Health Workflow Process Analysis and Redesign
Def of Notation
the set of shapes and drawing conventions that are used to create process diagrams
4 characteristics of processes
1) have steps, activities, actions, operations, or tasks 2) the steps have sequence or order 3) processes have inputs and outputs 4) processes happen over and over, i.e., are ongoing.
3 process diagram flaws
1. Black holes as Yourdon calls them, are processes that have inputs but no outputs. 2. Miracles are processes that have outputs but no inputs. 3. Mysteries are unlabeled flows and unlabeled processes.
Gane-Sarson notation allow you to represent 6 process aspects:
1. Context 2. Data Flow Steps 3. Information Content (TEXT) 4. Data Transformation 5. Flow control and state (TEXT) 6. Roles involved
Yourdon Data Flow Diagrams allow you to represent 5 process aspects:
1. Context 2. Process Steps 3. Data Flow Steps 4. Information Context (TEXT) 5. Data Transformation
3 steps to diagram a process
1. Identify the purpose for which the diagram will be used 2. Get clear about which process aspects need to be visualized; choose diagram type Decide the required level of detail 3.Pick appropriate notation
ISO 5807 allows you to represent 5 process aspects:
1. Process steps 2. Data Flow Steps 3. Data transformation 4. Flow control and state 5. Roles involved
One to One
2 vertical lines
Yourdon Context Diagram is used for..
50,000 foot bird's-eye view rather than the details helpful to document and share knowledge about what is included in a process (the scope). represents an entire system as a single process and highlights the interfaces between the system and the outside world
Def of functional decomposition
A process used to represent each process in more detailed steps / processes. Each process in a DFD can be "exploded", i.e., redrawn to show increasing levels of detail. Context diagram is highest level As many lower-levels as needed
Def of Task
A step in a process Some tasks may be broken down into smaller tasks Primitive tasks can not be broken down into smaller tasks
Def of Process Map
A visual representation of a process that shows where the process begins and ends The steps or tasks in the process The sequence or order of the steps Use standard symbols so that a process map created by one person can be understood and used by others Different approaches use different symbol sets Also called process diagrams and flowcharts
Gane-Sarson Conventions include:
Choosing meaningful names for processes, flows, stores, and terminators, Numbering the processes and data stores, Making sure the DFD is internally consistent and consistent with any associated DFDs, and Exceptions and error handling are shown on lower-level diagrams.
Zero to Many
Circle + Crow
Zero to One
Circle + Vertical Line
Yourdon open-ended rectangle
Collection of Data... at rest should be named with a noun or noun phrase, and can be computerized or non-computerized, such as paper charts.
What is the best methodology to choose when an analyst needs to show information movement and the order of the steps?
Data flow diagram
Yourdon Data Flow Diagram (DFD) is used for...
Detailed Diagram
When are Entity-Relationship Diagrams (E-R Diagrams or ERD) used?
ERDs are used in projects where the data content for a system needs to be documented information content often called "data models" used to specify or document static content
Gane-Sarson Double Square Symbol
Entities - Represent people, organizations, or other things that interact with the system. They send or consume information.
ERDs represent content (3)
Entities - things about which we collect and store data Relationships - describe how the data values are linked & fit together Attributes - the actual pieces of data that we collect and store
Hopkins "Rules for Correctness" for Gane-Sarson diagrams
Entities may not send data directly to other entities, Entities may not send data directly to data stores (data must be processed in some way first), and Entities may not get data directly from data stores (data must be processed in some way first).
What are the 4 Gane-Sarson symbols?
Entity - Double square Process - Rounded rectangle Data Flow - Arrow Data Store - Open-ended rectangle
An analyst needs to show information content. What notation would be appropriate?
Entity-Relationship diagram is designed to represent only information content
HITECH
Health Information Technology for Economic and Clinical Health
Process Diagramming Methods
ISO 5807 Flow Charting Yourdon-code Yourdon-DeMarco Gane-Sarson Unified Modeling Language (UML) E-R diagram
An analyst needs to show detailed process steps. What notation would be appropriate?
ISO data flow diagram can be used to represent process steps and their sequence and control, as well as information transformation and roles involved in the process
Process Analysis Skills
Knowledge of data and data system concepts Knowledge of clinical workflow concepts Able to communicate such concepts Able to identify problem areas
T or F: Lines should run up & down or left and right
True Do not use diagonal lines.
ERD line with a circle notation represents what?
