Tips for investigating common workflow issues

Aug. 26, 2016
Claire Wiggill, Vice President of Strategy and Business Development, PMG

Workflows are like the human body. If something goes wrong, the entire system is affected.

For healthcare IT professionals, the stakes are particularly high when it comes to workflow issues because they serve as the control center, turning patient data into action. In addition to the domino effect of productivity loss experienced by insurance providers, physicians, and pharmacists, patients can also be at risk for improper care. In fact, preventable medical errors are the third leading cause of death in the United States, according to a recent study – and workflow technology, or lack thereof, is often at the center of it.1

That’s why it is so critical to have a clear and proven plan for properly identifying and addressing workflow issues as swiftly as possible. IT professionals need to put on their detective hats to identify the source of the issue and solve it before the business and the patients experience any adverse impact.

The usual suspects: Configuration and data input issues

As workflows are inherently unique to the businesses, processes, data, and users they involve, isolating the specific issue at play can be extremely difficult. However, the most common culprits are gaps in design or configuration and “bad” data input configuations.

When configuration issues pop up, most commonly, it’s due to a disconnect between the business processes and the workflow design. This gap can be caused by an error in development that was previously undetected, a changed business requirement, or a new process that has not yet been incorporated into the workflow. For example, if a hospital upgrades its EHR system without performing thorough testing of all impacted workflows, it may discover that the new system is incompatible with existing deployed software.

Unexpected data and incorrect user input are other prevalent challenges plaguing workflows. Think of the introduction of third-party dictation software as an example. If new software is incorporated into a teleradiology system that is integrated with your workflow, data errors, not encountered previously, could occur. Changes in data structure or encoding could result in incompatibility with existing workflows, stopping them in their tracks. Manual data entry mistakes are often due to a lack of proper user training or a poorly designed user interface. With the ongoing surge in healthcare hiring, proper onboarding around data input has never been so important.

Ultimately, problems with design, configuration, data input, and handling can be addressed with the right troubleshooting plan in place.

Putting the clues together and troubleshooting

In order to get to the root cause of a workflow issue, IT first has to gather data that will help isolate the cause. IT should ask five basic questions before diving in:

  1. What steps did the user take leading up to the error?
  2. Does the issue happen every time or just sometimes?
  3. Does the issue tend to happen only for specific users or groups?
  4. Did the workflow incur any changes since last used?
  5. Do I see warning signs or errors in logs?

These starter questions can help IT find contextual patterns and home in on the circumstances that trigger the issue. While logs may not be a fix to the problem, they are essential for diagnostics, as it’s critical that IT knows what the data is saying. Free third-party tools, like Fiddler, can help IT identify traffic bugs and performance bottlenecks in web applications that could be causing workflow issues.

Once IT has a better grasp of the context surrounding the failure, they can begin breaking the problem down and simplifying it. IT should start by determining if the issue is reproducible by duplicating the workflow and its related components in a sandbox environment. To the extent possible, eliminate other variables from the picture by discarding all non-essential elements until only the relevant pieces remain.

Spot the silver lining

Aside from fixing a workflow problem by solving the mystery and addressing the cause, the best strategy for diagnosing workflow issues focuses on identifying areas for future optimization. These could not only provide increased business benefit, but could allow your team to implement preventative maintenance, shifting your general support approach from reactive to proactive.

Incorrect or missing data in electronic health records and other health IT systems was classified as the second greatest hazard to patients last year in a survey conducted by the ECRI Institute.2 Rigorous data validation within the workflow can help mitigate this risk dramatically, while a gap in data validation that allows a workflow to proceed unchecked could cause immediate issues and will certainly introduce risks downstream. If proper validation is incorporated, missing or incorrectly formatted data will throw an error in a workflow. As long as error handling exists to route the workflow when there is bad data, an opportunity to correct the error can be incorporated into the workflow, both preventing the introduction of bad data and improving the business process.

Although workflow issues can interfere with productivity and patient care, addressing them can actually make your organization stronger. If IT can find ways to improve quality and make healthcare providers more efficient while mending workflow snags, it’s a win-win.