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Fundamentals of Health Workflow

Process Analysis and Redesign

Process Mapping: ISO 5807

Lecture b
This material Comp10_Unit3b was developed by Duke University, funded by the Department of Health and Human Services,
Office of the National Coordinator for Health Information Technology under Award Number IU24OC000024.

Process Mapping: ISO 5807

Learning Objectives
1. Create a process flowchart for a health care system (or system
component) using appropriate ISO 5807 symbols and conventions.
(Lecture b)
2. Create context and data flow diagrams for a health care system (or
system component) using appropriate Yourdon symbols and
conventions (Lecture c)
3. Choose the correct scope and detail level for a process flowchart and
data flow diagram (Lecture b, c)
4. Read and interpret Gane-Sarson data flow diagram (Lecture d)
5. Read and interpret an entity relationship diagram in crow’s foot
notation (Lecture e)
6. Read and interpret UML class, activity, and state diagrams (Lecture f)
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Process Mapping: ISO 5807

Lecture b - Topics

• Standard ISO 5807 process diagramming symbols and

conventions
• Reading an ISO 5807 flowchart in terms of the
information that could be generated and the workflow
steps that are being communicated
• Create ISO 5807 flowcharts for a health care system (or
system component) using correct symbols and
conventions

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Methods for Diagramming

Processes
ISO Gane- E-R
Process Aspects Yourdon UML
5807 Sarson diagram

Context X X X
Process steps X X
Data flow steps X X X X
Information content text text X X
Data transformation X X X X
Flow control and state X text X
Roles involved X X X
Table 3.2 Methods for Diagramming Processes
*UML extends beyond basic process features and models other aspects such as
sequence, communication, and interrelationships. We do not cover these aspects here.

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Flowchart

• A graphic depiction of the steps or activities that

constitute a process
• ISO 5807: 1985 standard
- Standard symbols for flowcharts

“Graphical representation of the definition, analysis, or method of

solution of a problem in which symbols are used to represent
operations, data, flow, equipment, etc.” (ISO, 1985)

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Flowchart

• Constructed from standard symbols

• Used to communicate processes
• Software functionality important in flowcharting
- The shapes available
- Connectors that attach to the shapes
- Connectors facilitate editing the flowchart

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Flowchart Symbols
terminal

process

decision

document

connector

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ISO 5807 section 9.2.1

Basic Process Symbol

Sign-in at front
“This symbol represents
desk any kind of processing
function, for example,
executing a defined
Mark patient
Confirm
as arrived
operation or group of
insurance operations resulting in a
change in value, form or
Pull chart location of information, or
in the determination of
which one of several flow
Escort to exam directions is to be
room followed.” (ISO, 1985)

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ISO 5807 section 9.2.2.4 Decision

“This symbol represents a decision
or switching type function having a
single entry but where there may
be a number of alternative exits,
one and only one of which may be
activated following the evaluation
of conditions defined within the
symbol. The appropriate results of
the evaluation may be written
adjacent to the lines representing
the paths.” (ISO, 1985)

Decision symbols can show

nominal decisions (yes/no), or
decisions with multiple possible
outcomes.

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ISO 5807 section 9.4.2

Terminator

“This symbol represents an exit to,

Example: Terminator symbol use or an entry from, the outside
environment, for example, start or
end of a program flow, external
Patient arrives use and origin or destination of
data.” (ISO 1985)
Sign-in at front
desk

Confirm Mark patient Confirm

insurance As arrived Contact info.

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Lecture b

Review: What’s Wrong with this

Flowchart?

Public domain image obtained from

http://commons.wikimedia.org/wiki/File:Lamp
Flowchart.png
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Decision With Multiple Outcomes

This particular example is part of a larger chart. Note the line entering from the left.

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ISO 5807 Section 9.1.2.4

Document
Example of document symbol use

“This symbol represents

A Patient human readable data, the
charts
medium being, for
example, printed output,
Review an OCR [optical character
charts recognition] or MICR
[magnetic ink character
recognition] document,
Re-file charts
microfilm, tally roll, data
entry forms.” (ISO 1985)
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Manual input versus manual

operation
ISO 5807 section 9.1.2.5 Manual input
“This symbol represents data, the
medium being of any type where the
information is entered manually at the
time of processing, for example, on-
line keyboard, switch settings, push
buttons, light pen, bar-code wand.”
(ISO 1985)

ISO 5807 section 9.2.2.2 Manual

operation
“This symbol represents any process
performed by a human being.” (ISO
1985)
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Example: Manual Operation and

Manual Input

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Data Symbols

ISO 5807 section 9.1.1.1 Data

“This symbol represents data,
the medium being
unspecified.” (ISO 1985)

