Browsing by Subject "Workflow"

Now showing 1 - 8 of 8
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    Cancer reporting: timeliness analysis and process reengineering
    (2015-11-09) Jabour, Abdulrahman M.; Jones, Josette; Dixon, Brian; Haggstrom, David; Davide, Bolchini
    Introduction: Cancer registries collect tumor-related data to monitor incident rates and support population-based research. A common concern with using population-based registry data for research is reporting timeliness. Data timeliness have been recognized as an important data characteristic by both the Centers for Disease Control and Prevention (CDC) and the Institute of Medicine (IOM). Yet, few recent studies in the United States (U.S.) have systemically measured timeliness. The goal of this research is to evaluate the quality of cancer data and examine methods by which the reporting process can be improved. The study aims are: 1- evaluate the timeliness of cancer cases at the Indiana State Department of Health (ISDH) Cancer Registry, 2- identify the perceived barriers and facilitators to timely reporting, and 3- reengineer the current reporting process to improve turnaround time. Method: For Aim 1: Using the ISDH dataset from 2000 to 2009, we evaluated the reporting timeliness and subtask within the process cycle. For Aim 2: Certified cancer registrars reporting for ISDH were invited to a semi-structured interview. The interviews were recorded and qualitatively analyzed. For Aim 3: We designed a reengineered workflow to minimize the reporting timeliness and tested it using simulation. Result: The results show variation in the mean reporting time, which ranged from 426 days in 2003 to 252 days in 2009. The barriers identified were categorized into six themes and the most common barrier was accessing medical records at external facilities. We also found that cases reside for a few months in the local hospital database while waiting for treatment data to become available. The recommended workflow focused on leveraging a health information exchange for data access and adding a notification system to inform registrars when new treatments are available.
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    Implementation of a Laboratory Information Management System To Manage Genomic Samples
    (2013-09-05) Witty, Derick; Merchant, Mahesh; Perumal, Narayanan B.; Turpin, Joseph
    A Laboratory Information Management Systems (LIMS) is designed to manage laboratory processes and data. It has the ability to extend the core functionality of the LIMS through configuration tools and add-on modules to support the implementation of complex laboratory workflows. The purpose of this project is to demonstrate how laboratory data and processes from a complex workflow can be implemented using a LIMS. Genomic samples have become an important part of the drug development process due to advances in molecular testing technology. This technology evaluates genomic material for disease markers and provides efficient, cost-effective, and accurate results for a growing number of clinical indications. The preparation of the genomic samples for evaluation requires a complex laboratory process called the precision aliquotting workflow. The precision aliquotting workflow processes genomic samples into precisely created aliquots for analysis. The workflow is defined by a set of aliquotting scheme attributes that are executed based on scheme specific rules logic. The aliquotting scheme defines the attributes of each aliquot based on the achieved sample recovery of the genomic sample. The scheme rules logic executes the creation of the aliquots based on the scheme definitions. LabWare LIMS is a Windows® based open architecture system that manages laboratory data and workflow processes. A LabWare LIMS model was developed to implement the precision aliquotting workflow using a combination of core functionality and configured code.
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    Implementing the IUPUI Open Access Policy
    (2016-05-20) Bahler, Shannon; Calvert, Lisa; Pike, Caitlin; Odell, Jere D.
    On October 7, 2014, the IUPUI Faculty Council adopted an open access policy. The IUPUI faculty have retained their rights to the final manuscript of scholarly articles. The faculty have also given the library permission to archive these articles in the institutional repository, IUPUI ScholarWorks. As with most "Harvard-model" OA policies, faculty members are free to opt out at the article level without explanation. Likewise, waivers from the policy's rights retention clause are provided to any publisher that requires them. In this panel presentation we describe how the library has implemented this policy on the IUPUI campus. In specific we focus on four aspects of the policy implementation: 1) the outreach strategy; 2) the article identification/notification workflow; 3) the deposit workflow; and 4) the evolving role of liaisons in supporting the OA policy. Currently, the results of this multifaceted implementation strategy include: more than 1,400 new submissions to IUPUI ScholarWorks, increased compliance with federal public access policies, and more faculty interest in self-archiving.
