6<
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
;. The /merican 0eritageR 8ictionar- of the English Language, $ourth Edition
cop-right S2555 b- 0oughton Mifflin 1ompan-. +pdated in 255:. "ublished b-
0oughton Mifflin
=. 'ickens 18, 0ollands H?. 8n!ineerin! 3sycholo!y and Human 3erformance&
(rd ed. +pper addle 3iver, 7H: "rentice 0all, Inc& 6:::.
>. 'ikipedia contributors. Q$lowchart.Q 0ikipedia, The 1ree 8ncyclopedia.
'ikipedia, The $ree Enc-clopedia, 22 Hun. 2565. 'eb. 2( Hun. 2565.
/ecture (a Charts3 .a,les and Fiures
#7one in this +nit%
/ecture (a !maes
lide <: 1aveman JEngraverK. #T6>555 -ears ago%. Lascau! 1ave: felids galler-,
3etrieved $ebruar- 2(, 2562 from: http:..commons.wikimedia.org.wiki.$ile:Lascau!)
diverticule)fL1(L/:lins.jpg
lide ;: DOT79:9#6 3oison ;. #n.d.%. 3etrieved $ebruar- 2(, 2562, from
1omplianceigns.com website: http:..www.compliancesigns.com.8,T):9:2.shtml
lide ;: <anual on Uniform Traffic Control Devices +<UTCD/ 7 Chapter #.& )e!ulatory
Si!ns. #n.d.%. 3etrieved $ebruar- 2(, 2562, from +nited tates 8epartment of
Transportation ) $ederal 0ighwa- /dministration website:
http:..mutcd.fhwa.dot.gov.htm.255(r6r2.part2.part2b6.htmPfigure2F(
lide ;: 0=7=4 Truck Turn Over .lack on >ellow Diamond 0arnin! Si!n. #n.d.%.
3etrieved $ebruar- 2(, 2562, from 1enterline uppl- website:
http:..www.bing.com.images.searchM*N3oadUignsUforUTrucksGviewNdetailGidN:;>1
88>>;((86/E8;9=>/<86=5=1$2=F$8FF(86=GfirstN626G$,3MNI8$3I3
lide =: 0ashin!ton DC ?" <edical Center 7<etro Subway <ap. #n.d.%. 3etrieved
$ebruar- 2(, 2562, from +..8epartment of 4eterans /ffairs website:
http:..www.washingtondc.va.gov.about.metro.asp
lide 25: 7ahm M. 8uke +niversit-, 2562.
lide 26: 7ahm M. 8uke +niversit-, 2562.
lide 22: 1ile6*amp1lowchart&pn!. #n.d.%. 3etrieved $ebruar- 2(, 2562, from 'ikimedia
1ommons website: http:..commons.wikimedia.org.wiki.$ile:Lamp$lowchart.png
lide 2;: $lowchart of patient intake diagram. 7ahm, M. 8uke +niversit-, 2562.
lide 2=: 1ontinuation of $lowchart of patient intake diagram. 7ahm, M. 8uke
+niversit-, 2562.
/ecture (,
6. Fo!, ?. Improving almost an-thing. Ideas and essa-s. 255=.
2. 1oiera, E. #255(%. 'uide to Health nformatics #2nd ed.%. London: 0odder /rnold
"ublishers.
(. EM3."ractice Management Evaluation "roject for Local "ublic 0ealth 1linics G
1ase Management. #n.d.%. 3etrieved $ebruar- 2(, 2562, from 1abarrus health
alliance website: http:..www.cabarrushealth.org.1ommon?round.
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow 6;
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
<. I,./7I ;95> Information processing ) 8ocumentation s-mbols and
conventions for data, program and s-stem flowcharts, program network charts
and s-stem resources charts. 6:9;.
;. Huran, HM, ?r-na, $M. #eds.% HuranAs Cualit- 1ontrol 0andbook. 6:99 Mc?raw)
0ill, Inc. 7ew Dork.
=. "ublic 0ealth Institute, 255=. Taking 1are of Fusiness: / 1ollaboration to
8efine Local 0ealth 8epartment Fusiness "rocesses. 8ecatur, ?/: "ublic
0ealth Informatics Institute. /vailable online at www.phii.org
>. Dourdon E. Hust Enough tructured /nal-sis. 255= revision. 1hapter :, available
free at http:..-ourdon.com.strucanal-sis.wiki.
/ecture (, Charts3 .a,les and Fiures
Table 2.6 "h-sical and Mental "rocess teps. 7ahm, M #2562%
Table 2.2 Methods for 8iagramming "rocesses. 7ahm, M #2562%
/ecture (, !maes
lide (: 'eor!e .o( J"hotographK. 3etrieved $ebruar- 2(, 2562 from:
http:..en.wikipedia.org.wiki.?eorgeIFo!
lide <: ?robe, 0. J"hotographerK. 8l!in pocket watch J"hotographK. #6:(5M%.
3etrieved $ebruar- 2(, 2562 from: http:..commons.wikimedia.org.wiki.$ile:'atch)
ancre)openIhg.jpg
lide <: Fananenfalter. J"hotographerK. 3ocket 0atch J"hotographK. 3etrieved
$ebruar- 2(, 2562 from: http:..commons.wikimedia.org.wiki.$ile:'atch)ancre)
openIhg.jpg
lide ;: Bravtchenko, I. J"hotographerK. Dairy 1arm J"hotographK. #2565%. 3etrieved
$ebruar- 2(, 2562 from:
http:..commons.wikimedia.org.wiki.$ile:Maples$armFed/ndFreakfast.jpg
lide ;: #3ight% blueprint, obtained from http:..commons.wikimedia.org.wiki.
lide 6<: ource: 7ahm, M. #2562%
2nit Re4uired Readins
#7one in this +nit%
2nit 'uested Readins
6. "ublic 0ealth Informatics Institute. Taking 1are of Fusiness: / 1ollaboration to
8efine Local 0ealth 8epartment Fusiness "rocesses. Jhomepage on the
InternetK. 255= /vailable from: "ublic 0ealth Informatics Institute. 'eb site:
http:..www.maine.gov.dhhs.btc."8$."0II)TakingI1areIofIFusiness.pdf
2. Hust Enough tructured /nal-sis #1hapter :% JInternetK. /vailable from:
http:..-ourdon.com.strucanal-sis.wiki.inde!.phpMtitleN1hapterI:
(. 'ikipedia: $lowchart JInternetK. /vailable from:
http:..en.wikipedia.org.wiki.$lowchart
<. 'ikipedia: +ML JInternetK. /vailable from:
http:..en.wikipedia.org.wiki.+nifiedIModelingILanguage
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow 6=
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
;. +ML 3esource "age. JInternetK. ,bject Management ?roup. /vailable from.
'eb site: http:..www.uml.org.
=. 'ikipedia: Entit- 3elationship topic:
http:..en.wikipedia.org.wiki.Entit-IrelationshipIdiagram
>. 1olligan, L., /nderson, H. E., "otts, 0. '. '., Ferman H., 8oes the process map
influence the outcome of *ualit- improvement workM / comparison of a
se*uential flow diagram and a hierarchical task anal-sis diagram. FM1 0ealth
ervices 3esearch 2565, 65:>. /vailable from
http:..www.biomedcentral.com.6<>2)=:=(.65.>
9. 3ural 0ealth IT /doption Toolbo!. This website compiles information about
0ealth IT adoption with a focus on rural settings. This is a government website
that is sponsored and maintained b- the +.. 8epartment of 0ealth and 0uman
ervices #00% 0ealth 3esources and ervices /dministration #03/%.
http:..www.hrsa.gov.healthit.toolbo!.3ural0ealthITtoolbo!.
'tudent Application Acti+ities
comp65Iunit2Iactivit-.doc
comp65Iunit2Iactivit-Ike-.doc
comp65Iunit2IselfIassess.doc
comp65Iunit2IselfIassessIke-.doc
05ternal Resources
/n- of the videos from +nit 6 or the clinic scenarios from the /ppendi! can be used for
learning applications in this section.
Microsoft 'ord flowchart how)to tutorials
http:..learngen.org.resources.leobjects.lg556(ta.html
http:..office.microsoft.com.en)us.word)help.draw)flowcharts)with)word)and)powerpoint)
0/5565;;2==.asp!
DouTube 4isio demonstrations: There are man- 4isio demonstration videos on
DouTube. The- are of variable *ualit-, but the- do show screen capture and can help a
new visio user learn the software. / link to e!ample videos is below.
http:..www.-outube.com.watchMvN-n,hfMI)48<GfeatureNfvw
4isio 8emonstrations for I, ;95> $lowcharts
http:..www.-outube.com.watchMvN-n,hfMI)48<GfeatureNfvw
70 Institute for Innovation and Improvement is part of the 7ational 0ealth ervice in
the +B. The 70 Institute for Innovation and Improvement hosts and maintains web
resources, including the link below about process mapping.
http:..www.institute.nhs.uk.*ualit-IandIserviceIimprovementItools.*ualit-IandIservice
IimprovementItools.processImappingI)IanIoverview.html
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow 6>
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
Component 10&2nit $
2nit .itle
!nterpretin and Creatin Process 1iarams
2nit 1escription
+nit ( is composed of several lectures, one for each diagramming method. Lecture a,
Interpreting and 1reating "rocess 8iagrams: Introduction ) provides an introduction to
these concepts and reviews information from +nit 2, Lecture b. Fased on feedback from
practitioners, we recommend using two methods #data flow diagrams in Dourdon
notation, and flowcharts%. In Lecture a, we review the process aspects that each
diagram t-pe covers. In separate presentations, we cover each diagram t-pe. $or the
two recommended methods, the presentation covers concepts and skills from reading
and interpreting the diagrams to actuall- creating them. $or the rest of the diagrams,
we cover onl- background, use, and notation, i.e., the presentation prepares the student
to read and interpret the diagram but not to create them.
2nit *,-ecti+es
F- the end of this unit the student will be able to:
6. 1reate a process flowchart for a health care s-stem #or s-stem
component% using appropriate I, ;95> s-mbols and conventions,
2. 1reate conte!t and data flow diagrams for a health care s-stem #or
s-stem component% using appropriate Dourdon s-mbols and conventions,
(. 1hoose the correct scope and detail level for a process flowchart and data
flow diagram,
<. 3ead and interpret ?ane)arson data flow diagram,
;. 3ead and interpret an entit- relationship diagram in crowAs foot notation,
and
=. 3ead and interpret +ML class, activit-, and state diagrams
2nit .opics & /ecture .itles
6. Be- process aspects that ma- re*uire anal-sis and diagramming
2. T-pes of process diagrams
(. tandard I, ;95> process diagramming s-mbols and conventions
<. 3eading an I, ;95> flowchart in terms of the information that could be generated
and the workflow steps that are being communicated
;. 1reate I, ;95> flowcharts for a health care s-stem #or s-stem component% using
correct s-mbols and conventions
=. Dourdon data flow diagram s-mbols and conventions
>. 1reating data flow diagrams #8$8s% for a given a health care scenario
9. ?ane)arson s-mbols and conventions for process mapping
:. 3eading ?ane)arson data flow diagrams
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow 69
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
65.+nderstand the background of how Entit-)3elationship 8iagrams #E38s% are used
and maintained, the s-mbol set used in producing E38s, and process aspects
covered b- them
66. +nderstand the notation conventions and be able to read #not create% a simple Entit-
3elationship 8iagram #E38%
62."urpose, s-mbols, and conventions for +ML
a. 1lass,
b. /ctivit- and
c. tate machine diagram
6(.3eading and interpreting the diagrams
(a Interpreting and 1reating "rocess 8iagrams: Introduction
(b "rocess Mapping: I, ;95>
(c "rocess Mapping: Dourdon 7otation for 8ata $low 8iagrams
(d "rocess Mapping: ?ane)arson 7otation
(e "rocess Mapping: Entit-)3elationship 8iagrams
(f "rocess Mapping: +nified Modeling Language #+ML%
2nit References
#/ll links accessible as of (.62.2562%
/ecture $a
6. "ublic 0ealth Informatics Institute. #255=%. Taking 1are of Fusiness: /
1ollaboration to 8efine Local 0ealth 8epartment Fusiness "rocesses. 8ecatur,
?/: "ublic 0ealth Informatics Institute.
/ecture $a Charts3 .a,les and Fiures
(.6 Table. 7ahm, Meredith #2562%.
/ecture $a !maes
lide >: 7ahm, Meredith #2562%.
/ecture $,
6. I,./7I ;95> Information processing ) 8ocumentation s-mbols and
conventions for data, program and s-stem flowcharts, program network charts
and s-stem resources charts. 6:9;.
/ecture $, Charts3 .a,les and Fiures
(.2 Table: 7ahm, M., 8uke +niversit-, 2562.
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow 6:
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
/ecture $, !maes
lide >: Image of -mbols used in standard flowcharting. 7ahm M. 8uke +niversit-,
2562
lide 9: Fasic process s-mbol utili@ation in a flowchart. 7ahm M. 8uke +niversit-, 2562
lide :: $lowchart showing decision tree about drug testing. 7ahm M. 8uke +niversit-,
2562
lide 65: +se of the Terminator s-mbol in workflow process diagramming. 7ahm M.
8uke +niversit-, 2562
lide 66: 4ikrant #own work%. 255=%. " flowchart about testin! lamp workin!& JflowchartK,
3etrieved $ebruar- 2>, 2562 from
http:..commons.wikimedia.org.wiki.$ile:Lamp$lowchart.png
lide 62: $lowchart of decision tree for patients coming into a hospital. 7ahm M. 8uke
+niversit-, 2562
lide 6(: E!ample of document s-mbol use. 7ahm M. 8uke +niversit-, 2562
lide 6<: 8efinition of manual input versus manual operation. 7ahm M. 8uke +niversit-,
2562
lide 6;: E!ample: Manual ,peration and Manual Input. 7ahm M. 8uke +niversit-,
2562.
lide 6=: -mbols for 8ata and stored data. 7ahm M. 8uke +niversit-, 2562
lide 6>: 8ata s-mbol e!ample. 7ahm M. 8uke +niversit-, 2562.
lide 69: E!ample of the 8ispla- s-mbol. 7ahm M. 8uke +niversit-, 2562
lide 6:: E!ample of the 1onnector s-mbol. 7ahm M. 8uke +niversit-, 2562
lide 25: The 8ela- s-mbol. 7ahm M. 8uke +niversit-. 2562.
lide 22: /nnotations or Qcall outsQ. 7ahm M. 8uke +niversit-, 2562.
lide 2(: E!ample of 8etail Level in flow charts. 7ahm M. 8uke +niversit-, 2562.
lide 2<: E!ample of appropriate and incorrect $low in a chart. 7ahm M. 8uke
+niversit-, 2562.
lide 2;: $low: $rom top to bottom or 3 to L. 7ahm M. 8uke +niversit-, 2562.
lide 2=: +se of line in flow diagrams. 7ahm M. 8uke +niversit-, 2562.
