A Framework for Analyzing Data from the Electronic Health Record: Verbal Orders as a Case in Point

Characterizing workflow for pediatric asthma patients in emergency departments using electronic health records

OBJECTIVE

The purpose of this study was to describe a workflow analysis approach and apply it in emergency departments (EDs) using data extracted from the electronic health record (EHR) system.

MATERIALS AND METHODS

We used data that were obtained during 2013 from the ED of a children's hospital and its four satellite EDs. Workflow-related data were extracted for all patient visits with either a primary or secondary diagnosis on discharge of asthma (ICD-9 code=493). For each patient visit, eight different a priori time-stamped events were identified. Data were also collected on mode of arrival, patient demographics, triage score (i.e. acuity level), and primary/secondary diagnosis. Comparison groups were by acuity levels 2 and 3 with 2 being more acute than 3, arrival mode (ambulance versus walk-in), and site. Data were analyzed using a visualization method and Markov Chains.

RESULTS

To demonstrate the viability and benefit of the approach, patient care workflows were visually and quantitatively compared. The analysis of the EHR data allowed for exploration of workflow patterns and variation across groups. Results suggest that workflow was different for different arrival modes, settings and acuity levels.

DISCUSSION

EHRs can be used to explore workflow with statistical and visual analytics techniques novel to the health care setting. The results generated by the proposed approach could be utilized to help institutions identify workflow issues, plan for varied workflows and ultimately improve efficiency in caring for diverse patient groups.

CONCLUSION

EHR data and novel analytic techniques in health care can expand our understanding of workflow in both large and small ED units.

The effect of "countrywide services management law" on the work motivation of the employees of Iranian ministry of health

Background:

Labor laws and regulations have inevitable effects on employees’ work motivation as well as the overall efficiency and productivity of the organization.

Objectives:

This study was conducted to assess the effects of the “Countrywide Services Management Law” on the work motivation level of the employees of the Iranian Ministry of Health.

Patients and Methods:

This cross-sectional study was done in 2011 in the Iran's Ministry of Health. Data was collected by a 51-item Likert scale questionnaire, in five domains including: organizational structure, information technology, training patterns, salary and bonus system and re-engineering process. The reliability and validity of the questionnaire was evaluated (Cronbach's alpha= 0.96). Data analysis was conducted using descriptive and inferential statistics (t-test).

Results:

Out of 192 samples examined, 55.2% of the respondents were female, 88 (45.8%) had BS degree and 116 (60.4%) had less than 10 years’ experience. The mean scores in the domains of organizational structure, information technology, training patterns, salary and bonus system and re-engineering patterns were: 3.11, 3.51, 3.05, 3.21 and 3.14, respectively. Relationship between the items related to manpower in the “Countrywide Services Management Law”, with employees' work motivation was significant (P < 0.0001). The training patterns did not show a significant relation (P < 0.26) with any of five domains.

Conclusions:

According to our results and the views of the employees of the Iranian Ministry of Health, “Countrywide Services Management Law” positively affected the personnel's work motivation regarding all the factors associated with motivation including: organizational structure, information technology, training patterns, salary and bonus system and re-engineering pattern. Finally, to enhance the workforce motivation and satisfaction level, application and implementation of the rules and regulations should be based on the organizational needs.