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Journal of Healthcare Engineering
Volume 2, Issue 3, Pages 303-320
Research Article

Re-engineering Workflows: Changing the Life Cycle of an Electronic Health Record System

Jane M. Brokel,1 Sheila Ochylski,2 and J. Michael Kramer3

1College of Nursing, University of Iowa, Iowa City, IA, USA
2Clinical Operations Improvement, Trinity Health - Novi, MI, USA
3Trinity Health - Novi, MI, USA

Received 1 June 2010; Accepted 1 May 2011

Copyright © 2011 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


An existing electronic health record (EHR) system was re-engineered with cross-functional workflows to enhance the efficiency and clinical utility of health information technology. The new designs were guided by a systematic review of clinicians' requests, which were garnered by direct interviews. To design cross-functional, patient-centered workflows, several multi-disciplinary teams from the health system of hospitals, clinics, and other services participated. We identified gaps and inconsistencies with current care processes and implemented changes that improved workflow for patients and clinicians. Our findings emphasize that, to coordinate care between many providers, process workflow must be standardized within and across settings and focus on patient care processes, not the technology. These new, comprehensive, admission-to-discharge workflows replaced the older, functional- and departmental-process flow charts that had fallen short. Our experience led to integrated redesign of the workflows, review prior to implementation and ongoing maintenance of this process knowledge across 37 hospital facilities.