/ecture $c
6. Dourdon, E. #255=%. Hust Enough tructured /nal-sis #3ev ed.%. 3etrieved from
http :..-ourdon.com.strucanal-sis.wiki
/ecture $c Charts3 .a,les and Fiures
(.( Table. 7ahm, M, Methods for diagramming processes, 2562.
/ecture $c !maes
lide >: 1onte!t 8iagram E!ample. 7ahm ,M., 8uke +niversit-, 2562.
lide 9: E!ample 8$8 for "atient visit. 7ahm, M. 8uke +niversit-, 2562.
lide :: Dourdon -mbols or dataflow diagrams. 7ahm, M., 8uke +niversit-, 2562.
lide 65: The QEntit-Q s-mbol in Dourdon notation. 7ahm, M., 8uke +niversit-, 2562.
lide 66: The Q"rocessQ s-mbol in Dourdon notation. 7ahm, M., 8uke +niversit-, 2562.
lide 62: The Q$lowQ s-mbol in Dourdon notation. 7ahm M., 8uke +niversit-, 2562.
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow 25
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
lide 6(: Q8ata toreQ s-mbol utili@ation in Dourdon notation. 7ahm, M., 8uke
+niversit-, 2562.
lide 26: 8iagram showing relationships of software processes in public health
departments. 1abarrus 0ealth /lliance. http:..www.cabarrushealth.org.
lide 2(: E!ample prescription refill conte!t diagram. 7ahm, M., 8uke +niversit-, 2562.
/ecture $d
6. ?ane, 1., G arson, T. #6:>:%. Structured Systems "nalysis6 Tools and
Techni@ues. Englewood 1liffs, 7H: "rentice 0all.
2. Ben 0opkins, Curriculum Council E uggested tandards for Information
-stems 255=: 2(9.>, 7ewman 1ollege, 2556 available at:
http :.. portal.newman.wa.edu.au.technolog-.62infs-s.html.B'0255(.Info-s
L252559.InformationL25-stemsL25)L25uggested
L25tandards.pdfhttp :..portal.newman.wa.edu.au.technolog-.62infs-s.html.B'
0255(.Info-sL252559.InformationL25-stemsL25)L25uggested
L25tandards.pdf
(. Information -stems Teachers, 1onsensus Meetings 255;. #eds.%. 255=,
Hanuar-%. N1O)<"TON S>ST8<S, Su!!ested Standards for nformation
Systems Tools #Dear 62 E2(9.>3%. 3etrieved from Trinit- 1ollege website:
http:..www.trinit-.wa.edu.au
/ecture $d Charts3 .a,les and Fiures
(.< Table. Methods for diagramming processes. 7ahm, M, 8uke +niversit-, 2562.
/ecture $d !maes
lide >: implified on)line appointment scheduling e!ample using ?ane)arson
notation. 7ahm M., 8uke +niversit-, 2562.
lide 9: ?ane)arson s-mbols. 7ahm M., 8uke +niversit-, 2562.
lide :: Entities s-mbol in ?ane)arson notation. 7ahm M., 8uke +niversit-, 2562.
lide 65: "rocess s-mbol in ?ane)arson notation. 7ahm M., 8uke +niversit-, 2562.
lide 66: $low s-mbol in ?ane)arson notation. 7ahm M., 8uke +niversit-, 2562.
lide 62: 8ata tore s-mbols in ane)?arson notation. 7ahm M., 8uke +niversit-,
2562.
/ecture $e
6. Fachman, 1. '. #6:=:, ummer%. 8ata tructure 8iagrams. Data.ase6 "
Auarterly Newsletter of S'.D3, =#2%, <)65.
2. 1hen, ". ". #6:=:, March%. The Entit-)3elationship Model: Toward a +nified 4iew
of 8ata. "C< Transactions on Database Systems, =#6%, :)(=.
(. 1odd, E. $. #6:=:, /ugust 6:%. 8erivabilit-, 3edundanc- and 1onsistenc- of
3elations tored in Large 8ata Fanks. .< )esearch )eport, ),B99.
<. Fernat, H, Crows 1oot Notation, +niversit- of 3egina, 8epartment of 1omputer
cience, 3egina, askatchewan, 1anada. /vailable from
http:..www2.cs.uregina.ca.Tbernatja.crowsfoot.html
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow 26
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
/ecture $e Charts3 .a,les and Fiures
#7one in this +nit%
/ecture $e !maes
lide 65: E38 E!ample. /dapted with permission from Fernat, H. Crows 1oot Notation,
+niversit- of 3egina, 8epartment of 1omputer cience, 3egina, askatchewan,
1anada. /vailable from http:..www2.cs.uregina.ca.Tbernatja.crowsfoot.html
lide 66: Entit-. 7ahm, M, 8uke +niversit-, 2562.
lide 62: 3elationship use in E)3 notation. 7ahm, M., 8uke +niversit-, 2562.
lide 6<: 1ardinalit- -mbols. 7ahm, M., 8uke +niversit-, 2562.
lide 6;: Modalit- -mbols. 7ahm, M., 8uke +niversit-, 2562.
lide 6=: 3eading Modalit- and 1ardinalit-. 7ahm, M., 8uke +niversit-, 2562.
/ecture $f
6. 'atson, /. #n.d.%. ?isual <odelin!6 past, present and future. 3etrieved $ebruar-
2>, 2562, from ,M? website: http:..www.uml.org.4isualIModeling.pdf
/ecture $f Charts3 .a,les and Fiures
(.; Table: Methods for diagramming processes. 7ahm, M., 8uke +niversit-, 2562.
/ecture $f !maes
lide :: 1lass 8iagram E!ample. 7ahm, M., 8uke +niversit-, 2562.
lide 65: 1lass 8iagram 7otation. 7ahm, M., 8uke +niversit-, 2562.
lide 66: 1lass 8iagram E Larger 4iew. 7ahm, M., 8uke +niversit-, 2562.
lide 6(: /ctivit- 8iagram -mbols. 7ahm, M., 8uke +niversit-, 2562.
lide 6<: /ctivit- 8iagram E!ample. 7ahm, M., 8uke +niversit-, 2562.
lide 6=: tate 8iagram -mbols. 7ahm, M., 8uke +niversit-, 2562.
lide 6>: tate 8iagram E!ample. 7ahm, M., 8uke +niversit-, 2562.
2nit Re4uired Readins
#7one in this unit%
2nit 'uested Readins
6. 'ikipedia, $lowchart JInternetK. /vailable from:
http:..en.wikipedia.org.wiki.$lowchart
2. "ublic 0ealth Informatics Institute. Taking 1are of Fusiness: / 1ollaboration to
8efine Local 0ealth 8epartment Fusiness "rocesses. Jhomepage on the
InternetK. 255= /vailable from: "ublic 0ealth Informatics Institute. 'eb site:
http:..www.maine.gov.dhhs.btc."8$."0II)TakingI1areIofIFusiness.pdf
(. Hust Enough tructured /nal-sis #1hapter :% JInternetK. /vailable from:
http:..-ourdon.com.strucanal-sis.wiki.inde!.phpMtitleN1hapterI:
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow 22
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
<. 'ikipedia: +ML JInternetK. /vailable from:
http:..en.wikipedia.org.wiki.+nifiedIModelingILanguage
;. +ML 3esource "age. JInternetK. ,bject Management ?roup. /vailable from. 'eb
site: http:..www.uml.org.
=. 'ikipedia: Entit- 3elationship JInternetK /vailable from:
http:..en.wikipedia.org.wiki.Entit-IrelationshipIdiagram
>. 1odd, E.$., / relational model of data for large shared databanks.
1ommunications of the /1M, vol 6( no =. 6:>5.
http:[email protected](f.cis;;5.codd.pdf
'tudent Application Acti+ities
comp65Iunit(Iactivit-.doc
comp65Iunit(Iactivit-Ike-.doc
comp65Iunit(IselfIassess.doc
comp65Iunit(IselfIassessIke-.doc
05ternal Resources
/n- of the videos from +nit 6 or the clinic scenarios from the /ppendi! can be used for
learning applications in this section.
0ow Life hould Fe /fter DouAve Implemented Electronic Medical 3ecords
$ilmed visit scheduling and patient encounter scenario in small pediatric practice with
technolog- assisted workflow. "roduced b- a commercial sponsor& > minutes and6=
seconds long. http:..www.-outube.com.watchMvN:>v;p:7k2IIGfeatureNrelated
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow 2(
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
Component 10&2nit 6
2nit .itle
Ac4uirin Clinical Process 7nowlede
2nit 1escription
In three lectures, this unit covers the concepts and methods for /c*uiring 1linical
"rocess Bnowledge in the health care setting needed b- the health care 'orkflow
/nal-sis and 3edesign pecialist
2nit *,-ecti+es
F- the end of this unit the student will be able to:
1% Identif- how the strategic goals and stakeholders for a given health care
facilit- can influence workflow processes in that facilit-,
(% 1reate an agenda for an opening meeting to discuss workflow processes
in a health care facilit-, in light of that facilit-As strategic goals and
stakeholders,
$% 1ompare and contrast different t-pes of knowledge and their impact on
organi@ations,
6% /nal-@e a health care scenario according to 1MMI levels,
8% Identif- the workflow processes that are likel- to be used b- a health care
facilit-,
9% Identif- the workflow processes that are essential to observe in order to
determine how best to streamline the operations in a given health care
facilit-, and
:% Identif- ke- individuals with whom the "ractice 'orkflow and Information
Management 3edesign pecialist should meet or observe in order to gain
an understanding of the nature and comple!it- of their work.
;% ?iven a process observation scenario, formulate the *uestions that would
facilitate a productive discussion of the workflow of information, activities
and roles within that facilit-,
<% uggest wa-s to successfull- respond to common challenges
encountered in knowledge ac*uisition,
10% ?iven a practice scenario, choose an appropriate knowledge ac*uisition
method,
11% ?iven a process anal-sis scenario including list of observations, create
agenda for visit closing meeting and an initial meeting report, and
1(% ?iven a set of diagrams and observations from an information gathering
meeting, draft a summar- report.
2nit .opics & /ecture .itles
6. Bnowledge /c*uisition #B/% goals in health care,
2. Importance of B/,
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow 2<
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
(. 1ategories of knowledge, and
<. Bnowledge and the 1apabilit- Maturit- Model #1MM%.
;. 1linic information such as mission, stakeholders and goals that can help inform the
anal-sis,
=. 1ommon clinic processes, and
>. 1reating a process inventor-.
9. Bnowledge sources,
:. "rocess information that should be considered in the anal-sis,
65. Methods to obtain the information,
66. Bnowledge ac*uisition plan, and
62. Initiating a relationship with a clinic.
<a /c*uiring 1linical "rocess Bnowledge
<b /c*uiring 1linical "rocess Bnowledge
<c /c*uiring 1linical "rocess Bnowledge
2nit References
#/ll links accessible as of (.5<.62%
/ecture 6a
6. ?aines, Frian 3. #n.d.% Or!ani2ational Cnowled!e "c@uisition& /ccessed /ugust
6, 2565. /vailable free from
http:..pages.cpsc.ucalgar-.ca.Tgaines.reports.BM.,B/.inde!.html
2. Milton, 7. 3. #255>%. Cnowled!e "c@uisition in 3ractice6 " Step7by7step 'uide
+Decision 8n!ineerin!/. London: pringer)4erlag.
/cknowledgement: Material used in this lecture comes from the following source:
6. "assive Bnowledge 4ersus /ctive Bnowledge, March <, 2565. /ccessed on
/ugust 2, 2565, available from http:..www.be-onduni.com.2565.5(.passive)
knowledge)versus)active)knowledge.
/ecture 6a Charts3 .a,les and Fiures
#7one in this +nit%
/ecture 6a !maes
lide :: ?aines, Frian 3. #n.d.% Or!ani2ational Cnowled!e "c@uisition& /ccessed
/ugust 6, 2565. /vailable free from
http:..pages.cpsc.ucalgar-.ca.Tgaines.reports.BM.,B/.inde!.html
lide 66: ?aines, Frian 3. #n.d.% Or!ani2ational Cnowled!e "c@uisition& /ccessed
/ugust 6, 2565. /vailable free from
http:..pages.cpsc.ucalgar-.ca.Tgaines.reports.BM.,B/.inde!.html
lide 62: ?aines, Frian 3. #n.d.% Or!ani2ational Cnowled!e "c@uisition& /ccessed
/ugust 6, 2565. /vailable free from
http:..pages.cpsc.ucalgar-.ca.Tgaines.reports.BM.,B/.inde!.html
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow 2;
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
lide 6(: ource: Meredith 7ahm, "h8.
/ecture 6,
/cknowledgement: Material used in this lecture comes from the following sources
6. ?aines, Frian 3. #n.d.% Or!ani2ational Cnowled!e "c@uisition& /ccessed /ugust
6, 2565. /vailable free from
http:..pages.cpsc.ucalgar-.ca.Tgaines.reports.BM.,B/.inde!.html
2. Milton, 7. 3. #255>%. Cnowled!e "c@uisition in 3ractice6 " Step7by7step 'uide
+Decision 8n!ineerin!/. London: pringer)4erlag.
(. "assive Bnowledge 4ersus /ctive Bnowledge, March <, 2565. /ccessed on
/ugust 2, 2565, available from http:..www.be-onduni.com.2565.5(.passive)
knowledge)versus)active)knowledge.
/ecture 6, Charts3 .a,les and Fiures
#7one in this +nit%
/ecture 6, !maes
lide >: ource: Meredith 7ahm, "h8.
/ecture 6c
/cknowledgement: Material used in this lecture comes from the following sources
6. ?aines, Frian 3. #n.d.% Or!ani2ational Cnowled!e "c@uisition& /ccessed /ugust
6, 2565. /vailable free from
http:..pages.cpsc.ucalgar-.ca.Tgaines.reports.BM.,B/.inde!.html
2. Milton, 7. 3. #255>%. Cnowled!e "c@uisition in 3ractice6 " Step7by7step 'uide
+Decision 8n!ineerin!/. London: pringer)4erlag.
(. "assive Bnowledge 4ersus /ctive Bnowledge, March <, 2565. /ccessed on
/ugust 2, 2565, available from http:..www.be-onduni.com.2565.5(.passive)
knowledge)versus)active)knowledge.
