Date of Award


Document Type


Degree Name

Doctor of Philosophy (PhD)

Legacy Department

Industrial Engineering


Gramopadhye, Anand K

Committee Member

Melloy , Brian J

Committee Member

Cho , Byung Rae

Committee Member

Kurz , Mary E


This study focused on the clinical workflow evolutions when implementing the health information technology (HIT). The study especially emphasized on administrating medication when the electronic health record (EHR) systems were adopted at rural healthcare facilities. Mixed-mode research methods, such as survey, observation, and focus group, were used to investigate insightful interventions to compensate potential errors during the medication administration process. Research data were collected from three South Carolina small-scale rural hospitals over several clinical departments.
The major purposes of this study were two folds: (1) to assess medical staff's computer competency for the new IT system, and (2) to investigate potential errors in the medication administration workflow while using the EHR system. First, a paper-based computer skill survey was administered to rural healthcare facilities to identify specific computer tasks which staff has difficulties in performing, to recognize the particular unit which needs more IT support, and to identify the local computer experts in each unit. Survey results showed that medical personnel was less confident in connecting to peripheral equipment and computer troubleshooting activities. In addition, the more experienced and older workforce in rural healthcare facilities had lower self-rated abilities in using computers and less interest in leaning computers. This group personnel played critical roles in potentially hindering the adoption of EHRs.
To investigate the changes of workflow while passing medications, direct observations and focus groups were applied on five units across two rural hospitals. This study modeled and described a detailed context-appropriate workflow of the medication administration process before and after implementing EHR systems. Comprehensive task analysis techniques were used to document detailed work procedures and then it was examined carefully for potential errors in each single task.
Study results provided comparisons of potential errors in pre- and post-EHR system implementation and demonstrated the evolution of the workflow regarding the medication administration process at the rural healthcare facilities. Twenty recommendations for implementing the EHR system regarding environment, organization, tasks, tools and person aspects were established to identify and improve information technology specifications.
This study not only delivered a clear roadmap of how to assist small-scale rural hospitals in evaluating healthcare personnel's computer skills and modeling clinical practices; but also provided a framework to describe a clinical procedure using system-engineering tools, and the results of the study had used to develop a series of interventions for improvement.