My driving force as a researcher is understanding the interaction between People, Organizations, and Technology. My research focuses on clinical workflow, coordination and collaboration, and “invisible” work. Although I am an engineer by training, I found that the research questions that interest me the most are best studied using qualitative methods and I am both an expert in and advocate for the application of qualitative methods to biomedical informatics research. The primary goal of my research is to provide knowledge and information that will contribute to developing and implementing more useful and usable health information technology.

Theme 1: Understanding the Meaning of Workflow
We were interested in learning more about how researchers in different academic disciplines have studied workflow, including how they defined the term “workflow.” We analyzed terminology in literature across healthcare, social sciences, and engineering and developed the Workflow Elements Model, a conceptual framework for defining workflow terminology.

Related publication:

Unertl KM, Novak LL, Johnson KB, Lorenzi NM, Traversing the many paths of workflow research: a systematic literature review, JAMIA 2010; 17(3):265-273.

Theme 2: Clinical Workflow in Chronic Disease Care
My interest in studying clinical workflow began with researching workflow in chronic disease care. My focus has been on understanding how clinical workflow interacts with health information technology and how we can better incorporate knowledge about workflow into the design and implementation of technology. I have studied workflow in specialty ambulatory care clinics across several different chronic diseases, including diabetes mellitus, cystic fibrosis, multiple sclerosis, and sickle cell disease. I am continuing to explore the unique information needs and workflow requirements for chronic disease care environments, with the aim of identifying related health information technology design concepts. Methods that I have applied to study workflow in chronic disease care include ethnographic observation, participatory observation, informal interviews, artifact collection, photography, and semi-structured interviews. In addition to Grounded Theory approaches to data collection and data analysis, I also have extensive experience in developing graphical models of workflow and information flow, to assist with visualizing the rich and complex qualitative data that these research methodologies have generated.

Related publications:

Unertl KM, Weinger MB, Johnson KB, Applying direct observation to model workflow and assess adoption, AMIA Annual Symposium Proceedings, 2006:794-8.

Unertl KM, Weinger MB, Johnson KB, Variation in use of informatics tools among providers in a diabetes clinic, AMIA Annual Symposium Proceedings, 2007:756-760.

Unertl KM, Weinger MB, Johnson KB, Lorenzi NM, Describing and modeling workflow and information flow in chronic disease care, JAMIA 2009; 16(6):826-836.

Theme 3: Workflow in Health Information Exchange
For my doctoral research project, I had the opportunity to contribute to the evaluation of the MidSouth eHealth Alliance (MSeHA), a Regional Health Information Organization based in the Memphis, Tennessee region. My focus was on how the health information exchange technology used by MSeHA interacted with clinical workflow, primarily in emergency department and safety net ambulatory clinic environments. Methods that I used in this research area included ethnographic observation, informal interviews, artifact collection, photography, and semi-structured interviews. Data for this project were initially analyzed using Grounded Theory open coding approaches.

Related publications:

Johnson KB, Unertl KM, Chen Q, Lorenzi NM, Nian H, Bailey J, Frisse M, Health information exchange usage in emergency departments and clinics: the who, what and why, JAMIA 2011; 18(5):690-697.

Frisse ME, Johnson KB, Nian H, Davison CL, Gadd CS, Unertl KM, Turri PA, Chen Q, The financial impact of health information exchange on emergency department care, JAMIA 2012; 19(3):328-333.

Unertl KM, Johnson KB, Lorenzi NM, Health information exchange technology on the front lines of healthcare: workflow factors and patterns of use, JAMIA 2012; 19(3):392-400.

Theme 4: Applying Sociotechnical Frameworks to Biomedical Informatics Research:
My initial approaches to workflow were rooted in Human Factors Engineering. Over time, I have moved towards more of a Sociotechnical Systems perspective on workflow, work systems, and organizations. Using the same data discussed in Theme 3, I expanded on a framework developed by Bonnie Nardi and Vicki O’Day, in their work Information Ecologies: Using Technology with Heart. The analysis built on the local information ecology concept developed by Nardi and O’Day to expand to a Regional Health Information Ecology.

Related publication:

Unertl KM, Johnson KB, Gadd CS, Lorenzi NM, Bridging Organizational Divides in Health Care: An Ecological View of Health Information Exchange, JMIR Medical Informatics 2013; 1(2): e3.

Theme 5: Community-Based Participatory Research in Biomedical Informatics:
My most current research, funded through a career development grant from the National Library of Medicine, focused on applying concepts from Community-Based Participatory Research (CBPR) to biomedical informatics. Through a cross-case comparison of different CBPR informatics projects across multiple institutions and communities, we examined different approaches that researchers have taken to CBPR in the informatics field.

Related publication:

Unertl KM, Schaefbauer CL, Campbell T, Senteio C, Siek KA, Bakken S, Veinot TC, Integrating community-based participatory research and informatics approaches to improve the engagement and health of underserved populations. Accepted, JAMIA (in press).