/ecture 6c Charts3 .a,les and Fiures
#7one in this +nit%
/ecture 6c !maes
#7one in this +nit%
2nit Re4uired Readins
#7one in this +nit%
2nit 'uested Readins
6. Milton 73. Bnowledge ac*uisition in practice: / step b- step guide& 6st ed.
London: pringer& 255>.
2. 'ikipedia: 1apabilit- Maturit- Model JInternetK /vailable from:
http:..en.wikipedia.org.wiki.1apabilit-IMaturit-IModel
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow 2=
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
'tudent Application Acti+ities
comp65Iunit<Iactivit-.doc
comp65Iunit<Iactivit-Ike-.doc
comp65Iunit<IselfIassess.doc
comp65Iunit<IselfIassessIke-.doc
05ternal Resources
/n- of the videos from +nit 6 can be used for learning applications in this section.
Bnowledge /c*uisition web resource: http:..www.epistemics.co.uk.7otes.=()5)5.htm
This resource is considerabl- broader than the content for this unit& therefore, not
recommended for students. This resource is provided for the instructor to place the
material in this unit in the broader conte!t of Bnowledge /c*uisition. This resource was
created and is maintained b- a commercial organi@ation, Epistemics.
?aines, Frian 3. #n.d.% ,rgani@ational Bnowledge /c*uisition. /ccessed /ugust 6,
2565. This is a free article from a recogni@ed Bnowledge /c*uisition e!pert from the
+niversit- of 1algar-. This resource is *uite philosophical and theoretical, and thus, is
provided as a resource for instructors rather than students. The resource is provided
because it provides a solid e!ploration of the concept of Bnowledge /c*uisition.
/vailable free from http:..pages.cpsc.ucalgar-.ca.Tgaines.reports.BM.,B/.inde!.html
Milton 73. Bnowledge ac*uisition in practice: / step b- step guide& 6st ed. London:
pringer& 255>
'ikipedia: 1apabilit- Maturit- Model JInternetK /vailable from:
http:..en.wikipedia.org.wiki.1apabilit-IMaturit-IModel
E!ample process diagrams for man- common clinic processes. /ccessible from the
/03C website. This resource has pdf documents of man- different clinical processes.
The- can be used as e!amples, or as materials for e!ercises and *ui@ *uestions.
http:..healthit.ahr*.gov.portal.server.ptM
openN;62GobjI8N6666G"ageI8N5GcachedNtrueGmodeN2GuserI8N9:;:PCuestion
3ural 0ealth IT /doption Toolbo!
This website compiles information about 0ealth IT adoption with a focus on rural
settings. This is a government website that is sponsored and maintained b- the +..
8epartment of 0ealth and 0uman ervices #00% 0ealth 3esources and ervices
/dministration #03/%.
http:..www.hrsa.gov.healthit.toolbo!.3ural0ealthITtoolbo!.
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow 2>
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
Component 10&2nit 8
2nit .itle
Process Analysis
2nit 1escription
In two lectures, $undamentals of 0ealth 'orkflow "rocess /nal-sis and 3edesign:
"rocess /nal-sis covers the background and methodolog- for process anal-sis.
2nit *,-ecti+es
F- the end of this unit the student will be able to:
6. 8escribe the purpose of process anal-sis,
2. 8escribe skills and knowledge necessar- for process anal-sis,
(. "erform a process anal-sis for a given clinic scenario,
<. ?iven results of a process anal-sis draft a summar- report, and
;. ?iven results of a process anal-sis, identif- desired EM3 functionalit-
2nit .opics & /ecture .itles
6. ,bjectives of "rocess /nal-sis
2. 3elevant concepts for process anal-sis
(. teps for process anal-sis
<. tarting with process inventor- and diagrams
;. $or each process, listing
a. 4ariations applicable to the clinic
b. E!ceptions
=. /nd 3eporting findings
>. "rocess 4ariations for common clinic processes
a. "atient check)in
b. "atient visit
c. "rescription
d. 3eceived documentation
e. Labs G diagnostic tests
f. 3eferral and consults
g. 8isease management
h. Filling
9. Identif-ing E03 functionalit- from "rocess /nal-sis
;a "rocess /nal-sis
;b "rocess /nal-sis
2nit References
#/ll links accessible as of (.5<.62%
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow 29
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
/ecture 8a
6. /nal-sis. #n.d.%. In <erriam70ebster Online Dictionary. 3etrieved $ebruar- 2>,
2562 from http:..www.merriam)webster.com.dictionar-.
2. 8eming, '. E. #6:92%. Out of Crisis. 1ambridge, M/: MIT "ress.
(. "rocedure. #n.d.%. In "merican Society of Auality 'lossary. 3etrieved $ebruar-
2>, 2562 from http:..as*.org.glossar-.p.html
<. "rocess. #n.d.%. In <erriam70ebster Online Dictionary. 3etrieved $ebruar- 2>,
2562 from http:..www.merriam)webster.com.dictionar-.
/ecture 8a Charts3 .a,les and Fiures
#7one in this +nit%
/ecture 8a !maes
lide <: $8/. #n.d.%. 0& 8dwards Demin!. 3etrieved $ebruar- 2>, 2562, from
http:..commons.wikimedia.org.
lide 6(: "ractice $unctions. 7ahm, M., 8uke +niversit-, 2562.
/ecture 8,
#7one in this +nit%
/ecture 8, Charts3 .a,les and Fiures
#7one in this +nit%
/ecture 8, !maes
lide 6>: 3ole)Fased $lowchart. 7ahm, M. #2562%
lide 6:: Translating /nal-sis 3esults to E03 $unctionalit-. 7ahm, M. #2562%
2nit Re4uired Readins
#7one in this +nit%
2nit 'uested Readins
6. / s-stems approach to operational redesign workbook. Massachusetts: Masspro
Jcited 2565 /ug <K Masspro, the Medicare Cualit- Improvement ,rgani@ation for
Massachusetts, under contract to 1M. Jp. 6);5K. /vailable free from
http:..www.masspro.org.0IT.docs.tools.8,CITL25'FL25forL25'EF.pdf
2. Facjer, L/. In search of a super superbill, $amil- "ractice Management. JInternetK
255= ep& 6(#9%: Jp. <()<<K. /vailable from
http:..www.aafp.org.fpm.255=.5:55.p<(.html
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow 2:
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
'tudent Application Acti+ities
comp65Iunit;Iactivit-.doc
comp65Iunit;Iactivit-Ike-.doc
comp65Iunit;IselfIassess.doc
comp65Iunit;IselfIassessIke-.doc
05ternal Resources
/n- of the videos from +nit 6 can be used for learning applications in this section.
$amil- "ractice Management Toolbo!: created and maintained b- /merican /cadem- of
$amil- "h-sicians #//$"%. Most items in the toolbo! are from published articles in
$amil- "ractice Management. /rticles more than one -ear old are free, articles less
than a -ear re*uire a membership to access. /vailable at:
http:..www.aafp.org.online.en.home.publications.journals.fpm.fpmtoolbo!.html
/rticle: 1ase tud- of "atient $low /nal-sis
"otisek, 7. M., Malone, 3. M., hillida-, F. F., Ives, T. H., 1helminski, ". 3., 8e'alt, 8.
/., "ignone, M. "., +se of patient flow anal-sis to improve patient visit efficienc- b-
decreasing wait time in a primar- care)based disease management programs for
anticoagulation and chronic pain: a *ualit- improvement stud-. FM1 0ealth erv 3es.
255>& >: 9. "M1I8: "M16>9<59= available free from:
http:..www.ncbi.nlm.nih.gov.pmc.articles."M16>9<59=.
E03 /doption tools were created and are maintained b- 0ealth Insight. Healthnsi!ht is
a private, non)profit communit- based organi@ation dedicated to improving the
healthcare s-stems of 7evada and +tah. "articularl- of interest is the workflow anal-si s
template. These tools are freel- available at:
http:..www.healthinsight.org.Internal.E03I/doption"rocess.html
/ -stems /pproach to ,perational 3edesign 'orkbook. "roduced b- Masspro, the
Medicare Cualit- Improvement ,rgani@ation for Massachusetts, under contract to 1M.
#n.d.% accessed on /ugust <, 2565. This resource includes ,rief te5t descriptions3
,est practices3 and practice e5amples and pro,lems% /vailable free from
http:..www.masspro.org.0IT.docs.tools.8,CITL25'FL25forL25'EF.pdf
The /genc- for 0ealthcare 3esearch and Cualit- #/03C% has a website with workflow
anal-sis tools. Man- of the tools are hosted b- other organi@ations, but all can be
accessed for free through the /03C site. /ccessed /ugust <, 2565, available from
http:..healthit.ahr*.gov.portal.server.ptM
openN;62GobjI8N6666G"ageI8N5GcachedNtrueGmodeN2GuserI8N9:;:
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow (5
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
3ural 0ealth IT /doption Toolbo!
This website compiles information about 0ealth IT adoption with a focus on rural
settings. This is a government website that is sponsored and maintained b- the +..
8epartment of 0ealth and 0uman ervices #00% 0ealth 3esources and ervices
/dministration #03/%.
http:..www.hrsa.gov.healthit.toolbo!.3ural0ealthITtoolbo!.
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow (6
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
Component 10&2nit 9
2nit .itle
Process Re=desin
2nit 1escription
This unit, "rocess 8esign, consists of ; lectures and covers the background and
methodolog- for process redesign in the health care facilit-
2nit *,-ecti+es
F- the end of this unit the student will be able to:
6. Identif- the factors that optimi@e workflow processes in health care
settings.
2. 8escribe how information technolog- can be used to increase the
efficienc- of workflow in health care settings.
(. Identif- aspects of clinical workflow that are improved b- E03.
<. "ropose wa-s in which the workflow processes in health care settings can
be re)designed to ensure patient safet- and increase efficienc- in such
settings.
;. +se knowledge of common software functionalit- and meaningful use
objectives to inform a process redesign for a given clinic scenario
2nit .opics & /ecture .itles
6. ,bjectives and goals of "rocess 3edesign,
2. +nproductive work,
(. Twent- seven strategies for optimi@ing processes, and
<. /n e!ample of each optimi@ation strateg-.
;. 8escribe how information technolog- can be used to increase the efficienc- of
workflow in health care settings
=. Identif- aspects of clinical workflow that are improved b- E03
>. ,bjectives, kills and Bnowledge for "rocess 3edesign,
9. 1ommon process problems,
:. olutions to process problems, and
65.0uman)1entered 8esign $ramework as applied to "rocess 3edesign.
66. Matching common clinic s-stem functionalit- to solve process problems.
62.,bjectives, skills and knowledge for "rocess 3edesign,
6(.0uman)1entered 8esign framework applied to "rocess 3edesign,
6<.1ommon process problems,
6;.olutions to process problems,
6=.Matching common clinic s-stem functionalit- to solve process problems, and
6>."rocess redesign for Meaningful +se.
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow (2
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
=a "rocess 3edesign
=b "rocess 3edesign
=c "rocess 3edesign
=d "rocess 3edesign
=e "rocess 3edesign
2nit References
#/ll links accessible as of (.5<.62%
/ecture 9a
6. /viVa, 1 #2565%. Community Health Clinic Ole, Case Study& 3rocess <appin! -
Documentation, 3re and 3ost 8<)& J"ower"oint slidesK. 3etrieved from
http:..www.rchc.net."ublic.,0IT.1linic"rocess3edesign)""T.pdf
2. 8eming, '. E. #6:92%. Out of Crisis. 1ambridge, M/: MIT "ress.
(. Lee, F. #n.d.%. <ana!er5*eader Comments. 3etrieved $ebruar- 2>, 2562, from
4irginia 1ommonwealth +niversit- website:
http:..www.people.vcu.edu.Trsleeth.ManagerLeaderCuotes.htm
<. Mansar, . L., G 3eijers, 0. /. #255;%. Fest practices in business process
redesign: validation of a redesign framework. Computers in ndustry, B;, <;>)
<>6. 3etrieved from http:..is.tm.tue.nl.staff.hreijers.0./.L253eijers
L25Festanden.MansarI255;I1omputers)in)Industr-.pdf
/ecture 9a Charts3 .a,les and Fiures
#7one in this +nit%
/ecture 9a !maes
lide <: $8/. #n.d.%. 0& 8dwards Demin!. 3etrieved $ebruar- 2>, 2562, from
http:..commons.wikimedia.org.
lide =: /viVa, 1 #2565%. Community Health Clinic Ole, Case Study& 3rocess <appin! -
Documentation, 3re and 3ost 8<)& J"ower"oint slidesK. 3etrieved from
http:..www.rchc.net."ublic.,0IT.1linic"rocess3edesign)""T.pdf
/ecture 9,
6. Futler, B., Fahrami, /., Esposito, 1, 0ebron, /. #2555%. 1onceptual models for
coordinating the design of user work with the design of information s-stems. .
Data - Cnowled!e 8n!ineerin!, 44#2%, 6:6)6:9.
2. Futler /. #2566, Ma-%. Human Center for Desi!n - 8n!ineerin!, University of
0ashin!ton, <"TH <ethod - Tools for 8vidence7based Health T, "resentation
at 8uke +niversit-, 8urham, 71.
(. I, :2<6)265:2565#E% Ergonomics of humanEs-stem interaction W"art
265:0uman)centred design for interactive s-stems. 3etrieved from
http:..www.iso.org.iso.isoIcatalogue.catalogueIics.catalogueIdetailIics.htmM
csnumberN;25>;
<. Mansar, . L., G 3eijers, 0. /. #255;%. Fest practices in business process
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow ((
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
redesign: validation of a redesign framework. Computers in ndustry, B;, <;>)
<>6. 3etrieved from http:..is.tm.tue.nl.staff.hreijers.0./.L253eijers
L25Festanden.MansarI255;I1omputers)in)Industr-.pdf
/ecture 9, Charts3 .a,les and Fiures
#7one in this +nit%
/ecture 9, !maes
lide >: I, 018 $ramework. I, :2<6)265:2565#E% Ergonomics of humanEs-stem
interaction W"art 265:0uman)centred design for interactive s-stems. 3etrieved from
http:..www.iso.org.iso.isoIcatalogue.catalogueIics.catalogueIdetailIics.htmM
csnumberN;25>;
lide 9: Integrating "rocess and information. Image used with permission. Futler et al.
#2555%
/ecture 9c
#7one in this +nit%
/ecture 9c Charts3 .a,les and Fiures
#7one in this +nit%
/ecture 9c !maes
lide ;: 1linical "ractice EM3 interfaces. 7ahm, M., 8uke +niversit-. #2562%.
lide 9: 1hart showing whether a clinic ma- want to interface with a labXs LIM. 7ahm,
M., 8uke +niversit-. #2562%.
lide 6<: Healthview 3atient *o!in. #n.d.%. 3etrieved $ebruar- 29, 2562, from
8ukeMedicine website:
http:..www.dukehealth.org.patientsIandIvisitors.healthview.inde!
lide 69: C6: 1onte!t 8iagram. 7ahm, M., 8uke +niversit-. #2562%.