Modality of 0 The symbol is placed on the inside, next to the cardinality symbol
3 types of tasks
Physical Mental Computational
Gane-Sarson Rounded rectangle Symbol
Represent Processes that transform data Should be named or described with: Single word (a verb), Phrase or Simple sentence describing what the process does
Gane-Sarson Arrow Symbol
Represent data flow (one type or a consolidation) names/labels indicate the meaning of the data that moves along the flow Every line needs an arrow head to indicate direction
Yourdon Entity Symbol (rectangle) represent...
Represent people, organizations, or other things that interact with an information processing system Computerized or manual Named with a noun or noun phrase Send or consume information Data flows can come to and from entities only from processes
Gane-Sarson Open-ended rectangle Symbol
Represents a Collection of data at rest (passive) can be computerized or non-computerized, such as paper charts, microfiche, index cards, etc.
Yourdon Circle Symbol
Represents a Process named or described with a single word, phrase, or simple sentence that describes what the process does must have both inputs and outputs Can be used to describe who or what is carrying out the process
What is Gane-Sarson used for?
Represents the process context (that is, the process or system boundaries, interactions with the outside world, and the major functions) represents information content, the order or sequence of the data flow steps involved in the process, the transformations that occur or should occur, and the roles that perform the processes
Institute of Medicine (IOM) 6 Quality Areas for Health care
Safe Effective Efficient Timely Patient centered Equitable
Yourdon Curved Arrow Symbol
Show Process(Data) Flow Arrow heads on the flow indicate the direction of the movement of data The name of the process represents the meaning of the data that moves along the flow
Unique Aspects of Health Care
System of "experts" Physicians and physician extenders are ultimately ethically, morally and legally responsible for everything that happens to a patient Physicians have taken an oath to "above all, do no harm" Health care usually involves personal contact Decisions impact patient's health and well being Patient care involves teams of people working in information-intense situations Patterns of fundamental clinical routines are the product of years and decades of evolution
T or F: Text descriptions are done using "annotations" aka "call-outs."
TRUE This keeps text in the box to a minimum so it is readable. Lengthy text descriptions can be referenced to another page or footnote if necessary.
Def of Process Redesign
The revision of a process to improve it in some way. Anticipation of a good outcome
Def of Workflow
The sequence of processes through which a piece of work passes from initiation to completion Has inputs and outputs The words workflow and process will be used interchangeably
Def of Procedure
The steps in a process and how these steps are to be performed for the process to fulfill a customer's requirements; usually documented
The Display symbol is shaped like the traditional cathode ray tube (CRT) computer monitor viewed from the side. What is it used for?
The symbol represents data, the medium being of any type where the information is displayed for human use, for example, video screens, on-line indicators.
"Bullet" shaped symbol is used for....
The symbol used to represent a delay in a process
Def of Clinical Workflow
The way in which activities in the health care setting are carried out, by whom, in what order, etc. Examples Admitting a patient, Submitting a claim, Prescribing a medication
the symbol for a manual operation is an isosceles trapezoid (a quadrilateral with two parallel sides and the sides that aren't parallel are equal in length and both angles coming from a parallel side are equal) is used to represent what?
This symbol represents any process performed by a human being.
The symbol for manual input is a quadrilateral with two parallel sides, two 90° angles, one obtuse angle and one acute angle is used to represent what?
This symbol represents data, the medium being of any type where the information is entered manually at the time of processing, for example, on-line keyboard, switch settings, push buttons, light pen, bar-code wand
T or F: Affirmative responses to yes/no decisions should all be in the same direction.
True
T or F: All lines that represent flow based on decisions should be labeled.
True
T or F: Cardinality is indicated on BOTH ends of the relationship line, so there is a left to right cardinality and a right to left cardinality
True
T or F: Class diagrams are referred to as information models
True
T or F: Data flows can come to and from entities only from processes
True
T or F: Data flows to data stores can not come from other data stores or from entities
True
T or F: Data flows with a verb name signify a process that has been omitted.
True
T or F: Flowcharts should "read" from top to bottom or right to left.
True
T or F: For a Gane-Sarson diagram, if the same entity is shown more than once in a diagram, a diagonal line is added to the lower right-hand corner to visually distinguish it.
True
T or F: Gane-Sarson notation is specific to data flow diagrams which show the movement, transformation and storage of data
True
T or F: If text descriptions refer to more than one box in a flowchart, a dotted line can be drawn around the steps that the text describes or refers to.
True
T or F: In ERD notation, the entity name appears in the top of the box. The attributes are listed in the box below the name.
True
T or F: Parallelogram Symbol represents data, the medium being unspecified
True
T or F: Stores are passive; processes put data in or read data.
