School of Information and Computer Sciences and School of Medicine, University of California, Irvine, Irvine, California (K.Z.).
MedStar Health National Center for Human Factors in Healthcare, Washington, DC (R.M.R.).
Ann Intern Med. 2020 Jun 2;172(11 Suppl):S116-S122. doi: 10.7326/M19-0871.
Clinical workflow is the enactment of a series of steps to perform a clinical activity. The transition from paper to electronic health records (EHRs) over the past decade has been characterized by profound challenges supporting clinical workflow, impeding frontline clinicians' ability to deliver safe, efficient, and effective care. In response, there has been substantial effort to study clinical workflow as well as workarounds-exceptions to routine workflow-in order to identify opportunities for improvement. This article describes predominant methods of studying workflow and workarounds and provides examples of the applications of these methods along with the resulting insights. Challenges to studying workflow and workarounds are described, and recommendations for how to approach such studies are given. Although there is not yet a set of standard approaches, this article helps advance workflow research that ultimately serves to inform how to coevolve the design of EHR systems and organizational decisions about processes, roles, and responsibilities in order to support clinical workflow that more consistently delivers on the potential benefits of a digitized health care system.
临床工作流程是执行一系列步骤以开展临床活动的过程。在过去十年中，从纸质病历到电子健康记录（EHR）的转变给临床工作流程带来了巨大的挑战，阻碍了一线临床医生提供安全、高效和有效的医疗服务的能力。有鉴于此，人们已经投入了大量精力来研究临床工作流程和工作流程的变通方法（即常规工作流程的例外），以确定改进的机会。本文介绍了研究工作流程和变通方法的主要方法，并提供了这些方法应用的示例，以及由此产生的见解。本文还描述了研究工作流程和变通方法所面临的挑战，并就如何开展此类研究提出了建议。尽管目前还没有一套标准的方法，但本文有助于推进工作流程研究，最终有助于了解如何共同发展 EHR 系统的设计以及关于流程、角色和责任的组织决策，以支持更一致地实现数字化医疗系统潜在效益的临床工作流程。
