CENTERIS/ProjMAN/HCIST.
Keywords: Information Systems; Health Information System; Business Process Re-engineering; Healthcare; Clinical Workflow
* Corresponding author. Tel.: +47-735-506-29; fax: +47-735-944-66.
E-mail address: soudabeh@idi.ntnu.no.
Available online at www.sciencedirect.com
© 2013 The Authors Published by Elsevier Ltd.
Selection and/or peer-review under responsibility of SCIKA – Association for Promotion and Dissemination of
Scientifi c Knowledge
950 Soudabeh Khodambashi / Procedia Technology 9 ( 2013 ) 949 – 957
1. Introduction
Information technology (IT) is used in many industries today, with substantial benefits. “Medical
information science is the science of using system-analytic tools to develop procedures (algorithms) for
management, process control, decision making and scientific analysis of medical knowledge” [1]. On one
hand, the ability of healthcare organizations to perform their function (such as order entry, report writing and
decision support systems), reduce errors (medication and diagnosis) and achieve their goals can be provided
by using information technology-based systems, also known as Health Information Systems (HIS) [2, 3]. On

the other hand, some hazards such as its failure and its negative effects on patient or user related to application
of HIS have been reported [2]. However, healthcare organizations must strive to achieve their best possible
performance. So, evaluation of HIS is crucial to ensure that maximum benefits are gained by HIS. If the new
technology that applied in health care is not adapted to the current user activity, it may causes dissatisfaction
of users and they refuse to accept new technology. In other word, evaluation of HIS enables the assessment of
the extent to which HIS are fulfilling decision makers and users objectives in supporting the services of
healthcare delivery [2, 4, 5].
Based on reviewed literature, 45% of HIS were rejected due to user resistance [6-8]. It was reported that
misfit between system and clinical practice were more common, so, the ability of the new technology to fit to
the clinical environment became important. Therefore, it is essential to evaluate and redesign the clinical
process and workflow to make sure fit between clinical processes and HIS as implementing of information
technology in healthcare needs workflow redesign in order to achieve success [9].
Process defines as “a structured, measured set of activities designed to produce a specified output for a
particular customer or market. It implies on a strong emphasis how work is done within an organization” [10,
11]. Business process is defined as “a set of logically related tasks performed to achieve a defined business
outcome.” [10, 12]. The definition of clinical process can be similar to business process; with the difference
which it involves clinical activities. Clinical process includes steps that govern how to use resources to create
services based on customer requirements. A customer, in this definition, is a patient, a nurse or a specialist.
Clinical pathway also refers to clinical process, and was first introduced by Zander in the early 1980s to
healthcare [13].
Since the 1980’s, quality management methods have been introduced to be applied to healthcare
organizations. In the last decade, these methods have been used particularly to improve the quality of
healthcare, as well as improve healthcare processes. A number of management techniques were proposed and
applied to enhance adoption of HIS to clinical setting and the selection of methods depends on several factors
such as existing needs and particular work environment, available resources and available knowledge and
objectives. One of the methods of study on clinical process and clinical workflow is business process
reengineering (BPR). BPR can enable us to further understand the adoption of health information systems in
actual clinical settings [14]. Another suggested method in literature is Lean, which for optimizing clinical
workflow [15]. Lean method is used to focus more in details of the process as BPR has a holistic view about
the workflow. When BPR implemented in clinical process, the role of Lean method is to remove waste and