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    An observational study of workflows to support fecal testing for colorectal cancer screening in primary care practices serving Medicaid enrollees
    (BMC, 2022-01-25) Mojica, Cynthia M.; Gunn, Rose; Pham, Robyn; Miech, Edward J.; Romer, Ann; Renfro, Stephanie; Clark, Khaya D.; Davis, Melinda M.; Emergency Medicine, School of Medicine
    Background: Screening supports early detection and treatment of colorectal cancer (CRC). Provision of fecal immunochemical tests/fecal occult blood tests (FIT/FOBT) in primary care can increase CRC screening, particularly in populations experiencing health disparities. This study was conducted to describe clinical workflows for FIT/FOBT in Oregon primary care practices and to identify specific workflow processes that might be associated (alone or in combination) with higher (versus lower) CRC screening rates. Methods: Primary care practices were rank ordered by CRC screening rates in Oregon Medicaid enrollees who turned age 50 years from January 2013 to June 2014 (i.e., newly age-eligible). Practices were recruited via purposive sampling based on organizational characteristics and CRC screening rates. Data collected were from surveys, observation visits, and informal interviews, and used to create practice-level CRC screening workflow reports. Data were analyzed using descriptive statistics, qualitative data analysis using an immersion-crystallization process, and a matrix analysis approach. Results: All participating primary care practices (N=9) used visit-based workflows, and four higher performing and two lower performing used population outreach workflows to deliver FIT/FOBTs. However, higher performing practices (n=5) had more established workflows and staff to support activities. Visit-based strategies in higher performing practices included having dedicated staff identify patients due for CRC screening and training medical assistants to review FIT/FOBT instructions with patients. Population outreach strategies included having clinic staff generate lists and check them for accuracy prior to direct mailing of kits to patients. For both workflow types, higher performing clinics routinely utilized systems for patient reminders and follow-up after FIT/FOBT distribution. Conclusions: Primary care practices with higher CRC screening rates among newly age-eligible Medicaid enrollees had more established visit-based and population outreach workflows to support identifying patients due for screening, FIT/FOBT distribution, reminders, and follow up. Key to practices with higher CRC screening was having medical assistants discuss and review FIT/FOBT screening and instructions with patients. Findings present important workflow processes for primary care practices and may facilitate the implementation of evidence-based interventions into real-world, clinical settings.
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    Provider Use of a Novel EHR display in the Pediatric Intensive Care Unit. Large Customizable Interactive Monitor (LCIM)
    (Schattauer, 2016-07-20) Asan, Onur; Holden, Richard J.; Flynn, Kathryn E.; Yang, Yushi; Azam, Laila; Scanlon, Matthew C.; BioHealth Informatics, School of Informatics and Computing
    OBJECTIVES: The purpose of this study was to explore providers' perspectives on the use of a novel technology, "Large Customizable Interactive Monitor" (LCIM), a novel application of the electronic health record system implemented in a Pediatric Intensive Care Unit. METHODS: We employed a qualitative approach to collect and analyze data from pediatric intensive care physicians, pediatric nurse practitioners, and acute care specialists. Using semi-structured interviews, we collected data from January to April, 2015. The research team analyzed the transcripts using an iterative coding method to identify common themes. RESULTS: Study results highlight contextual data on providers' use routines of the LCIM. Findings from thirty six interviews were classified into three groups: 1) providers' familiarity with the LCIM; 2) providers' use routines (i.e. when and how they use it); and 3) reasons why they use or do not use it. CONCLUSION: It is important to conduct baseline studies of the use of novel technologies. The importance of training and orientation affects the adoption and use patterns of this new technology. This study is notable for being the first to investigate a LCIM system, a next generation system implemented in the pediatric critical care setting. Our study revealed this next generation HIT might have great potential for family-centered rounds, team education during rounds, and family education/engagement in their child's health in the patient room. This study also highlights the effect of training and orientation on the adoption patterns of new technology.
