Applying direct observation to model workflow and assess adoption.

Lack of understanding about workflow can impair health IT system adoption. Observational techniques can provide valuable information about clinical workflow. A pilot study using direct observation was conducted in an outpatient chronic disease clinic. The goals of the study were to assess workflow and information flow and to develop a general model of workflow and information behavior. Over 55 hours of direct observation showed that the pilot site utilized many of the features of the informatics systems available to them, but also employed multiple non-electronic artifacts and workarounds. Gaps existed between clinic workflow and informatics tool workflow, as well as between institutional expectations of informatics tool use and actual use. Concurrent use of both paper-based and electronic systems resulted in duplication of effort and inefficiencies. A relatively short period of direct observation revealed important information about workflow and informatics tool adoption.