/ecture 9d
6. 1M E03 Meaningful +se ,verview. #n.d.%. 3etrieved $ebruar- 2:, 2562, from
1enters for Medicare G Medicaid ervices website:
https:.. www.cms.gov.E03Incentive"rograms.(5IMeaningfulI+se.asp
2. Electronic pecifications, Eligible "rofessionals #E"s%. #n.d.%. 3etrieved $ebruar-
2:, 2562, from 1enters for Medicare G Medicaid ervices website:
https:..www.cms.gov.Cualit-Measures.5(IElectronicpecifications.asp
(. Eligible "rofessional Meaningful +se 1ore Measures Measure 6 of 6;, 1",E for
Medication ,rders. #2565, 7ovember >%. 3etrieved from 1enters for Medicare G
Medicaid ervices website:
http:.. www.cms.gov.E03Incentive"rograms.8ownloads.6I1",EIforIMedication
I,rders.pdf
<. Eligible "rofessional Meaningful +se 1ore Measures Measure 2 of 6;, 8rug
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow (<
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
Interaction 1hecks. #2565, 7ovember >%. 3etrieved from 1enters for Medicare G
Medicaid ervices website:
http:.. www.cms.gov.E03Incentive"rograms.8ownloads.2I8rugIInteractionI1he
cksE".pdf
;. Eligible "rofessional Meaningful +se 1ore Measures Measure ( of 6;, Maintain
"roblem List. #2565, 7ovember >%. 3etrieved from 1enters for Medicare G
Medicaid ervices website:
http:.. www.cms.gov.E03Incentive"rograms.8ownloads.(IMaintainI"roblemILis
tE".pdf
=. Eligible "rofessional Meaningful +se 1ore Measures Measure < of 6;, e)
"rescribing #e3!%. #2565, 8ecember 26%. 3etrieved from 1enters for Medicare G
Medicaid ervices website:
http:.. www.cms.gov.E03Incentive"rograms.8ownloads.<Ie)prescribing.pdf
>. Eligible "rofessional Meaningful +se 1ore Measures Measure ; of 6;, /ctive
Medication List. #2565, 7ovember >%. 3etrieved from 1enters for Medicare G
Medicaid ervices website:
http:.. www.cms.gov.E03Incentive"rograms.8ownloads.;I/ctiveIMedicationILis
t.pdf
9. Eligible "rofessional Meaningful +se 1ore Measures Measure = of 6;,
Medication /llerg- List. #2565, 7ovember >%. 3etrieved from 1enters for
Medicare G Medicaid ervices website:
http:.. www.cms.gov.E03Incentive"rograms.8ownloads.=IMedicationI/llerg-ILi
st.pdf
:. Eligible "rofessional Meaningful +se 1ore Measures Measure > of 6;, 3ecord
8emographics. #2565, 7ovember >%. 3etrieved from 1enters for Medicare G
Medicaid ervices website:
http:..www.cms.gov.E03Incentive"rograms.8ownloads.>I3ecordI8emographic
s.pdf
65. Eligible "rofessional Meaningful +se 1ore Measures Measure 9 of 6;, 3ecord
4ital igns. #2565, 7ovember >%. 3etrieved from 1enters for Medicare G
Medicaid ervices website:
http:..www.cms.gov.E03Incentive"rograms.8ownloads.9L253ecordL254ital
L25ignsL252566.pdf
66. Eligible "rofessional Meaningful +se 1ore Measures Measure : of 6;, 3ecord
moking tatus. #2565, 7ovember >%. 3etrieved from 1enters for Medicare G
Medicaid ervices website:
http:..www.cms.gov.E03Incentive"rograms.8ownloads.:I3ecordImokingItat
us.pdf
62. entinel Event /lert, +sing medication reconciliation to prevent errors. #255=,
Hanuar- 2;%. 3etrieved from The Hoint 1ommission website:
http:..www.jointcommission.org.assets.6.69.E/I(;."8$
6(. 'hat are the re*uirements for tage 6 of Meaningful +se #2566 and 2562%M 1M
E03 Meaningful +se ,verview. #n.d.a%. 3etrieved $ebruar- 2:, 2562, from
1enters for Medicare G Medicaid ervices website:
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow (;
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
https:..www.cms.gov.E03Incentive"rograms.(5IMeaningfulI+se.aspPF,,BM/
3B<
/ecture 9d Charts3 .a,les and Fiures
#7one in this +nit%
/ecture 9d !maes
lide ;: Meaningful +se tages. /vailable at ttp:..www.cms.gov.ehrincentiveprograms.
lide =: 'hat are the re*uirements for tage 6 of Meaningful +se #2566 and 2562%M
C<S 8H) <eanin!ful Use Overview. #n.d.%. 3etrieved $ebruar- 2:, 2562, from 1enters
for Medicare G Medicaid ervices website:
https:&&www%cms%o+&0HR!ncenti+eProrams&$0>"eaninful>2se%asp?@**7"AR
76
lide >: Image adapted from 1enters for Medicare G Medicaid ervices #2565%.
<edicare - <edicaid 8H) ncentive 3ro!ram <eanin!ful Use Sta!e = )e@uirements
Overview D3ower3oint slidesE 3etrieved from
https:&&www%cms%o+&0HR!ncenti+eProrams&1ownloads&"2>'tae1>Re4*+er+ie
w%pdf
/ecture 9e
6. C<S 8H) <eanin!ful Use Overview. #n.d.%. 3etrieved $ebruar- 2:, 2562, from
1enters for Medicare G Medicaid ervices website:
https:&& www%cms%o+&0HR!ncenti+eProrams&$0>"eaninful>2se%asp
2. 8lectronic Specifications, 8li!ible 3rofessionals +83s/. #n.d.%. 3etrieved $ebruar-
2:, 2562, from 1enters for Medicare G Medicaid ervices website:
https:&&www%cms%o+&Auality"easures&0$>0lectronic'pecifications%asp
(. 8li!ible 3rofessional <eanin!ful Use Core <easures <easure =% of =B, Clinical
Auality <easures +CA<s/& #2565, 7ovember >%. 3etrieved from 1enters for
Medicare G Medicaid ervices website:
http:&& www%cms%o+&0HR!ncenti+eProrams&1ownloads&10>Clinical>Auality
>"easures%pdf
<. 8li!ible 3rofessional <eanin!ful Use Core <easures <easure == of =B, Clinical
Decision Support )ule& #2565, 7ovember >%. 3etrieved from 1enters for
Medicare G Medicaid ervices website:
http:&& www%cms%o+&0HR!ncenti+eProrams&1ownloads&11>Clinical>1ecisio
n>'upport>Rule%pdf
;. 8li!ible 3rofessional <eanin!ful Use Core <easures <easure =# of =B,
8lectronic Copy of Health nformation& #2565, 7ovember >%. 3etrieved from
1enters for Medicare G Medicaid ervices website:
http:&& www%cms%o+&0HR!ncenti+eProrams&1ownloads&1(>0lectronic>Cop
y>of>Health>!nformation%pdf
=. 8li!ible 3rofessional <eanin!ful Use Core <easures <easure =4 of =B, Clinical
Summaries& #2566, /pril 69%. 3etrieved from 1enters for Medicare G Medicaid
ervices website:
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow (=
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
http:&&www%cms%o+&0HR!ncenti+eProrams&1ownloads&1$>Clinical>'umm
aries%pdf
>. 8li!ible 3rofessional <eanin!ful Use Core <easures <easure =$ of =B,
8lectronic 8(chan!e of Clinical nformation& #2565, 7ovember >%. 3etrieved from
1enters for Medicare G Medicaid ervices website:
http:&&www%cms%o+&0HR!ncenti+eProrams&1ownloads&16>0lectronic>05c
hane>of>Clinical>!nformation%pdf
9. 8li!ible 3rofessional <eanin!ful Use Core <easures <easure =B of =B, 3rotect
8lectronic Health nformation& #2565, 7ovember >%. 3etrieved from 1enters for
Medicare G Medicaid ervices website:
http:&& www%cms%o+&0HR!ncenti+eProrams&1ownloads&18>Core>Protect0l
ectronicHealth!nformation%pdf
:. 'hat are the re*uirements for tage 6 of Meaningful +se #2566 and 2562%M
C<S 8H) <eanin!ful Use Overview. #n.d.a%. 3etrieved $ebruar- 2:, 2562, from
1enters for Medicare G Medicaid ervices website:
https:&& www%cms%o+&0HR!ncenti+eProrams&$0>"eaninful>2se%asp?@**
7"AR76
/ecture 9e Charts3 .a,les and Fiures
#7one in this +nit%
/ecture 9e !maes
lide ;: Meaningful +se tages. /vailable at http:..www.cms.gov.ehrincentiveprograms.
lide =: 'hat are the re*uirements for tage 6 of Meaningful +se #2566 and 2562%M
C<S 8H) <eanin!ful Use Overview. #n.d.%. 3etrieved $ebruar- 2:, 2562, from 1enters
for Medicare G Medicaid ervices website:
https:..www.cms.gov.E03Incentive"rograms.(5IMeaningfulI+se.aspPF,,BM/3B<
lide >: Image adapted from 1enters for Medicare G Medicaid ervices #2565%.
<edicare - <edicaid 8H) ncentive 3ro!ram <eanin!ful Use Sta!e = )e@uirements
Overview D3ower3oint slidesE 3etrieved from
https:..www.cms.gov.E03Incentive"rograms.8ownloads.M+Itage6I3e*,verview.pdf
2nit Re4uired Readins
#7one in this +nit%
2nit 'uested Readins
6. 'ikipedia: "ractice Management oftware. JInternetK. /vailable from
http:..en.wikipedia.org.wiki."racticeImanagementIsoftware
2. 'ikipedia: "icture /rchival and 1ommunication -stem. JInternetK. /vailable from
http:..en.wikipedia.org.wiki."ictureIarchivingIandIcommunicationIs-stem
(. 'ikipedia: "atient "ortals. JInternetK. /vailable from
http:..en.wikipedia.org.wiki."atientIportal
<. 'ikipedia: Laborator- Information -stem. JInternetK. /vailable from
http:..en.wikipedia.org.wiki.LabIinformationIs-stem
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow (>
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
'tudent Application Acti+ities
comp65Iunit=Iactivit-.doc
comp65Iunit=Iactivit-Ike-.doc
comp65Iunit=IselfIassess.doc
comp65Iunit=IselfIassessIke-.doc
05ternal Resources
Y+sing the "atient "ortalZ. This video is produced b- a clinic as a tutorial for their
patients on how to use their portal. /vailable on DouTube at
http:..www.-outube.com.watchMvN,*f2v'1Ch0C
3ural 0ealth IT /doption Toolbo!
This website compiles information about 0ealth IT adoption with a focus on rural
settings. This is a government website that is sponsored and maintained b- the +..
8epartment of 0ealth and 0uman ervices #00% 0ealth 3esources and ervices
/dministration #03/%.
http:..www.hrsa.gov.healthit.toolbo!.3ural0ealthITtoolbo!.
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow (9
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
Component 10&2nit :
2nit .itle
Facilitatin "eetins for !mplementation 1ecisions
2nit 1escription
In one lecture, this unit, $acilitating Meetings for Implementation 8ecisions, covers a
method and the associated logistics for conducting meetings in which health care facilit-
decision makers review options for major process and implementation related decisions
and make decisions. The purpose of the meetings is to outline the decisions that need
to be made, to assure that decision makers have the necessar- information for decision
making, and to facilitate decision making. This unit provides the "ractice 'orkflow and
Information Management 3edesign pecialist with tools for conducting decision making
meetings. There are man- methods for conducting and facilitating meetings. 0ere, we
provide one method, discuss ke- concepts, and provide references to resources that
-ou can use as -ou develop -our skills and portfolio of tools for meeting facilitation
2nit *,-ecti+es
F- the end of this unit the student will be able to:
6. 8escribe major health care facilit- decisions in process redesign that
includes E03 technolog-
2. 8raft an agenda and facilitation plan for a decision making meeting,
(. "repare a presentation to communicate findings of a workflow anal-sis or
process redesign to health care facilit- decision makers,
<. 8ocument those decisions that are made and actions identified in a
decision making meeting, and
;. 1riti*ue a decision making meeting agenda, facilitation plan or scenario to
identif- problems and how the- could have been prevented
2nit .opics & /ecture .itles
6. 1oordinating a decision making meeting
2. +sing appropriate group methods to discuss and make decisions on inefficiencies
(. Identif-ing opportunities for streamlining manual and computer)aided processes, and
the
<. Transition from anal-sis and redesign to implementation planning, and we will also
give e!amples of the plan content.
;. $acilitating ,ptimi@ation 8ecisions
2nit References
#/ll links accessible as of 6.2=.2562%
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow (:
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
/ecture :
6. Folea, /., G cott, F. #2565%. Creatin! effective meetin!s& 3etrieved 2566, from
Fusiness advisors.net: http:..business)
advisors.net.files.dwnld.1reatingIEffectiveIMeetingsIa.pdf
2. ?roup decision making. 2566. In 'ikipedia.org. 3etrieved 8ecember 26, 2566,
from http:..en.wikipedia.org.wiki.?roupIdecisionImaking
/ecture : Charts3 .a,les and Fiures
>.6 Table: 1ourtes- of 8r. M 7ahm, 2562.
>.2 $igure: "ermission for use b- eC0ealth olutions #formerl- Louisiana 0ealth 1are
3eview% and the Mississippi 3egional E!tension 1enter. 2562
/ecture : !maes
#7one in this unit%
2nit Re4uired Readins
#7one in this unit%
2nit 'uested Readins
6. 'ikipedia: $acilitating "roductive Meetings JInternetK. /vailable from:
http:..en.wikipedia.org.wiki.$acilitationI#business%
2. Babcenell /I, Langle- H, 0upke 1. Innovations in planned care& I0I Innovation
eries white paper. 1ambridge, M/: Institute for 0ealth care Improvement& 255=.
/vailable from:
http:..www.ihi.org.I0I.3esults.'hite"apers.Innovationsin"lannedU1are'hite"ap
er.htm
(. 8elbec* /L, and 4an de 4en /0. / group process model for problem
identification and program planning. The Hournal of /pplied Fehavioral ciences
6:>6& >#<%: <=>)<:2
<. 0a-nes 1. The facilitators perspective on meetings and implications for group
support s-stems design. The 8atabase for /dvances in Information -stems.