True
T or F: Symbols (aka Shapes) are used to create a diagram
True
T or F: The most popular use of Yourdon notation is to depict the context in which a process operates (high level interactions among major entities & Interactions between the process and outside entities)
True
T or F: the symbol for stored data is a four-sided figure with two-parallel sides, one rounded concave end and one rounded convex end. "This symbol represents stored data in a form suitable for processing, the medium being unspecified"
True
T or F: Gane-Sarson notation does not use event lists to indicate things that stimulate action from the system
True Things that stimulate action from a system are indicated by entities - Double Square Symbol
T or F: Information is neither created nor destroyed, it must come from and go to somewhere. Information comes from and goes to entities and data stores via processes.
True Watch for spontaneous data creation and black holes. Note: "in-only" data stores may be ok, as when being read by another system. Also "out-only" data stores may be ok, as when getting data from another system.
T or F: Everything on one page should be at the same detail level
True A good DFD fits on one page and is not too crowded.
T or F: Arrows FROM data stores mean "read, retrieve, or use" data from the data store
True Data stores are passive
T or F: Arrows TO data stores mean "write, update, or delete" data into the data store
True Data stores are passive
T or F: Start with higher level (context) diagrams to understand the scope and boundaries. These may be used for discussions with leadership in the health care setting. Then decompose the processes to lower levels of detail when needed.
True Remember the ultimate goal is an optimized clinic process, not a large detailed set of diagrams.
T or F: ERDs and UML class diagrams basically represent the same thing: data and relationships between data values
True They us different notation & Both support multiple levels of abstraction and inheritance
T or F: When we use the terms data flow and information flow, we mean the steps or path that the data takes through a work process or a system or some combination of both, including the order of steps, and operations performed on the data (or information).
True - for purposes of the exam/study Process = workflow Data Flow = Information Flow
Two parallel lines are used to denote what?
Two parallel lines are used to denote that things above them must be done before things below them can be done. (no arrows here)
Def of Process Analysis
Understanding process elements and the relationships between them Identification of opportunities for improvement
What does a Practice Workflow and Information Management Redesign Specialist do?
Uses knowledge and understanding of... 1. An organization's objectives, structure and procedures, & 2. Information technology to improve an organization's operations
One to Many
Vertical Line + Crow
Description of the role of Practice Workflow and Information Management Redesign Specialist
Workers in this role assist in reorganizing the work of a provider and facility staff to take full advantage of the features of health IT in pursuit of meaningful use of health IT to improve health and care. In contrast to other roles, the practice workflow and information management redesign specialist WORKS WITH PROVIDERS to make changes in clinic processes.
What is the best methodology to choose when an analyst needs to show the context in which a process operates?
Yourdon
ERD notation: Entity
a person, place or thing about which we want to collect and store data has a name, attributes, and an identifier the identifier uniquely identifies an instance of an entity
ERD notation: Relationship
a relationship between two entities is represented by a line has a name which is a verb also has cardinality and modality
Def of Process
a series of actions or operations "conducing" to an end -or- a set of interrelated work activities characterized by a set of specific inputs and value added tasks that make up a procedure for a set of specific outputs
Meaningful Use Qualified EHR
an electronic record of health-related information that: Includes patient demographic and clinical health information Has the capacity to: -Provide clinical decision support -Support physician order entry -Capture and query information relevant to health care quality -Exchange electronic health information with, and integrate such information from, other sources
ERD straight vertical line notation represents what?
cardinality of 1 The symbol is placed on the outside of the relationship line, closest to the entity
ERD Barker or "crow's foot" notation represents what?
cardinality of Many The symbol is placed on the outside of the relationship line, closest to the entity
Event List
contains things that stimulate action from the system Required when using Yourdon notation
Decision Triangle
designates a decision point from which the process branches into two or more paths
Document Symbol
designates a human readable document pertinent to the process
Process Box/Rectangle
designates an activity or task
Terminal Symbol - oval shaped
identifies the beginning or end of a process or origin and destination of data
Def of Cardinality (1 or many)
indicates the MAXimum number of times an instance in one entity can be associated with instances in the related entity
Def of Modality (1 or 0)
indicates the MINimum number of times an instance in one entity can be associated with an instance in the related entity
Def of Dataflow
involves the transformations or operations performed on data as it moves within and between systems *** Different than workflow
How should process steps that show re-work (i.e. queries for data discrepancies going back to a data sender) be drawn?
opposite of the direction of the progressing process
Arrow Symbol
represents a process path, the arrowhead indicates the direction of the flow
A Dashed Line is used for
used to denote an alternate path. Arrows represent the direction of the flow.
Solid Line is used for
used to denote data or process flow. Arrows represent the direction of the flow.
A jagged line is used for
used to denote data transfer by a telecommunications link. Arrows represent the direction of the flow.
Circle Symbol
used to indicate that a flowchart continues on another page