title: Managing and Communicating Operational Workflow: Designing and Implementing an Electronic Outpatient Whiteboard.
abstract: BACKGROUND
  Healthcare team members in emergency department contexts have used electronic whiteboard solutions to help manage operational workflow for many years. Ambulatory clinic settings have highly complex operational workflow, but are still limited in electronic assistance to communicate and coordinate work activities.
  
  
  OBJECTIVE
  To describe and discuss the design, implementation, use, and ongoing evolution of a coordination and collaboration tool supporting ambulatory clinic operational workflow at Vanderbilt University Medical Center (VUMC).
  
  
  METHODS
  The outpatient whiteboard tool was initially designed to support healthcare work related to an electronic chemotherapy order-entry application. After a highly successful initial implementation in an oncology context, a high demand emerged across the organization for the outpatient whiteboard implementation. Over the past 10 years, developers have followed an iterative user-centered design process to evolve the tool.
  
  
  RESULTS
  The electronic outpatient whiteboard system supports 194 separate whiteboards and is accessed by over 2800 distinct users on a typical day. Clinics can configure their whiteboards to support unique workflow elements. Since initial release, features such as immunization clinical decision support have been integrated into the system, based on requests from end users.
  
  
  CONCLUSIONS
  The success of the electronic outpatient whiteboard demonstrates the usefulness of an operational workflow tool within the ambulatory clinic setting. Operational workflow tools can play a significant role in supporting coordination, collaboration, and teamwork in ambulatory healthcare settings.
authors.affiliation: Department of Biomedical Informatics, Vanderbilt University School of Medicine.
authors.forename: Bryan D
authors.initials: BD
authors.lastname: Steitz
authors.affiliation: Department of Biomedical Informatics, Vanderbilt University School of Medicine; Department of Pediatrics, Vanderbilt University School of Medicine.
authors.forename: Stuart T
authors.initials: ST
authors.lastname: Weinberg
authors.affiliation: Department of Biomedical Informatics, Vanderbilt University School of Medicine; Department of Quality Safety and Risk Prevention, Vanderbilt University Medical Center.
authors.forename: Ioana
authors.initials: I
authors.lastname: Danciu
authors.affiliation: Department of Biomedical Informatics, Vanderbilt University School of Medicine.
authors.forename: Kim M
authors.initials: KM
authors.lastname: Unertl
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration; D000553:Ambulatory Care / Q000458:organization & administration*; D003142:Communication; D003201:Computers; D006801:Humans; D009934:Organization and Administration; D010045:Outpatients; D010346:Patient Care Management / Q000458:organization & administration*; D057188:Workflow
keywords: Workflow; ambulatory care; decision making; health information technology