6::: um)$all& (5, #(,<% Jp. >2):5K. doi: 65.66<;.(<<2<6.(<<2<=. /vailable from:
http:..portal.acm.org.citation.cfmMidN(<<2<6.(<<2<=
'tudent Application Acti+ities
comp65Iunit>Iactivit-.doc
comp65Iunit>Iactivit-Ike-.doc
comp65Iunit>IselfIassess.doc
comp65Iunit>IselfIassessIke-.doc
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow <5
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
Component 10&2nit ;
2nit .itle
Auality !mpro+ement "ethods
2nit 1escription
This unit covers Cualit- Improvement Methods recommended for use in the 0ealth 1are
etting. Man- different approaches to *ualit- improvement have been used in the
health care arena. The workflow anal-sts will encounter organi@ations and people with
e!perience with a multitude of proven methods and fads. Thus, an awareness of the
histor-, methods, and tools of *ualit- improvement is critical. This unit introduces
students to these elements of CI, as well as categories of mistakes seen in these
methods. It is not intended to teach the student how to use these methods and tools.
2nit *,-ecti+es
F- the end of this unit the student will be able to:
6. 8escribe strategies for *ualit- improvement
2. 8escribe the role of Leadership in Cualit- Improvement
(. 8escribe the local clinic improvement capabilities
<. 8escribe and recommend tools for *ualit- improvement
;. 1ompare and contrast the *ualit- improvement methodologies and tools
and their appropriate uses in the health care setting
2nit .opics & /ecture .itles
6. $oundations of Cualit- Improvement
2. Methods for Cualit- Improvement
(. Tools for performing Cualit- Improvement
<. / culture of Cualit- Improvement
;. Mistakes in Cualit- Improvement
9a Cualit- Improvement Methods
9b Cualit- Improvement Methods
2nit References
#/ll links accessible as of (.5<.62%
/ecture ;a
6. 1aliff, 3. M. #255=%. Translating 1linical Trials into "ractice #ke-note%. Te( Heart
nst ,&, 44#2%, 6:2)6:=.
2. 1hang, 3. D. #6:::%. Continuous 3rocess mprovement #3ev ed.%. an $rancisco,
1/: Hosse-)Fass "feiffer.
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow <6
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
(. Bohn, L. T., 1orrigan, H. M., G 8onaldson, M. . #Eds.%. #2555%. nstitute Of
<edicine6 To 8rr is Human6 .uildin! a Safer Health System. 'ashington, 81:
7ational /cadem- "ress.
<. 3ansom, . F., Hoshi, M. ., G 7ash, 8. #Eds.%. #255<%. The Healthcare Auality
.ook6 ?ision, Strate!y, and Tools #6 ed.%. 1hicago, IL: 0ealth /dministration
"ress.
;. The Duke Databank for Cardiovascular Disease 7 Overview. #n.d.%. 3etrieved
$ebruar- :, 2562, from 8uke Medical 1enter Librar- G /rchives website:
http:..digitaldukemed.mc.duke.edu.databank.overview.html
/ecture ;a Charts3 .a,les and Fiures
#7one in this +nit%
/ecture ;a !maes
lide ;: 8r. Eugene / tead, Hr. JphotoK. 3etrieved $ebruar- 5:, 2562 from:
http:.. digitaldukemed.mc.duke.edu.databank.Images.steadIeugeneIthumbnail.jpg
lide ;: 0ardware 1onfiguration JimageK. 3etrieved $ebruar- 5:, 2562 from:
http:.. digitaldukemed.mc.duke.edu.databank.Images.hardwareIconfigurationI6:>6.jpg
lide 66: 8")user. #2565%. "lan)8o)1heck)/ct 8eming circle, 3etrieved $ebruar- 9,
2562, from http:..commons.wikimedia.org.wiki.$ile:8emingI"81/Ic-cle."7?
/ecture ;,
=& 8e Fono, E. #6:9;%. Si( Thinkin! Hats. Little Frown and 1ompan-.
#& Health Care Criteria for 3erformance 8(cellence. #n.d.%. 3etrieved $ebruar- 2(,
2562, from The 7ational Institute of tandards and Technolog- #7IT% website:
http:..www.nist.gov.baldrige.publications.hcIcriteria.cfm
4& ?oldratt, E. M. #6::<%. tFs not luck. ?reat Farrington, M/.: 7orth 3iver "ress.
$& I, :555. #n.d.%. In 0ikipedia. 3etrieved from
http:..en.wikipedia.org.wiki.I,I:555
B& NST, .aldri!e 3erformance 8(cellence 3ro!ram, The <alcolm .aldri!e National
Auality mprovement "ct of =9:G, 3ublic *aw =%%7=%G. #6:9>, /ugust 25%.
3etrieved $ebruar- 9, 2562, from 7ational Institute of tandards and Technolog-
#7IT%, +.. 8epartment of 1ommerce website:
http:..www.nist.gov.baldrige.about.improvementIact.cfm
;& [vretveit, H, Cualit- and safet- in health care, 2552
G& 3ansom, . F., Hoshi, M. ., G 7ash, 8. #Eds.%. #255<%. The Healthcare Auality
.ook6 ?ision, Strate!y, and Tools #6 ed%. 1hicago, IL: 0ealth /dministration
"ress.
:& Tague, 7. 3. #255<%. The Auality Toolbo( #2nd ed.%. Milwaukee, 'I: /C Cualit-
"ress.
/ecture ;, Charts3 .a,les and Fiures
#7one in this +nit%
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow <2
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
/ecture ;, !maes
lide 6= E Si( Si!ma D<"C JdiagramK. 3etrieved $ebruar- :, 2562 from: +3L:
http:..www.orielstat.com.lean)si!)sigma.si!)sigma)dmaic.overview
lide 6> E Measuring -our uccess. JimageK. 3etrieved $ebruar- :, 2562 from '3L:
http:..www.istockphoto.com.stock)photo)<69;6>;)measuring)-our)success.phpM
stN;efaaf;
2nit Re4uired Readins
#7one in this +nit%
2nit 'uested Readins
6. /genc- for 0ealthcare 3esearch and Cualit- #/03C%. JInternetK Improving
healthcare *ualit- fact sheet. /vailable from:
http:..www.ahr*.gov.news.*ualfact.htm
2. 'ikipedia: Cualit- Improvement Topic JInternetK /vailable
from:http:..en.wikipedia.org.wiki.Cualit-Iimprovement
(. 1aliff 3M. Translating clinical trials into practice. Te!as 0eart Institute Hournal
JInternetK 255=&((#2% 6:2)6:=. /vailable from:
http:..www.ncbi.nlm.nih.gov.pmc.articles."M16;2<=:(.
<. 4arke- ", 3eller B3, 3oger B. Fasics of *ualit- improvement in health care.
Ma-o 1linic "roceedings JInternetK. doi: 65.<5=;.92.=.>(;. 255> Hun& 92#=% >(;)
>(:. /vailable from: http:..www.ma-oclinicproceedings.org.article.552;)
=6:=#66%=66:<)<.fullte!t
;. Fatalden, "F., 8avidoff $. 'hat is Y*ualit- improvementZ and how can it
transform healthcareM Cual af 0ealth 1are.JInternetK 255>&6=:2)(
doi:65.66(=.*shc.255=.5225<= /vailable from:
http:..*shc.bmj.com.content.6=.6.2.e!tract
=. 1hang 3D. 1ontinuous process improvement, 3ichard 1hang /ssociates. Irvine:
1/, 6::<.
>. 3ansom F, Hoshi M, and 7ash 8F. ed. The healthcare *ualit- book: 4ision,
strateg-, and tools. 0ealth /dministration "ress: 1hicago, /+"0/ "ress:
'ashington, 255;.
'tudent Application Acti+ities
comp65Iunit9Iactivit-.doc
comp65Iunit9Iactivit-Ike-.doc
comp65Iunit9IselfIassess.doc
comp65Iunit9IselfIassessIke-.doc
05ternal Resources
Institute for 0ealth care Improvement website. /vailable at http:..www.ihi.org.ihi
/merican 0ealth Cualit- /ssociation, http:..www.ah*a.org.
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow <(
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
/merican ociet- for Cualit-, Learn /bout Cualit- web resource. /vailable free from:
http:..as*.org.learn)about)*ualit-.
3eading: ,verview and 3esources for Cualit- Improvement sections #left)hand menu
selections% of the 1enters for Medicare G Medicaid ervices #1M% website, ,verview
of 0ealth care Cualit- Improvement ,rgani@ations #CI,s%
http:..www.cms.gov.Cualit-Improvement,rgs.
3eading: "atient afet- and Cualit- Improvement website, 8uke +niversit- 0ealth
-stem: even 1hapters on left)hand navigation menu include ,verview, Introduction,
Measurement "rocess and ,utcome indicators, Methods of CI, Things CI is 7ot,
ummative e!perience and ummar-. /vailable free from:
http:..patientsafet-ed.duhs.duke.edu.moduleIa.measurement.measurement.html
uggested 3eading: Introduction to 1ontinuous Cualit- Improvement Techni*ues for
0ealthcare "rocess Improvement, tratit oftware Inc. /vailable free from
http:..www.statit.com.services.1CI,verview.pdf
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow <<
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
Component 10&2nit <
2nit .itle
/eadin and Facilitatin Chane
2nit 1escription
This unit, Leading and $acilitating 1hange, introduces the concepts of change and the
impact of such change on the providers and staff within a health care facilit-. It
enhances the understanding that workflow anal-sts must be sensitive to the human
component as the- e!amine and propose modifications in processes. This unit
prepares the student to recogni@e and address common change management
problems, and to work with individuals and groups to facilitate change.
2nit *,-ecti+es
F- the end of this unit the student will be able to:
6. E!plain concerns e!pressed b- participants in a process anal-sis G
redesign scenario in terms of common change management concepts.
2. "ropose strategies to gain acceptance of changes in work processes.
(. 1reate and criti*ue a facilitation plan, including appropriate facilitation
tools for a given process anal-sis G redesign scenario, and
<. ?iven a health care change management scenario, e!plain outcomes in
terms of common change management concepts
2nit .opics & /ecture .itles
6. 1hange Management concepts
2. Tools for $acilitating change
(. $acilitation "lanning
2nit References
#/ll links accessible as of (.5<.62%
/ecture <
6. /!elrod, 3. 0. #2555%. Terms of en!a!ement6 Chan!in! the way we chan!e
or!ani2ations& an $rancisco: Ferrett)Boehler.
2. Flock, ". #2552%. The answer to how is yes6 "ctin! on what matters& an
$rancisco: Ferrett)Boehler.
(. Flock, "., G 7owlan, H. #6:::%. Stewardship, 1lawless Consultin!6 " !uide to
!ettin! your e(pertise used& an $rancisco: Hosse-)Fas."feiffer.
<. ?all, H. #6:>9%. Systemantics6 How systems really work and how they fail& 7ew
Dork: "ocket.
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow <;
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
;. Hanssen, 1. $. #n.d.%. "bout The 1our )ooms of Chan!e. 3etrieved $ebruar- 2:,
2562, from Cuarternit- The 0ome of 1laes $ Hanssen website:
http:..www.claesjanssen.com.four)rooms.about)the)four)rooms)of)
change.inde!.shtml
=. enge, "., Bleiner, /., 3oberts, 1., 3oss, 3., G mith, F. #6::<%. The 1ifth
Discipline 1ieldbook6 Strate!ies and tools for buildin! a learnin! or!ani2ation&
7ew Dork: 1rown Fusiness.
/cknowledgement: Material used in this lecture comes from the following sources
6. Boestenbaum, ". #6::6%. *eadership6 The nner Side of 'reatness& an
$rancisco: Hosse-)Fass, Inc.
2. enge, "., Bleiner, /., 3oberts, 1., 3oth, ?., 3oss, 3., mith, F., #6:::%.The
Dance of Chan!e& 7ew Dork: 8oubleda-
/ecture < Charts3 .a,les and Fiures
#7one in this +nit%
/ecture < !maes
lide ;: 8iagram showing organi@ational changes. $endt, B. 3owan)1abarrus
1ommunit- 1ollege, 2566.
lide =: Hanssen, 1. $. #n.d.%. "bout The 1our )ooms of Chan!e. 3etrieved $ebruar-
2:, 2562, from Cuarternit- The 0ome of 1laes $ Hanssen website:
http:..www.claesjanssen.com.four)rooms.about)the)four)rooms)of)change.inde!.shtml
and 7ahm, M. 8uke +niversit-, 2566.
lide 66: "hotograph of stepping stones through a garden. Jtock "hotograph-K
3etrieved from istockphoto.com.nahm556
lide 6(: "icture of a hand stretching a rubber band. Jtock "hotograph-K 3etrieved
from istockphoto.com.nahm556
lide 6<: "icture of a personXs hands in a Q1hinese $inger TrapQJtock "hotograph-K
3etrieved from istockphoto.com.nahm556
lide 6>: ,rgani@ational chart of emplo-ees and 1E,. $endt, B. 3owan)1abarrus
1ommunit- 1ollege, 2566.
lide 6>: Image of a teering committee reporting to the 1E,. $endt, B., mith, 1.
3owan)1abarrus 1ommunit- 1ollege, 2562.
lide 22: 8iagram showing alternating work sessions and communication events. 7ahm
M. 8uke +niversit-, 2562.
2nit Re4uired Readins
#7one in this +nit%
2nit 'uested Readins
6. 'ikipedia: 1hange Management JInternetK. /vailable from:
http:..en.wikipedia.org.wiki.1hangeImanagement
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow <=
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
2. 1hapman /. 1hange management: organi@ational and personal change
management, process, plans, change management and business development
tips JInternetK c255;. 2565. /vailable from:
http:..www.businessballs.com.changemanagement.htm
(. 1hambers 3. $un with 26As: a sourcebook for workshop facilitators: 26 sets of 26
wa-s to approach participator- events. JInternetK 2555. /vailable from
http:..portals.wi.wur.nl.files.docs.ppme.1hambersI26sIworkshops.pdf
'tudent Application Acti+ities
comp65Iunit:Iactivit-.doc
comp65Iunit:Iactivit-Ike-.doc
comp65Iunit:IselfIassess.doc
comp65Iunit:IselfIassessIke-.doc
05ternal Resources
'ikipedia: 'isdom of the 1rowd Topic. /vailable at
http:..en.wikipedia.org.wiki.'isdomIofItheIcrowd
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow <>
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
Component 10&2nit 10
2nit .itle
Process Chane !mplementation and 0+aluation
2nit 1escription
This +nit focuses on helping students develop skills needed to implement and evaluate
the effectiveness of changes designed to improve workflow processes and the *ualit- of
care in health care facilit-. This +nit prepares the student to implement a process
change b- covering three ke- skill sets: 6% develop a process change plan
#implementation plan%, 2% communicate a process change plan, and (% to develop an
evaluation plan.
