Information Hang-overs in Healthcare Service Systems

The literature on business process design has focused on issues such as bottlenecks, workflow configuration (series versus parallel), replacing an existing workflow with a shorter one, etc. One important issue that has not received adequate attention is the information-intensive nature of medical service systems. Performance of clinical workflows depends not only on how various steps are carried out but also on when certain information items are collected. We report the results of a long-term empirical study that looked at the implementation of a radiology information system (RIS) at a large regional network of radiology clinics. We find that a failure to gather necessary clinical background information in earlier steps significantly delays later steps and causes them to hang over, with a significant impact on the total turnaround time of diagnostic reports. We show that information systems can solve this problem by separating the task of gathering information from its usage and relocating that task upstream in the workflow. We argue that such unbundling can lead to shorter report turnaround times even if it significantly increases the utilization of the bottleneck server. These results have broader implications for the optimal design of other clinical workflows, such as the process of filling prescriptions in pharmacies or the typical surgical preanesthesia evaluation in hospitals. Finally, we explain why the impact of addressing hang-over is often nonuniform across clinical modalities, providers, and patient types.