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    STAAR workflow: a cloud-based workflow for scalable and reproducible rare variant analysis
    (Oxford University Press, 2022) Gaynor, Sheila M.; Westerman, Kenneth E.; Ackovic, Lea L.; Li, Xihao; Li, Zilin; Manning, Alisa K.; Philippakis, Anthony; Lin, Xihong; Biostatistics and Health Data Science, Richard M. Fairbanks School of Public Health
    Summary: We developed the variant-Set Test for Association using Annotation infoRmation (STAAR) workflow description language (WDL) workflow to facilitate the analysis of rare variants in whole genome sequencing association studies. The open-access STAAR workflow written in the WDL allows a user to perform rare variant testing for both gene-centric and genetic region approaches, enabling genome-wide, candidate and conditional analyses. It incorporates functional annotations into the workflow as introduced in the STAAR method in order to boost the rare variant analysis power. This tool was specifically developed and optimized to be implemented on cloud-based platforms such as BioData Catalyst Powered by Terra. It provides easy-to-use functionality for rare variant analysis that can be incorporated into an exhaustive whole genome sequencing analysis pipeline. Availability and implementation: The workflow is freely available from https://dockstore.org/workflows/github.com/sheilagaynor/STAAR_workflow.
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    Workflow Associated With the Collection of Clinical Lab Data at the Point of Care
    Pearson, Brian Jeffrey; McDaniel, Anna M.
    It is important for health clinics to capture clinical laboratory results such as point-of-care testing (POCT) data in order to meet personal health information needs while increasing patient throughput and improving clinical and economical outcomes. Personal health information needs should be exchanged at three levels: among patients and providers, across a community, and across the country. Health information technology is an important tool in addressing such a need while providing efficiency, safety, and quality. Electronically stored clinical data are necessary to attain the benefit of health information technology, so that the provider can achieve greater patient safety and efficiency through provider order entry, disease management, and clinical decision support. In any field of health care and medicine it is important to carefully document all forms of data. The purpose of this study was to examine the workflow associated with the collection of clinical lab data at the point of care. Staff members at an ambulatory, multi-specialty primary care clinic in Indianapolis, Indiana, were observed via a continuous time-motion study. Flowcharts were created for the step-by-step workflow process of a general POCT, lab, and for each role observed. Analysis of the subjects’ interview responses revealed the content of the pros and cons of possible data transfer modes from an electronic medical record (EMR) to a health information exchange (HIE). The tables derived from the time-motion study table were then analyzed, resulting in the creation of tables summarizing the approximate total time and percentage involved for each category of tasks observed. It was found that the majority of the time spent throughout the workflow process is on behalf of the nurse vs. the medical records clerk, who is involved, the least amount of time. The nurse plays the role of directing the entire workflow process of point of care testing and clinical laboratory tests. It was observed that the POCT results are recorded directly into a patient’s chart, resulting in no electronic documentation, while clinical laboratory test results are stored electronically in an EMR and printed out for chart storage. The processing task category takes the most amount of time throughout the duration of workflow process for POCT, clinical laboratory test, and the observed subject. Changes in the workflow process would most likely affect the phlebotomist; least likely affect the primary care provider, while the nurse, check-out clerk, and medical records clerk would be minimally affected. Overall, a change in the workflow process for a provider such as the medical facility observed in the study would create a higher patient intake and faster result turnaround, resulting in quality patient care. The use of data transfer of POCT and the clinical laboratory from an EMR to a HIE would create a broader depth of content that would be available for healthcare providers locally, regionally, nationally, and ultimately internationally.
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    You and me and the computer makes three: variations in exam room use of the electronic health record
    (Oxford University Press, 2014-02) Saleem, Jason J.; Flanagan, Mindy E.; Russ, Alissa L.; McMullen, Carmit K.; Elli, Leora; Russell, Scott A.; Bennett, Katelyn J.; Matthias, Marianne S.; Rehman, Shakaib U.; Schwartz, Mark D.; Frankel, Richard M.; Medicine, School of Medicine
    Challenges persist on how to effectively integrate the electronic health record (EHR) into patient visits and clinical workflow, while maintaining patient-centered care. Our goal was to identify variations in, barriers to, and facilitators of the use of the US Department of Veterans Affairs (VA) EHR in ambulatory care workflow in order better to understand how to integrate the EHR into clinical work. We observed and interviewed 20 ambulatory care providers across three geographically distinct VA medical centers. Analysis revealed several variations in, associated barriers to, and facilitators of EHR use corresponding to different units of analysis: computer interface, team coordination/workflow, and organizational. We discuss our findings in the context of different units of analysis and connect variations in EHR use to various barriers and facilitators. Findings from this study may help inform the design of the next generation of EHRs for the VA and other healthcare systems.