2nit *,-ecti+es
F- the end of this unit the student will be able to:
6. 8evelop a "rocess 1hange Implementation "lan for a health care facilit-
that includes tasks to be accomplished, responsible parties for various
tasks, a timeline, and the human and material resources needed
2. Identif- management tracking and measurement opportunities for the
process change
(. ,utline elements of an evaluation plan that will help determine the
success of a workflow process change implemented in a health care
facilit-
<. 8escribe how the workflow anal-st can help a health care facilit-
continuall- improve its workflow processes, based on results of ongoing
evaluations
2nit .opics & /ecture .itles
6. 1ommon process changes
2. Implementation plan components
(. 1ommunication for implementation
<. 1ommon implementation problems
;. Evaluating the new process
2nit References
#/ll links accessible as of 6.2=.2562%
/ecture 10
#7one in this unit%
/ecture 10 Charts3 .a,les and Fiures
#7one in this +nit%
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow <9
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
/ecture10 !maes
lide ;: Map Image Jtock photograph-K. /vailable from:
http:..www.istockphotograph-.com.nahm5556
lide 6=: 1hecklist "ad Image Jtock photograph-K. /vailable from:
http:..www.istockphotograph-.com
lide 69: IT "rofessional Troubleshooting Image Jtock photograph-K. /vailable from:
http:..www.istockphotograph-.com
lide 6:: 1halkboard Image Jtock photograph-K. /vailable from:
http:..www.istockphotograph-.com
2nit Re4uired Readins
#7one in this +nit%
2nit 'uested Readins
6. / s-stems approach to operational redesign workbook #/ppendi! /%.
Massachusetts: Masspro Jcited 2565 /ug <K Masspro, the Medicare Cualit-
Improvement ,rgani@ation for Massachusetts, under contract to 1M. Jp. >6UK.
/vailable free from http:..www.masspro.org.0IT.docs.tools.8,CITL25'FL25f
orL25'EF.pdf
2. 4arke- ", 3eller B3, 3oger B. Fasics of *ualit- improvement in health care.
Ma-o 1linic "roceedings JInternetK. doi: 65.<5=;.92.=.>(;. 255> Hun& 92#=% >(;)
>(:. /vailable from:
http:..www.ma-oclinicproceedings.org.article.552;)=6:=#66%=66:<)<.abstract
(. Fatalden, "F., 8avidoff $. 'hat is Y*ualit- improvementZ and how can it
transform health careM Cual af 0ealth 1are.JInternetK 255>&6=:2)(
doi:65.66(=.*shc.255=.5225<= /vailable from:
http:..*shc.bmj.com.content.6=.6.2.e!tract

'tudent Application Acti+ities
comp65Iunit65Iactivit-.doc
comp65Iunit65Iactivit-Ike-.doc
comp65Iunit65IselfIassess.doc
comp65Iunit65IselfIassessIke-.doc
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow <:
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
Component 10&2nit 11
2nit .itle
"aintainin and 0nhancin the !mpro+ements
2nit 1escription
This +nit focuses on helping the student develop the skills to recogni@e and access
changes that can be maintained, develop alternative processes and methods needed to
keep the practice running if the E03 s-stem fails and appl- to these activities an
understanding of health IT, meaningful use, and the challenges practice settings will
encounter in achieving, sustaining and enhancing meaningful use.
2nit *,-ecti+es
F- the end of this unit the student will be able to:
6. 8esign control strategies to maintain performance of clinic processes
2. 8evelop and present a sustainabilit- and continuous improvement plan for
a health care setting
(. 'ork with practice staff to develop a set of plans to keep the practice
running #to the e!tent necessar- and practical% if the E03 s-stem fails
<. 'ork with practice staff to evaluate the new processes as implemented
and identif- problems and changes that are needed
2nit .opics & /ecture .itles
6. Monitoring processes to maintain performance gains
2. 1ontinuing to improve process performance
(. 1ontingenc- planning for E03 downtime
a. providing patient care when the E03 is down
b. maintaining availabilit- of health information to providers and patients in major
emergencies
66a Maintaining and Enhancing the Improvements
66b Maintaining and Enhancing the Improvements
2nit References
#/ll links accessible as of 6.2=.2562%
/ecture 11a
6. 1ontinuous *ualit- improvement. 2562. In /merican ociet- for Cualit- ?lossar-.
3etrieved Hanuar- (, 2562, from http:..as*.org.glossar-.p.html .
2. 0arrington, H. 0. #6:92%. Dou canAt control what -ou canXt measure. In T.
8eMarco, 1ontrolling software projects: management, measurement and
estimation #p. (%. 7ew Dork: Dourdon "ress.
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow ;5
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
(. In)control process. 2566. In /merican ociet- for Cualit- ?lossar-. 3etrieved
8ecember (6, 2566, from http:..as*.org.glossar-.p.html.
<. Institute of Medicine& 1ommittee on Cualit- of 0ealth 1are in /merica. #2556%.
1rossing the Cualit- 1hasm: / 7ew 0ealth -stem for the 26st 1entur- 2556.
'ashington: 7ational /cadem- "ress.
;. Institute on Medicine, 1ommittee on Cualit- of 0ealth 1are in /merica. #2555%.
To Err is 0uman: Fuilding a afer 0ealth -stem. #L. T. Bohn, H. M. 1orrigan, G
M. . 8onaldson, Eds.% 'ashington, 81: 7ational /cadem- "ress.
=. Bai@en. 2562. In /merican ociet- for Cualit- ?lossar-. 3etrieved Hanuar- (,
2562, from http:..as*.org.glossar-.p.html.
>. ,ut)control process. 2566. In /merican ociet- for Cualit- ?lossar-. 3etrieved
8ecember (6, 2566, from http:..as*.org.glossar-.p.html.
9. "rocess control. 2566. In /merican ociet- for Cualit- ?lossar-. 3etrieved
8ecember (6, 2566, from http:..as*.org.glossar-.p.html.
:. hewhart, '. /. #6:(6%. Economic 1ontrol of Cualit- of Manufactured "roduct.
/C Cualit- "ress.
65. hortell, . M., Fennett, 1. L. and F-ck, ?. 3. #6::9%, /ssessing the Impact of
1ontinuous Cualit- Improvement on 1linical "ractice: 'hat It 'ill Take to
/ccelerate "rogress. Milbank Cuarterl-, >=:;:(E=2<. doi:65.6666.6<=9)
555:.5565>
66. tatistical process control. 2566. In /merican ociet- for Cualit- ?lossar-.
3etrieved 8ecember (6, 2566, from http:..as*.org.glossar-.p.html.
62. Thomson, '. #699(%. Electrical +nits of Measurement. "opular Lectures , >(.
Lecture 66a 1harts, Tables and $igures
66.6 1hart: "enfield, 8aniel. 255>. 1ontrol 1hart. J"ublic domainK 3etrieved 2566 from
http:..en.wikipedia.org.wiki.$ile:1ontrol1hart.svg
/ecture 11a !maes
#7one in this unit%
/ecture 11,
#7one in this unit%
/ecture 11, Charts3 .a,les and Fiures
#7one in this unit%
/ecture 11, !maes
lide <: Ikeda, Masaki. 2559. Lightening at aitama J1reative 1ommonsK. 3etrieved
256d from http:..commons.wikimedia.org.wiki.$ile:ThunderIatIaitama.jpg
lide <: "edneault, -lvain. 255=. / fire in Massueville J1reative 1ommonsK. 3etrieved
256dfrom http:..en.wikipedia.org.wiki.$ile:$ire"hotograph-.jpg
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow ;6
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
lide <: Tegtmeier, teve. +nion 1it- ,klahoma J1reative 1ommonsK. 3etrieved 2562
from http:..commons.wikimedia.org.
lide 9: $EM/ 1ommunit- 3elations Team #13% in a meeting in ?eorgia. J"ublic
domainK 3etrieved 2562 from http:..commons.wikimedia.org
2nit Re4uired Readins
#7one in this unit%
2nit 'uested Readins
6. Melum, MM. 0ow to make 1CI work for -ou ) continuous *ualit- improvement of
health care. "h-sician E!ecutive. $ind/rticles.com. /vailable from:
http:..findarticles.com.p.articles.miIm59<(.isIn=Iv6>.aiI66=<>2(5.
2. Fennett, L, lavin, L. 1ontinuous *ualit- improvement: 'hat ever- health care
manager needs to know. Jupdated 2552 /pr 6;K /vailable from:
http:..www.cwru.edu.med.epidbio.mphp<(:.1CI.htm
(. 8eveloping a contingenc- plan for ehr downtime and data loss JInternetK 1enter
for 0ealth IT at //$". /vailable from:
http:..www.centerforhit.org.online.chit.home.cme)
learn.tutorials.networking.network256.contingenc-.html
<. $ahrenhol@, 1?, mith, LH& Tucker, B, 'arner, 8. "lan F: / practical approach to
downtime planning in medical practices. Hournal of /0IM/. 255: 7ov)8ec&95:
#66% (<)(9. /vailable from:
http:..librar-.ahima.org.!pedio.groups.public.documents.ahima.bok6I5<;<9=.hcs
pMd8oc7ameNbok6I5<;<9=
;. Mohammed, M/, 'orthington, ", 'oodall, '0. "lotting basic control charts:
tutorial notes for health care practitioners. Cual af 0ealth 1are. 2559
/pr&6>#2%:6(>)<;.
=. Erratum in: Cual af 0ealth 1are. 255: $eb&69#6%:95.
'tudent Application Acti+ities
comp65Iunit66Iactivit-.doc
comp65Iunit66Iactivit-Ike-.doc
comp65Iunit66IselfIassess.doc
comp65Iunit66IselfIassessIke-.doc
05ternal Resources
Todd mith podcast on measurement, available from
http:..www.littlethingsmatter.com.blog.2565.59.2(.Dou)1ant)Improve)'hat)-ou)8ont)
Measure., Dou 1anAt Improve 'hat Dou 8onAt Measure. "osted /ugust 2(
rd
2565. This =
minute 6> second podcast is accompanied b- a written transcript. It is from a
commercial source and is posted on a website marketing Todd mithAs latest book.
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow ;2
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
,n)line one page summar- of 8r. 'alter /. hewhart. /merican ociet- for Cualit-
website. /ccessed 8ecember (6, 2566. /vailable from http:..as*.org.about)as*.who)we)
are.bioIshewhart.html
,n)line 8eming $unnel E!periment imulator. /vailable on a commercial website
through a free trial. http:..www.s-mphon-tech.com.funnele!p.htm
DouTube video of the 8eming $unnel E!periment being conducted, followed b-
discussion and summar-. This is a < minute and ;= second publicall- available video
posted b- 3umba Training Ltd. a commercial source. /ccessed Hanuar- 6, 2562,
available from http:..www.-outube.com.watchMvN:\(o=<$/tv/
DouTube video, '. Edwards 8eming "art 6. / : minute and ;( second publicall-
available video about the work of 8r. 8eming. /ccessed Hanuar- 6, 2562, available from
http:..www.-outube.com.watchMvN?0vnIm:+EoC
DouTube video, '. Edwards 8eming "art 2. /n 9 minute and ;2 second publicall-
available video about the work of 8r. 8eming, /ccessed Hanuar- 6, 2562, available from
http:..www.-outube.com.watchM73N6GfeatureNendscreenGvNmB$?j9sB;39
DouTube video, '. Edwards 8eming "art (. / : minute and <; second publicall-
available video about the work of 8r. 8eming, /ccessed Hanuar- 6, 2562, /vailable from
http:..www.-outube.com.watchMvN='eTaL3b)FsGfeatureNrelated
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow ;(
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
Component Acronym Blossary
810I /cron-m ?uide #Hanuar- 2566%
Acronym )ame
//$" /merican /cadem- of $amil- "h-sicians
/FIM /merican Foard of Internal Medicine
/1B /cknowledgment #8ata networks%
/1Ls /ccess 1ontrol Lists
/1M /ssociation for 1omputing Machiner-
/1MI /merican 1ollege of Medical Informatics
/13 /merican 1ollege of 3adiolog-
/8aM /nal-sis 8ata Model
/8/ /merican 8ental /ssociation
/8Es /dverse 8rug Events
/83 /dverse 8rug 3eaction
/8T /dmissions, 8ischarge, Transfer
/0I1 /merican 0ealth Information 1ommunit-
/0IM/ /merican 0ealth Information Management /ssociation
/0I" /mericaXs 0ealth Insurance "lans
/03C /genc- for 0ealthcare 3esearch and Cualit-
/M /mplitude Modulation
/M/ /merican Medical /ssociation
/MI/ /merican Medical Informatics /ssociation
/7I /merican 7ational tandards Institute
/"I /pplication "rogramming Interfaces
/33/ /merican 3ecover- and 3einvestment /ct
/1 O62 /ccredited tandards 1ommittee
/TM /merican ociet- for Testing /nd Materials
/C /merican ociet- for Cualit-
/T/ /merican Telemedicine /ssociation
/T1F /uthori@ed Testing and 1ertification Fodies
/TM /s-nchronous Transfer Mode
/+" /cceptable +se "olic-
F1M/ Far 1ode Medication /dministration
F1" Fusiness 1ontinuit- "lanning
FI Fispectral Inde!
FMI Fod- Mass Inde!
