FEATURESA Task-Analytic Framework Comparing Preoperative Electronic Health Record–Mediated Nursing Workflow in Different SettingsZheng, Lu MS, MHI, RN; Kaufman, David R. PhD; Duncan, Benjamin J. MS; Furniss, Stephanie K. PhD; Grando, Adela PhD; Poterack, Karl A. MD; Miksch, Timothy A. MBA; Helmers, Richard A. MD; Doebbeling, Bradley N. MD, MScAuthor Information Author Affiliations: Biomedical Informatics, Arizona State University, Scottsdale (Ms Zheng, Mr Duncan, and Drs Kaufman, Furniss, Grando, and Doebbeling); Information and Knowledge Management, Mayo Clinic, Rochester, Minnesota (Drs Kaufman, Furniss, Grando, and Helmers and Mr Miksch); and Science of Healthcare Delivery, Arizona State University (Dr Doebbeling); and Department of Anesthesiology, Mayo Clinic (Dr Poterack), Phoenix, Arizona. D.R.K. is senior author. The Mayo Clinic provided all funding support for the project. R.A.H., K.A.P., and T.A.M. are employees of the Mayo Clinic. The other authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Corresponding author: Lu Zheng, MS, RN, MHI, Mayo Clinic, Samuel C. Johnson Research Blvd, Scottsdale, AZ 85259 (firstname.lastname@example.org). CIN: Computers, Informatics, Nursing: June 2020 - Volume 38 - Issue 6 - p 294-302 doi: 10.1097/CIN.0000000000000588 Buy Metrics Abstract Preoperative care is a critical, yet complex, time-sensitive process. Optimization of workflow is challenging for many reasons, including a lack of standard workflow analysis methods. We sought to comprehensively characterize electronic health record–mediated preoperative nursing workflow. We employed a structured methodological framework to investigate and explain variations in the workflow. Video recording software captured 10 preoperative cases at Arizona and Florida regional referral centers. We compared the distribution of work for electronic health record tasks and off-screen tasks through quantitative analysis. Suboptimal patterns and reasons for variation were explored through qualitative analysis. Although both settings used the same electronic health record system, electronic health record tasks and off-screen tasks time distribution and patterns were notably different across two sites. Arizona nurses spent a longer time completing preoperative assessment. Electronic health record tasks occupied a higher proportion of time in Arizona, while off-screen tasks occupied a higher proportion in Florida. The contextual analysis helped to identify the variation associated with the documentation workload, preparation of the patient, and regional differences. These findings should seed hypotheses for future optimization efforts and research supporting standardization and harmonization of workflow across settings, post–electronic health record conversion. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.