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Nursing Informatics & Technology: A Blog for All Levels of Users

Clinical Workflow Analysis & Process Redesign: Part 1

Published May 3, 2011 9:27 AM by Angela Lewis
So why and what are we doing when we analyze clinicians' workflow? What do we want to accomplish by redesigning their processes? Why do it?

The big picture answer is: We in clinical informatics have been charged with implementing information system tools to improve the quality of care, increase safety, improve efficiency, decrease errors, and -  related to healthcare reform - achieve compliance with federal mandates, i.e., meaningful use. The answer at the individual healthcare organization level is that they, too, have been charged with implementing information system tools such as computerized provider order entry (CPOE), barcode medication verification (BMV), electronic medical records (EMRs), etc., to improve quality of care, increase safety, improve efficiency, decrease errors and achieve compliance with federal mandates.

CPOE, BMV, EMRs (and all the other associated acronyms) automate clinical care by automating the care delivery processes of clinicians.

But automation for automation's sake is poor practice. Automation for automation's sake is not our objective and it should NEVER be our objective. We also DO NOT want to automate an already poor process.

It is a well-known fact that the implementation of information systems technologies within the clinical setting impacts clinical processes and workflows. Doctors fear the new CPOE implementation will negatively impact their productivity. Nurses are concerned the implementation of the EMR and computers at the bedside will take away from their nurse-patient interactions.

It's true the implementation of clinical information systems can't help but impact how clinicians practice - how they render care, perform their daily tasks and how they do their jobs. Those technological changes impact the clinical environment, the clinician and the patient. Ideally we want that "impact" to be positive not negative.

By understanding and adequately performing clinical workflow analysis and process redesign prior to implementing information system technologies, we further ensure the success of the technological changes and also that we achieve our original goals of: improving the quality of care, increasing safety, improving efficiency, decreasing errors and achieving compliance with federal mandates.

Earlier I wrote that automation for automation's sake is not our objective. There are other objectives achieved as a result of understanding the why and best practices of clinical work flow analysis and process redesign.

Do No Harm

This is the first objective. Analysis and redesign decreases the potential for harm, injury or death to the patient.

Improving Clinical Practice

How many times have you heard this? "It's about the patient - patient care comes first." If one of our goals is to improve clinical practice and we know that done correctly the implementation of information systems technologies has the potential to improve patient care and thereby clinical practice - then it stands to reason that the utilization of workflow analysis and process redesign can help us improve clinical practice and thereby patient care.

Clinical Practice vs. Technology

As clinical informaticists it is our responsibility to make sure the technology is not dictating or driving clinical practice but that clinical best practices drive the technology and that the technologies are utilized as effective tools by the clinicians. We DO NOT want the tail wagging the dog. Do we?

Seize the Opportunity - Carpe Diem!

Our objective should be to perform workflow analysis and process redesign before implementation. This is where the true opportunities come to improve, optimize, re-engineer and streamline inefficient clinical processes and workflows.


If we truly want to control the impact that implementing technology will have on clinical practice (the patient and the clinician) than analysis and redesign are a must. A doctor once told me: "Angela, your job is to make this process as painless as possible!"

In my next post, Part II, will look at:

  • Clinical Workflows - The Good, the Bad and the Ugly
  • Analysis, Approaches, Tools and Methodologies
  • Future State and Testing
  • Our Original Questions and Ultimate Goals
This blog is brought to you by ADVANCE and Intel.
posted by Angela Lewis


Dear Angela,

I just noticed that I forgot to provide you with my email address before posting my comment.

Please consider this as an addendum to my previously sent comment on your Blog and an inquiry of materials regarding my upcoming Epic assessment test.


Sam Terie or

Sam, , PA Hospital December 6, 2016 1:39 AM
Washington DC

Dear Angela,

Thank you for for your expertise in the matter of Healthcare Informatics and the detailed information provided on your May 3rd, 2011 blog regarding Clinical Workflow Analysis & Process Redesign.

After 14+ yrs providing healthcare in various settings as RN and then as a PA, not to mention working as clinical documentation specialist/ clinical coder with Epic EHR end-user exposure, I finally got this opportunity to embark in the Epic EHR implementation process at my current job. The PCD of IMCU where I work asked me to take an Epic's assessment test for EPIC clinical analyst position.

I was informed that this test has 3 components;

1.math 2. Verbal/ problem solving & critical thinking and 3. Technical learning assessment/ programming concepts.

Since you have all the credentials having went through the whole process at least twice during the time you were preparing for the Epic ASAP and Epic ClinDoc if am not mistaken, I was wondering if you can help me directing my focus on areas of concentration for my self preparation? Or if you can send me a weblink or reading material to get me acquainted with the focusing areas for my upcoming assessment test on Dec 14th 2016.

Any suggestion especially in areas of programming concept would be greatly appreciated !



Sam December 6, 2016 1:24 AM
Washington DC

I am being ask to take an assessment for an EPIC clinical nurse informatics for the transition to the EPIC system .

The Test is over 1.math 2. programming 3.critical thinking and 4 problem solving

Does anyone know of any practice test or information I was not provided any other information for this appointment

Joyce Coleman August 19, 2014 7:58 PM

My current role as Senior Consultant for a Healthcare Management consulting firm is in many ways very

July 6, 2011 4:41 PM

My current role as Senior Consultant for a Healthcare Management consulting firm is in many ways very

July 6, 2011 3:11 PM

In Clinical Workflow Analysis and Process Redesign Part I , I attempted to answer the questions: why

May 24, 2011 7:35 AM

Great post Angela! All of it is too true. Thanks for highlighting this.

Nicole Mohiuddin May 3, 2011 3:45 PM

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    Occupation: Nursing informatics experts and enthusiasts
    Setting: Various settings in healthcare and academia
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