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow ;<
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
bps Fits "er econd
F3I8? Fiomedical 3esearch Integrated 8omain ?roup
F/ Fod- urface /rea
FLM Fioinformatic e*uence Markup Language
1/ 1ertificate /uthorit-
1a83 1ancer 8ata tandard 3epositor-
1/" 1ollege of /merican "athologists
1F/ 1abarrus 0ealth /lliance
118 1ontinuit- of 1are 8ocument
110IT 1ertification 1ommission for 0ealthcare Information Technolog-
11,' 1linical 1onte!t ,bject 'orkgroup #0L>%
113 1ontinuit- of 1are 3ecord
18/ 1linical 8ocument /rchitecture
18/0 1linical 8ata /c*uisition tandards 0armoni@ation
181 1enters for 8isease 1ontrol and "revention
18E 1ommon 8ata Elements
18I1 1linical 8ata Interchange tandards 1onsortium
18M 1hronic 8isease Management
18 1linical 8ecision upport
183 1ochrane 8atabase of -stematic 3eviews
18 1linical 8ecision upport -stem
1E7 European 1ommittee for tandardi@ation
1? 1linical ?enomics
10$ 1ongestive 0eart $ailure
10I 1onsumer 0ealth Informatics
1I1/ 1onte!t Inspired 1omponent /rchitecture
1I 1linical Information -stem
1MET 1ommon Message Element T-pe
1MM 1apabilit- Maturit- Model
1MMI 1apabilit- Maturit- Model Integration
1M 1enters for Medicare and Medicaid ervices
1,"8 1hronic ,bstructive "ulmonar- 8isease
1,T 1ommercial ,ff)the)helf
1"M 1ommon "roduct Model
1",E 1omputeri@ed "rovider ,rder Entr-
1"T 1urrent "rocedural Terminolog-
1CI 1onsumer Cualit- Initiatives
13L 1ertificate 3evocation List
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow ;;
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
13T 1athode 3a- Tube
1I 1omputable emantic Interoperabilit-
1M/.1/ 1arrier ense Multiple /ccess.1ollision /voidance
1M/.18 1arrier ense Multiple /ccess . 1ollision 8etection
1T 1omputed Tomograph-
1T/ 1enter for Technolog- and /ging
1T/ 1linical Translational cience /ct
1'M 1ommon 'arehouse Model
8/1 8iscretionar- /ccess 1ontrol
8/M 8omain /nal-sis Model
8$8s 8ata $low 8iagrams
801" 8-namic 0ost 1onfiguration "rotocol
800 8epartment of 0ealth and 0uman ervices
8I1,M 8igital Imaging and 1ommunications in Medicine
8M/I1 8efine, Measure, /nal-@e, Improve, 1ontrol
8MIM 8omain Message Information Model
87 8omain 7ame ervice
8o8 8epartment of 8efense
8o 8enial of ervice
83? 8iagnosis)related ?roup
8L 8igital ubscriber Line
8 8ecision upport -stem
8T+ 8raft tandard for Trial +se
8T8 8ocument T-pe 8efinition
8+3/ 8ata +se and 3eciprocal upport /greement
E/ Enterprise /rchitecture
EFM Evidence Fased Medicine
E1? Electrocardiograph-
E8 Emergenc- 8epartment
E8I Electronic 8ata Interchange
E8M Electronic 8ocument Management -stem
EE? Electroencephalogram
E03 Electronic 0ealth 3ecords
E03)$M Electronic 0ealth 3ecord)-stems $unctional Model
E03) Electronic 0ealth 3ecord)-stems
E034/ Electronic 0ealth 3ecord 4endors /ssociation
eM/3 Medication /dministration 3ecords
EME/ European Medicines /genc-
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow ;=
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
EMI Electromagnetic Interference
eM3 Electronic Medical 3ecords
EM3 Electronic Medical 3ecords. "atient Management
EM3."M Electronic "rotected 0ealth Information
e"0I Enterprise Master "atient Inde!
E"MI Electronic "rescribing
E)3 Entit-)3elationship
E38s Entit-)3elationship 8iagrams
e3O Electronic "rescribing
E4 Enterprise 4ocabular- ervice
$/1/ $ederal /dvisor- 1ommittee /ct
$8/ $ood and 8rug /dministration
$88I $iber 8ata 8istributed Interface
$E3"/ $amil- Educational 3ights and "rivac- /ct
$M $re*uenc- Modulation
$ME/ $ailure Mode and Effects /nal-sis
$T" $ile Transfer "rotocol
$C01 $ederall- Cualified 0ealth 1enter
?87 ?lobal 8ata -nchronisation 7etwork
?ELL, an object)oriented e!pression language for clinical decision support
?EM ?uideline Elements Model
?I7 ?eneric Incident 7otification
?I ?eographic Information -stem
?LI$ ?uideLine Interchange $ormat
018 0uman 1entered 8esign
01I 0ealth 1are Information -stem
081 0ealth 8isparities 1ollaborative
08$ 0ierarchical 8ata $ormat
00 +.. 8epartment of 0ealth and 0uman ervices
0IE 0ealth Information E!change
0IM 0ealth Information Management
0IM 0ealth Information and Management -stems ociet-
0I"// 0ealth Insurance "ortabilit- and /ccountabilit- /ct
0I 0ealth Information -stem or 0ospital Information -stems
0I"1 0ealth Information ecurit- and "rivac- 1ollaboration
0IT 0ealth Information Technolog-
0ITE10 0ealth Information Technolog- for Economic and 1linical 0ealth
0IT"1 0ealth Information Technolog- "olic- 1ommittee
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow ;>
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
0IT1 0ealth Information Technolog- tandards 1ommittee
0IT" 0ealth Information Technolog- tandards "anel
0L> 0ealth Level even
0M8 0ierarchical Message 8escriptions
03/ 0ealth 3esources and ervices /dministration
0" 0ealthcare ervices pecification "roject
0TT" 0-perte!t Transfer "rotocol
0' 0ardware
0@ 0ert@
I/7/ Internet /ssigned 7umbers /uthorit-
I18 International 1lassification of 8iseases
I18)65)
1M International 1lassification of 8iseases, 65th 3evision, 1linical Modification
I10
International 1onference on 0armonisation of Technical 3e*uirements for
3egistration of "harmaceuticals for 0uman +se
I1M" Internet 1ontrol Message "rotocol
I1"1 International 1lassification of "rimar- 1are
I13 Individual 1ase afet- 3eport
I1T Information and 1ommunication Technologies
I1+ Intensive 1are +nit
I8 Intrusion 8etection -stem
IE Internet E!plorer
IE1 International Electrotechnical 1ommission
IEEE Institute of Electrical and Electronics Engineers
IET$ Internet Engineering Task $orce
I? Implementation ?uide #0L>%
I0E Integrating the 0ealthcare Enterprise
I0 Indian 0ealth ervices
I0T8, International 0ealth Terminolog- tandards 8evelopment ,rganisation
II Internet Information ervices
I73 International 7ormali@ed 3atio
I,M Institute of Medicine
I" Internet "rotocol
I".," Inpatient.,utpatient
I Information -stem
I87 Integrated ervices 8igital 7etwork
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IT Information Technolog-
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LIM Lab Information Management -stem
LL1 Logical Link 1ontrol
L,I71 Logical ,bservation Identifiers 7ames and 1odes
M/1 Mandator- /ccess 1ontrol
M/3 Medication /dministration 3ecord
M8 Medical 8octor
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MIME Magnetic Ink 1haracter 3ecognition
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71I 7ational 1ancer Institute
71I)1FIIT 7ational 1ommittee on 4ital 0ealth tatistics
7140 7ational 1ancer Institute 1enter for Fioinformatics and Information
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781 7ational 8rug 1odes
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7ET 7ational Electronic Telecommunications -stem for urveillance
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7I1 7etwork Interface 1ards
7I0 7ational Institutes of 0ealth
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70I7 7ationwide 0ealth Information 7etwork
7LF 7etwork Load Falancing
7LM 7ational Librar- of Medicine
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,'L 'eb ,ntolog- Language
"/1 "icture /rchiving and 1ommunication -stems
"FM "harmac- Fenefit Managers
"1I "eripheral 1omponent Interconnect
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"8/s "ortable 8igital /ssistants or "ersonal 8igital /ssistants
"81/ "lanE8oE1heckE/ct
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"081 "ublic 0ealth 8ata tandards 1onsortium
"0E3 "ublic 0ealth Emergenc- 3esponse
"0I "rotected 0ealth Information
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"03 "ublic 0ealth Informatics Institute
"03)$M "ersonal 0ealth 3ecord)$unctional Model
"I1 "rocess Improvement 1ommittee #0L>%
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"MI "atient Master Inde!
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3/M 3andom /ccess Memor-
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3$I 3adio $re*uenc- Interference
3$I8 3adio $re*uenc- Identifiers
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7,ME8
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T" hielded Twisted)"air
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TE"3 Toward an Electronic "atient 3ecord 1onference
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TTL Time to Live
+/T +ser /cceptance Testing
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+ML +niform Modeling Language
+ML +nified Medical Language -stem
+3Ls +niversal 3esources Locators
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4"7 4irtual "rivate 7etwork
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OML E!tensible Markup Language
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Appendi5 1: )arrati+e Clinical Workflow 'cenarios
1ommon processes in ph-sician practices include
/ppointment scheduling
7ew patient intake
E!isting patient intake
E!am and "atient /ssessment
,rdering Labs . receiving G communicating results
"rescriptions
3eferrals out . in
8iagnostic testing
Filling
This appendi! contains narrative clinical scenarios for several of the clinical processes
common to private practices . primar- care. These scenarios are used in the lecture
e!amples and learning applications. 'hen used, the- should be provided as a hand)out
. download for the students.
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'cenario: *n=line Appointment 'chedulin
"atient "aul wakes up at ;:(5 am for the third da- in a row feeling awful, he has been
nauseous and vomiting. 0e decides that it is time to see his primar- care provider,
"h-sician /ssistant "am, at Fig 1it- $amil- "ractice. 0e remembers that the- have
recentl- added a patient portal where patients can see their clinical information and also
schedule appointments.
"atient "aul grabs his laptop and finds their website. 0e sees a Yfor "atientsZ tab and
clicks it. 0e enters his log)in information. / page comes up and one of the options is
Ychedule an appointmentZ. "atient "aul enters toda-As date. Three time slots with "/
"am are available and he chooses the 9:55 am time slot and submits the re*uest. 0e
sees a message on the screen that confirms his appointment has been added to the
schedule. 0e logs off, sets his alarm clock for >:55 and goes back to sleep.
'cenario: @y Phone Appointment 'chedulin
"atient "att- wakes up at ;:(5 am for the third da- in a row feeling awful, she has a
roaring headache and a fever. he decides that it is time to see her primar- care
provider, 8octor 8an at uburban $amil- 1linic. he thinks the- open at 9:55 am, and
sets her alarm clock for 9:55 am and goes back to sleep.
/t 9:55, she awakes and finds the office phone number. 3eceptionist 3onald answers.
"atient "att- asks 3eceptionist 3onald for the soonest appointment with 8octor 8an.
3eceptionist 3onald states that ::(5 is the earliest. "atient "att- sa-s that ::(5 is fine.
3eceptionist 3onald adds her to the schedule for ::(5.
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'cenario: )ew Patient !ntake and Reistration D usin paper chart
"atient "eter arrives at the uburban $amil- 1linic and is signed in b- 3eceptionist
3onald. 3eceptionist asks "atient "eter if he has been seen at the clinic before. 0e
sa-s no. 3eceptionist 3onald asks him for his insurance information and hands him a
clip board with three forms on it and asks him to complete them.
'hen he has completed the forms, 3eceptionist 3onald locates "atient "eterAs record
on the clinicAs schedule, marks his record as YarrivedZ, and confirms "atient "eterAs
contact and insurance information. 3eceptionist 3onald instructs "atient "eter to have
a seat in the waiting room. 0e creates a new patient chart for him and affi!es the forms
that he completed in the waiting room. 3eceptionist 3onald finds 7urse 7ed and gives
him the new chart.
7urse 7ed goes to the waiting room entrance and calls "atient "eter. 7urse 7ed
escorts "atient "eter to the e!am room, interviews him regarding s-mptoms and.or
complaints and records into the 7urses notes form for that visit, and takes and records
vital signs in the appropriate section of the form. 7urse 7ed then alerts 8octor 8an that
the patient is read- to be seen, b- placing the chart in the bo! on the e!am room door.
'ithin a few minutes, 8octor 8an takes the chart from the bo! on the e!am room door
and glances through the first page. 8octor 8an then enters the e!am room where he
e!amines "atient "eter and records findings in the notes section of the chart. 8uring the
e!am, 8octor 8an determines if a prescription, procedure, lab work or a referral is
re*uired and completes the necessar- paperwork if applicable. 8octor 8an provides
some additional instructions to "atient "eter and concludes the visit. $inall-, 8octor
8an provides the patient chart to the office staff to be re)filed. ,n the wa- out, "atient
"eter pa-s his co)pa- and concludes the office visit.
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'cenario: 05istin Patient !ntake and Reistration D paper chart
"atient "att- arrives at the clinic and is signed in b- 3eceptionist 3onald. 3eceptionist
3onald locates "atient "att-As record on the clinicAs schedule. 0e notices that she is an
e!isting patient, and marks her record as YarrivedZ, and confirms "atient "att-As contact
and insurance information. 3eceptionist 3onald instructs "atient "att- to have a seat in
the waiting room.
7urse 7ed sees that "atient "att- has arrived and pulls her chart from the filing room.
7urse 7ed goes to the waiting room entrance and calls "atient "att-. 7urse 7ed
escorts "atient "att- to the e!am room, interviews her regarding s-mptoms and.or
complaints and records into the 7urses."rogress notes, and takes and records vital
signs in progress notes. 7urse 7ed then alerts 8octor 8an that the patient is read- to
be seen.
'ithin a few minutes, 8octor 8an takes the chart from the bo! on the e!am room door
and glances through the first page. 8octor 8an then enters the e!am room where he
e!amines "atient "att- and records findings in the progress notes section of the chart.
8uring the e!am, 8octor 8an determines if a prescription, procedure, lab work or a
referral is re*uired and completes the necessar- paperwork if applicable. 8octor 8an
provides some additional instructions to "atient "att- and concludes the visit. $inall-,
8octor 8an provides the patient chart to the office staff to be re)filed. ,n the wa- out,
"atient "att- pa-s her co)pa- and concludes the office visit.
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'cenario: 05am and Patient Assessment Dusin 0"R and ePrescri,in
"atient "aul has a scheduled appointment with Ms. Hames, a "h-sician /ssistant at Fig
1it- $amil- "ractice, for a sore throat. Medical /ssistant /llie escorts "atient "aul to
the e!am room, weighing him on the scale in the hall on the wa-. In the e!am room,
Medical /ssistant /llie asks Mr. mith the reason for his visit while taking his vital signs.
"atient "aul states that he has had a sore throat for three da-s, that it has been getting
worse and is reall- painful to swallow. Medical /ssistant /llie documents "atient "aulAs
chief complaint and vital signs and then confirms "atient "aulAs allergies and current
medications before leaving the e!am room.
Fefore entering the e!am room, "/ Hames looks over "atient "aulAs chart on the
computer in the hallwa-. he notices that his chief complaint, sore throat, has triggered
a local health alert for strep throat. "/ Hames closes the record on the hall computer,
enters the e!am room and asks "atient "aul about his sore throat, how long ago it
started, and if "atient "aul had run a fever. "/ Hames also asks "atient "aul if he is
taking an- over the counter medications for his sore throat. "atient "aul states that he
has been running a high fever, 656.; degrees $, and that he is using aspirin for the fever
and throat spra- and cough drops, and gargles with salt water, and he adds that it has
been several -ears since he has had a sore throat like this. "/ Hames listens to "atient
"aulAs heart and breathing then she e!amines his ears, nose, and throat. "/ Hames
asks if "atient "aul has had a runn- nose, cough or hoarsenessM "atient "aul states
that he has not.
