title: Integrating Process Mining and Cognitive Analysis to Study EHR Workflow.
abstract: There are numerous methods to study workflow. However, few produce the kinds of in-depth analyses needed to understand EHR-mediated workflow. Here we investigated variations in clinicians' EHR workflow by integrating quantitative analysis of patterns of users' EHR-interactions with in-depth qualitative analysis of user performance. We characterized 6 clinicians' patterns of information-gathering using a sequential process-mining approach. The analysis revealed 519 different screen transition patterns performed across 1569 patient cases. No one pattern was followed for more than 10% of patient cases, the 15 most frequent patterns accounted for over half ofpatient cases (53%), and 27% of cases exhibited unique patterns. By triangulating quantitative and qualitative analyses, we found that participants' EHR-interactive behavior was associated with their routine processes, patient case complexity, and EHR default settings. The proposed approach has significant potential to inform resource allocation for observation and training. In-depth observations helped us to explain variation across users.
authors.affiliation: Department of Biomedical Informatics, Arizona State University, Scottsdale, AZ.
authors.forename: Stephanie K
authors.initials: SK
authors.lastname: Furniss
authors.affiliation: Department of Biomedical Informatics, Arizona State University, Scottsdale, AZ; Office of Information and Knowledge Management.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Burton
authors.affiliation: Department of Biomedical Informatics, Arizona State University, Scottsdale, AZ.
authors.forename: Adela
authors.initials: A
authors.lastname: Grando
authors.affiliation: Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN.
authors.forename: David W
authors.initials: DW
authors.lastname: Larson
authors.affiliation: Department of Biomedical Informatics, Arizona State University, Scottsdale, AZ.
authors.forename: David R
authors.initials: DR
authors.lastname: Kaufman
mesh_terms: D000884:Anthropology, Cultural; D003071:Cognition; D057286:Electronic Health Records / Q000458:organization & administration; D006801:Humans; D057226:Information Seeking Behavior; D016247:Information Storage and Retrieval; D007396:Internship and Residency; D009722:Nurse Practitioners; D010564:Personnel, Hospital; D010823:Physician Assistants; D014584:User-Computer Interface; D057188:Workflow