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5 pts.
 Workflow assessments
What can you do before even speaking to a vendor in terms of a comprehensive workflow assessment? Is this something that IT staff can work with clinicians on independently beforehand, or is it best that this coincide with a vendor assessment and corresponding install?

ASKED: June 11, 2010  9:10 PM
UPDATED: July 18, 2010  11:56 am

Answer Wiki:
Workflow assessment and analysis should be done well before install. Creating flowcharts is an extremely valuable exercise, even if you did not ever change to a EMR. There are sure to be improvements that you can make to your organization and processes by assessing your workflow -- just doing this alone is worth the exercise. In healthcare organizations there are often "black holes" where data (Charts/notes etc) get "lost" -- sometimes for days. There are also "camouflaged" holes that have people doing what appears to be useful (but is really useless) work . These need to be resolved before moving to electronic systems. My operational dictum: Lousy processes, when computerized, will still produce lousy results. They just produce them faster. Clean up your processes first. You don't need any special software to produce a flowchart. You can do it right from Word. Need any help to produce these? Ask at my blog MedDyNow and I will devote a blog to the process.
Last Wiki Answer Submitted:  June 12, 2010  12:50 am  by  Dyson12   35 pts.
All Answer Wiki Contributors:  Dyson12   35 pts.
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When a vendor sells his software, he would like to see or access, if the software can do the job in was intended to do. Sometime the software may not be build for a special kind of practice, but the sales person would like to tweak the software and may be able to give approximate solution to the need.

It’s always better to involve the IT and keep the work flow ready, before the vendor comes for assessment – it may be data flow diagram or process flow diagram – basically how things are done in the office on a daily basis. This will reduce the consulting / assessment time and cost, but will not avoid the assessment by the vendor.

The vendor’s assessment will give them the idea on whether their software can do the job 100% or not.

 200 pts.


This is a very interesting question. I find it that in most cases the IT would be a great asset to involve in the workflow assessment. This can be a useful interaction between technology folks and the rest of the organization. The key obstacle that I few for some of the practices is that they do not have an IT or system analyst. This mean that the individual is a machine person and not interested in creating value in technology. So, workflows and processes would be no interest to them. The only way to identify those individuals that will be tremendous values add, would be to have discussions and see which IT superstars exist in your organizations that are engaged and interested in participating in the process.

 1,785 pts.


Great input, everyone! There’s no doubt that it pays to get clinical workflows in order well before approaching vendors. (Our recent story on workflow design pointed to a recent survey, the results of which suggest that integration, data integrity and presentation are the biggest problem areas in EHR workflow.) Also, don’t forget that it’s your system — you should not change longstanding workflows simply because a vendor says you have to. Far too many providers have fallen into that trap.

 490 pts.


I am currently working with technical and non-technical staff in the implementation of a suite of an industry popular EMR/EHR applications who are directly responsible for integrating work flows into these applications. My role is that of applications infrastructure technical architect responsible for the configuration and integration of the enterprise network infrastructure supporting application interfaces, user community campuses and affiliates who utilize these applications. After about nine projects in this same capacity this is the first time that I have actually been involved in discussing the technical needs of a work flow applications support group!

This technology has moved from infancy to adolescence and the quagmire of advanced computer technologies failing to integrate into another medical environment seems to be the scenario for every implementation. Why these implementations fail miserably, and cost two to three times the original estimate, is that there is no technical engineering ownership by the client. Although the vendors are now seasoned integrators with an installed base, they are among the worst advisers for engineering end-to-end EMR/EHR systems which adhere to industry best practices, regulatory compliance, scalability and performance requirements. This happens because their clients are inexperienced and continue to divorce themselves of the responsibility for the engineering design of their environment and depend solely on the advise and recommendations of the vendor.

Until the medical community follows the first rule of vendor management this scenario will continue to plague the community without any foreseeable change in the near future. That rule is, do not allow the software vendor on your EHR/EMR Medical Enterprise Network.

So now how are you going to implement your EMR/EHR system. When you figure out what the answer is after following the premise of not allowing the software vendor on your enterprise network, you will miss your dead line, not implement a system that you expected to have in the first place and if you’re lucky, it will only cost you double of the original estimate, but confidence is high that it will be at least (at least) three times the original estimate.

 280 pts.


Please know that I come from many years of implementing first generation advanced computer technologies for many disciplines. The implementation of computer technology for the medical community today seems to be at odds with itself. When I first became involved with a first generation EMR/EHR system, it was for what is considered the largest implementation to date – 45 production environments, nationwide, 11 million patients seven years ago. Since then I have consulted to twelve entities – hospitals, clinics, clinical laboratories, health insurance. The software implementation for this first generation enterprise network was far from meeting any industry standards for best practices. The implementation had already begun before our small team of architects were hired on and it was not to long before we all agreed that this was at best a gross misfit attempt.

The group of us were mostly seasoned veterans in the IT industry and for some odd reason we all seemed to get along on a personal level as well. Imagine that, high powered geeks getting along. Yes, it could easily be said that our IT managers and the vendor were clueless about implementing anything on a large scale enterprise network. Our group had lots of experience in the implementation of several large scale enterprise networks for several industries. Guess what, the process is always the same.

Why I mention the above circumstance is to say that for all the EMR/EHR environments since that first implementation, none of them have been implemented using enterprise network industry best practices. Although the vendor has since become an icon in the industry, they continue to install their software at a level that seasoned enterprise network IT folks would all agree is just one step above college campus. Today the vendor has a reputation for implementing their software on the largest health care service in the continental USA, but fail to mention that they were not allowed on that network, at least during my tenure of two years, which is why it was successful.

It can easily be determined that enterprise networking industry best practices are not being implemented in this industry as the costs and planning of a proper implementation are not being followed – I see this first hand. This is more social failure than technical. Ask why are EMR/EHR implementations that are 70 million costing 200 million, and 200 million costing 500 million? This process is surely becoming gross misfit on a grand scale throughout the entire industry. They say it is very difficult to change horses in the middle of stream, and although this would be the right decision it is not one that is chosen by those desperately trying to mitigate business risks.

So as part of this discussion, until your EMR/EHR software is installed on a solid enterprise network foundation and your implementation disallows the vendor onto your enterprise network, you will continue to become victim to unpredictable results at almost every level conceivable – in my opinion. ~jzr

 280 pts.

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