"/ Hames tells "atient "aul that there are an unusuall- high number of strep cases in
the communit- over the past month, and that based on the appearance of his throat that
he ma- have strep throat, and that she would like to collect a sample b- swabbing his
throat with a *)tip and do a rapid strep test. "atient "aul agrees. "/ Hames swabs his
throat with a long cotton tipped swab, and does the test.
$ive minutes later, "/ Hames returns and tells "atient "aul that the test was positive
and that she would like to start him on an antibiotic. "atient "aul readil- agrees. "/
Hames pulls his record up on the computer in the e!am room, enters the rapid strep
result, and asks "atient "aul if his "harmac- is still the one on ;;; Main t. "atient
"aul answers affirmativel-, and "/ Hames sends the prescription electronicall-. "/
Hames tells "atient "aul that the prescription will probabl- be read- on his wa- home,
tells him to get some rest and to call the office if he does not feel better in three to five
da-s or if his pain worsens.
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'cenario: *rderin /a,s D usin an 0"R
Mr. mith arrives at the office of 8octor Hones for a scheduled appointment. 0e checks
in as usual with the receptionist, provides mone- to cover his co)pa-, and within 6;
minutes is called back to an e!am room. ,nce in the e!am room, 7urse /dams asks
his chief compliant, takes his vital signs, and confirms his medications with the
medications listed in Mr. mithAs electronic chart. Mr. mith states that the reason for
his visit is that the toe nail of his right big toe has become discolored. 0e suspects
toenail fungus, and has tried several home remedies and over the counter antifungals,
but the- have not helped. 0e wants to get rid of his toenail fungus. 7urse /dams asks
him to remove his shoe and sock so that 8octor Hones can look at his toe.
8r. Hones e!amines the toe and also strongl- suspects toenail fungus. 0e is
considering prescribing a new oral antifungal. 0e e!plains the available treatment
options to Mr. mith and advantages and disadvantages of each. Mr. mith indicates
interest in the oral antifungal option. 8octor Hones e!plains to Mr. mith that some oral
antifungals in a small percentage of patients cause liver problems, and that if Mr. mith
wants to tr- the medication, he needs to draw blood for a panel of liver tests before he
starts the medication to make sure that his liver function is normal, and after he has
taken the medicine for a while, to make sure that he is tolerating the oral antifungal. Mr.
mith agrees.
7urse /dams prepares to draw two tubes of blood from Mr. mith. In the phlebotom-
room in the office, 7urse /dams completes a lab sample re*uisition form, and peels bar
coded labels from the form and sticks them on the lab tubes. /s each tube is filled,
7urse /dams peels a label from the sample re*uisition form and sticks the label on the
tube. Immediatel- afterward, the tubes are placed in a centrifuge, and in cold storage.
#the lab courier arrives ever- da- at <:(5 and picks up the samples and re*uisition
forms%. 7urse /dams returns to the e!am room and e!plains that someone from the
office will call Mr. mith the ne!t da- when the lab results are back. Mr. mith thanks
7urse /dams and the office visit concludes.
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'cenario: Recei+in and Communicatin /a, Results D usin a paper chart
Ever- morning in 8octor HonesA practice, Fig 1it- $amil- "ractice, Medical /ssistant
?rant logs onto their account with the local lab and prints lab result sheets. Fasic
demographic information #from the sample re*uisition form% for each patient is included
on the lab sheet, along with the providerAs name. Mr. mithAs lab results are in those
available first thing in the morning. Medical /ssistant ?rant gives 7urse /dams the
printed lab results for Mr. mith. 7urse /dams glances through the results and sees
that all of the tests are within normal clinical limits. 7urse /dams asks Medical
/ssistant ?rant to phone Mr. mith and let him know that the lab results are normal,
and to let him know that the office will phone in a prescription for the oral antifungal to
his pharmac- on record, which of course, Medical /ssistant ?rant will confirm while on
the phone with Mr. mith. $ollowing the re*uest the da- before from 8r. Hones, 7urse
/dams also asks Medical /ssistant ?rant to schedule Mr. mith for a $ollow)up
appointment and blood draw in two weeks.
/fter calling Mr. mith, Medical /ssistant ?rant files the lab results in his chart.

0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow >2
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
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'cenario: Routine Prescription Re=fill D no 0"R
"att-, a patient at uburban $amil- 1linic, takes Fenecar 25mg once a da- #C8% for
blood pressure control. he has taken this medicine for two -ears with good results.
"atient "att- is a regular patient of 8octor 8anAs. "atient "att- does not use the Yauto
refillZ program at her local pharmac-. Toda-, she noticed that she onl- has a few pills left
and calls 8octor 8anAs office, who does not use an EM3 and does not use e"rescribing.
3eceptionist 3onald answers the phone. "atient "att- e!plains that she needs another
prescription because hers has run out. 3eceptionist 3onald asks "atient "att- for her
pharmac- information, takes a message, and gives it to 7urse 7ed who works with
8octor 8an.
7urse 7ed pulls "atient "att-As chart, confirms that she is well controlled on the
medication, and has been taking it for two -ears with good results. 7urse 7ed provides
the re*uest and a report on his review of the chart to 8octor 8an in the hallwa- later
that morning. 8octor 8an agrees and charts a re)fill.
7urse 7ed provides the chart with the re)fill indicated to 3eceptionist 3onald, who calls
the prescription into the pharmac-.
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow >(
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
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'cenario: Referral EtransferF out from primary care D usin 0"R
"atient mith arrives at Fig 1it- $amil- "ractice, a large private practice care facilit-,
with chest pain. 3eceptionist 3andi is the first to see "atient mith as he approaches
the front desk to sign in for his scheduled appointment. 3eceptionist 3andi signs
"atient mith in, and confirms his insurance and contact information on the arrival
screen in the practice EM3.
7urse 7anc- sees that "atient mith has arrived and calls him back to an e!am room.
In the e!am room, 7urse 7anc- asks "atient mith wh- he came in for a visit toda-.
"atient mith states that he has been having chest pain on and off for the last two da-s,
and that it is getting worse. 7urse 7anc- notices that "atient mith is sweating,
clamm-, and looks to be in distress. he takes his vital signs and *uickl- enters them
into the EM3. 7urse 7anc- leaves the e!am room to alert 8octor 8avid that she
suspects that "atient mith is having a heart attack, an acute condition re*uiring
assessment in an emergenc- room. he returns ver- *uickl- with 8octor 8avid, who
retakes "atient mithAs vital signs and starts a 62)lead E1?. /fter a *uick look at the
E1?, 8octor 8avid triggers immediate transport to the local hospital and he then
administers two aspirin to "atient mith.
'hile the ambulance is en)route, 8octor 8avid takes another 62)Lead E1? and
continues to monitor "atient mith. Information collected during the brief office visit is
made available for access b- the emergenc- department #E8%. This causes an alert to
appear on the E8 s-stem that a transfer patient is en)route and that data are available
for the E8 8octor Ed. E8 8octor Ed receives the alert and previews the data.
'hen "atient mith arrives at the local hospital Emergenc- 8epartment, a room has
been assigned and the E8 care team is waiting. Immediatel-, E8 8octor Ed assesses
the patient while the care team connects "atient mith to the E8 E1? s-stem and
blood is drawn for cardiac lab tests. The 62)lead and cardiac lab tests are ordered
using a standard order set in the E8 provider order entr- s-stem. E1? and laborator-
results are populated directl- into the patientAs electronic medical record. Fased on
elevated cardiac en@-mes and E1? changes, "atient mith is *uickl- taken to the
cardiac catheteri@ation lab and later admitted to the hospital.

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"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
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Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
'cenario: Referral EtransferF in to primary care D usin 0"R
"atient mith has recentl- been hospitali@ed for a heart attack. 0e was discharged two
da-s ago with new medications and instructions to follow)up with his primar- care
provider, 8octor 8avid at Fig 1it- $amil- "ractice within one week.
Foth Fig 1it- $amil- "ractice and the local hospital use EM3s, and are interoperable.
'hen "atient mith was discharged, the local hospital sent information about his
hospitali@ation including diagnosis, procedures, medications and other discharge
instructions electronicall- to Fig 1it- $amil- "ractice. The EM3 at Fig 1it- $amil-
"ractice associated the information with "atient mith and appended the information to
his electronic record, where it automaticall- triggered Fig 1it- $amil- "ractice to call
"atient mith and schedule his one week follow)up appointment. The Fig 1it- $amil-
"ractice EM3 also detected that two of the new medications prescribed b- the local
hospital were in the same classes as two of mithAs old medications. 'hile on the
phone with "atient mith rescheduling, Medical /ssistant /nd- also confirmed that
"atient "eter had discontinued use of the two old medications.
,ne week after discharge from the local hospital, "atient mith arrives at Fig 1it-
$amil- "ractice for his follow)up appointment.
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow >;
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
'cenario: 1ianostic testin D usin 0"R
"atient "andra was discharged last week from Trinit- Tertiar- 1are after a three da-
hospitali@ation for pneumonia. ,n her discharge, Trinit- Tertiar- 1are sent information
about her hospitali@ation including diagnosis, procedures, !)ra- images, medications
and other discharge instructions electronicall- to her medical home, Fig 1it- $amil-
"ractice. The discharge instructions stated that "atient "andra should follow)up with
her primar- care provider in two weeks if she felt better and sooner if her s-mptoms
worsened.
The electronic information about her hospitali@ation was received b- the medical record
at Fig 1it- $amil- "ractice and integrated in to her electronic record. The morning after
her discharge, the EM3 at Fig 1it- $amil- "ractice alerted Medical /ssistant /nd- to
call and schedule a follow)up appointment.
$eeling somewhat better, two weeks later, "atient "andra arrives for her follow)up
appointment at Fig 1it- $amil- "ractice. In the e!am room, 7urse 7anc- tells her that
the- would like to do an !)ra- to see how the infection in her lungs is clearing. "atient
"andra agrees and follow)up !)ra-s are done in the office.
8octor 8avid is alerted when the follow)up !)ra-s are available in the s-stem and
compares them to the !)ra-s from "atient "andraAs recent hospitali@ation. $rom the
comparison between the two, and an old image from a similar clear follow)up three
-ears ago, she observes that the infection has not cleared.
8octor 8avid enters the e!am room with this information and does a histor- and
ph-sical. 8octor 8avidAs findings during the respirator- assessment confirms his
suspicion that "atient "andra has not cleared the infection. /fter conve-ing this
information to "atient "andra and a short discussion, 8octor 8avid prescribes a newer
antibiotic, and tells "atient "andra that he would like for her to return in a week and
sooner if her s-mptoms worsen.
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow >=
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
'cenario: @illin D usin 0"R
"atient "andra has just been seen at Fig 1it- $amil- "ractice for a pneumonia follow)
up, where she had an office visit and !)ra-s. The office visit was scheduled through the
practice EM3, and the diagnosis, entered b- 8octor 8avid following the visit is
automaticall- coded on the record with I18)65 code set so that 8octor 8avid can see
and confirm the code. The !)ra- images in the s-stem trigger a diagnostic testing
#procedure% code on the record as well.
The codes are available in the s-stem before "atient "andra leaves the office. Filling
1oordinator 1ath- reviews the record and submits the claim for reimbursement that da-.
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow >>
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
'cenario: !nitial "eetin with clinic staff
/nal-st /m- has just arrived at The Internal Medicine ?roup #TIM?%, a mid)si@ed
practice of ten providers and thirt- emplo-ees. "ractice Manager Mar-, the wife of the
senior ph-sician greets her and shows her to the conference room where the staff
meeting is being held. /nal-st /m- came to TIM? that da- to initiate process anal-sis.
"ractice Manager Mar- started the meeting b- introducing /nal-st /m- as the
person who was there to help her with selecting an EM3 for the practice, and that she
hoped to have it installed and running in two months. 7urse 7anc- folded her arms and
whispered, Yhere we go againZ to the person sitting ne!t to her. 8octor 8an, a long time
practice member looked angril- at "ractice Manager Mar- and said, Ywe should talk
about this off Eline& this is the first IAve heard of thisZ. 0e was followed b- 3eceptionist
3achel, who said, Y,h gosh, am I going to get laid offM I canAt use a computer.Z.
/nal-st /m- felt prett- uncomfortable. "ractice Manager Mar- e!pected the
response she got& man- of her meetings with practice providers and staff had similar
outcomes.
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow >9
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
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Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
'cenario: Process Analysis 'ummary 05cerpt
/nal-st /m- is reading back through her notes and documents from a "rocess /nal-sis
that she recentl- completed for "erfect "rivate "ractice. The following is an e!cerpt of a
process anal-sis summar-.
$or the process Inventor-, /m- has documented the major clinic processes and their
variations, including:
/ppointment scheduling #manual but clinic wants to offer self)service web)based
scheduling%
"atient check)in
"atient visit
"rescriptions #manual toda- but clinic wants to move to e"rescribing%
/ssimilating received documentation
Labs #clinic sends all samples to single commercial central lab%
3eferral)out to specialist
8isease Management #0-pertension, 8iabetes, 10$, and /sthma%
Filling #practice has an e!isting "M%
/nal-st /m-As conte!t diagram is shown below.
The following pages contain flowcharts for several ke- processes
1
.
1
Flowcharts used with permission from eQHealth Solutions (formerly Louisiana Health Care Review and the
!ississippi Re"ional #$tension Center
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow >:
"rocess /nal-sis and 3edesign
4ersion (.5.pring 2562
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#HR
%ractice
!ana"ement System
Central La&
%atient portal
'
rd
party
Clearin"house
Diagnose
s
procedure
s
samples
results
Scheduled visits
Selected clinical
data
Billing
information
claims
%harmacies
prescriptio
ns
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"ward Number U#$OC%%%%#$&
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"ward Number U#$OC%%%%#$&
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow "rocess G 3edesign 9(
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health nformation Technolo!y under
"ward Number U#$OC%%%%#$&
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow "rocess G 3edesign 9<
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health nformation Technolo!y under
"ward Number U#$OC%%%%#$&
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow "rocess G 3edesign 9;
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health nformation Technolo!y under
"ward Number U#$OC%%%%#$&
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4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health nformation Technolo!y under
"ward Number U#$OC%%%%#$&
0ealth IT 'orkforce 1urriculum $undamentals of 0ealth 'orkflow "rocess G 3edesign 9>
4ersion (.5.pring 2562
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health nformation Technolo!y under
"ward Number U#$OC%%%%#$&