8) Even if it is the greatest idea in the world, if it doesn’t fit into workflow, STOP
Working in Health Information Technology is a world of checks and balances. On one hand you have innovators, so excited about design they can hardly contain themselves. On the other side you have end users, Providers, Nurses, and Techs that have to use the innovation. While a prototype might seem cutting edge, if it doesn’t fit into the workflow of an end user, if it makes their job more difficult, or if the technology has a steep learning curve, chances are it will fail.
As a Technology student this has been a hard lesson to learn. I want to share my enthusiasm about the newest designs and platforms with the wonderful Physicians I see using it. However I have learned that as seasoned veterans they are more cautious of these new implementations. The first time this really hit home for me was at the American Medical Informatics Association (AMIA) conference, during a Google glass demonstration.
The tech nerd in me was fascinated by the idea of saying “glass lets round”, and proceeding on my rounds will all the patient information right in my eye glasses. The patient part of my was skeptical, I’m not sure I would enjoy my physician looking around in a trance like manner (to scroll) and talking to his glasses when he was supposed to be looking at and talking to me. It was like a light-bulb went on, the merging of tech with usability and workflow is a delicate balance, mastering it is vital to success.
This delicate balance is why in every technical project, the following steps to validate workflow must be performed.
Before Build
1) Current state workflow: Follow each user around; ask questions about decision points, If there are multiple sites and multiple units be sure to validate continuity. DO NOT ASSUME. Don’t forget to look at:
- Current document workflow process
- Security and permission requirements
- Device availability
- Patient touch-points
- Identification of challenges and opportunities
- End-user input for optimization of current state process.
- Creation of a list of requirements from end users needed to meet process goals
A good outline of types of current state workflow and its relation to the EHR can be found here
2) Create Use Cases: A written description of how users will perform tasks with the new technology. A use case is a broken down sequence of steps, beginning with the end user’s goal and ending when that goal has been met. Make sure to include:
- Which roles ( Physician, nurse, ect) be specific, such as cardiologist or ICU nurse, are going to use the technology
- The goal that the technology hopes to achieve
- The steps the user must take using the technology to achieve the task
- How the technology should perform when the user completes each task
Tip: If you write good use cases, creating testing scripts later will be much easier.
A great outline on how to write a use case can be found here
3) High-level Future State Workflows: Use the current state workflows and the use cases to make an overview of future state workflows. This allows users to understand the scope of the project as well as what steps their design decisions will be impacting.
During Build
4) Use the list of requirements obtained during current state workflow to create design options for the end-users. If possible these should include mock ups
5) Engage end users in all design decision making
6) Make sure sign off is obtained by all stakeholders (remember this may not just be Physicians and Nurses, think Pharmacists, schedulers, HIM, legal ect)
Right at the End of Build
7) End User Validation: this is where sign off on final design decisions happens. Due to the busy nature of healthcare workers, getting everyone in a room can often be difficult. Options include:
- Call in meetings
- Engaging Site leads to obtain sign off from their group at service line meetings
- PowerPoints with signature lines
- In Depth Future State Workflows: Flesh out your high level document, this will aid in the creation of testing scripts, education and communication.
Once Build is Complete
8) Creation of Test Scripts: Turn the use cases into spreadsheets with places for end users to sign off on design and workflow validation. Leave a section for comments should the build fail.
- Testing is a big topic and will be addressed more in future posts, the take away now is that End Users must be engaged in User Acceptance Testing (UAT).
- If at all possible the end users doing the testing should not have participated in the design.
An example of a rough draft UAT testing script I wrote can be found here
9) Education: You know your users best, so match the education to their learning needs, some options we use include:
- Youtube videos
- Web Based Learning Modules
- PowerPoints
- Pocket Guides
- Presentations at Service line meetings
- Tips and Tricks
- Classroom Training
10) Create a Crosswalk or Start/Stop/Continue document: This allows the end users to be clear on what processes they begin using the technology, what processes they no longer do because of the technology and what processes stay the same. While this may seem repetitive it is a great clarification document.
Is there anything you do differently at your site? Would you like to see a more in-depth post on any of these topics?

**Originally Published on my blog BrittanyPartridge.com where I write about my experiences in Clinical Informatics, my observations of technology and lessons learned in my hospital system. Have a suggestion for a topic, or want more information on lessons learned? Shoot me an email or find me on LinkedIn**