ISO 5807 section 9.1.1.2

Stored data “This symbol
represents stored data in a
form suitable for processing,
the medium being
unspecified.” (ISO 1985)
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Data Symbol Example

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ISO 5807 section 9.1.2.8 Display

“This symbol represents data, the

medium being of any type where the
information is displayed for human use,
for example, video screens, on-line
indicators.” The display symbol is
shaped like the traditional cathode ray
tube (CRT) computer monitor viewed
from the side. (ISO 1985)

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ISO section 9.4.1 Connector

“This symbol represents an exit to, or an entry
from, another part of the same flowchart, and is
used to break a line, and to continue it
elsewhere. The corresponding connector
Escort to exam symbols shall contain the same unique
room identification.” (ISO 1985)
Record chief Example: Connector use.
complaint, vitals Above the line is the first page of a
document. Below the line is from the
Notify provider second page of the document.
1
Patient ready
Page 1
Examine Page 2
1
Patient

Order
Write order
Req?

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Lecture b

Delay
The symbol used to represent a
Delay delay in a process looks like a
“bullet”. Although not listed in ISO
5807, this symbol is commonly used
because in logic diagrams, it
represents an “and gate”. An “and
gate” denotes that two or more
things (thing 1 AND thing 2, two
A inputs) have to happen before
proceeding.

Two parallel lines are used to

denote that things above them must
be done before things below them
B C can be done. In the diagram,
processes B and C cannot start until
process A has been completed.
Adapted from (ISO 1985).

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Lecture b

Non-Symbol Flowcharting
Standard Conventions

This section covers:

• Use of text descriptions
• Detail level
• Flow direction
• Lines

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Text Descriptions
Text descriptions are done using
“annotations” aka “call-outs.”
This keeps the text in the box to
a minimum so the chart is more
readable. Lengthy text
descriptions can be referenced to This is a
another page or footnote if call-out
necessary.

If text descriptions refer to more

than one box in a flowchart, a
dotted line can be drawn around
the steps that the text describes
or refers to.

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Detail Level
Identify data Define Measure Record Process Analyze
to be collected

Report Report
(status) (results)

Identify data Ready to Analyze Report

Define Measure Record
to be collected process (results)

Check Validity, Code Render data in

completeness & Data electronic form
accuracy

Valid
Complete
accurate
?
Processing
complete

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Lecture b

Flow

Age > 18 yrs. Age > 18 yrs.

Yes Yes

Yes No
Comp. 2 wk Comp. 2 wk
Enroll washout
Not Eligible
washout

No Yes

Not Eligible
Enroll

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Flow

HIPAA consent HIPAA consent

signed signed

Administer
Draw blood
Health Question

Administer Draw blood

Health
Questionnaire

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Lines
• A solid line is used to denote data or process flow. Arrows
represent the direction of the flow.

• A dashed line is used to denote an alternate path. Arrows

represent the direction of the flow.

• A jagged line is used to denote data transfer by a

telecommunications link. Arrows represent the direction of the
flow.

• Two parallel lines denote a synchronization between two parallel

processes. i.e. that the things above it have to happen and all
come to the denoted state before the things below it can occur.
There are no arrows on synchronization lines.

All lines that represent flow based on decisions should be labeled.

Lines should run up & down or left and right. Do not use diagonal
lines.
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Lecture b

Process Mapping: ISO 5807

Summary – Lecture b
At this point you should be able to
• Recognize and use ISO 5807 standard
symbols and conventions,
• Read and interpret an ISO 5807 flowchart,
• Create ISO 5807 flowcharts for a health
care system (or system component) using
correct symbols and conventions.

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Process Mapping: ISO 5807

References – Lecture b

References
• ISO/ANSI 5807 Information processing - Documentation symbols and conventions for data, program and system
flowcharts, program network charts and system resources charts. 1985.

Charts, Tables, Figures

3.2 Table: Nahm, M., Duke University, 2012.

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Lecture b

Process Mapping: ISO 5807

References – Lecture b
Images
Slide 7: Image of Symbols used in standard flowcharting. Nahm M. Duke University, 2012
Slide 8: Basic process symbol utilization in a flowchart. Nahm M. Duke University, 2012
Slide 9: Flowchart showing decision tree about drug testing. N ahm M. Duke University, 2012
Slide 10: Use of the Terminator symbol in workflow process diagramming. Nahm M. Duke University, 2012
Slide 11: Iikrant (own work). 2006). A flowchart about testing lamp working. [flowchart], Retrieved February 27, 2012
from http://commons.wikimedia.org/wiki/File:LampFlowchart.png
Slide 12: Flowchart of decision tree for patients coming into a hospital. Nahm M. Duke University, 2012
Slide 13: Example of document symbol use. Nahm M. Duke University, 2012
Slide 14: Definition of manual input versus manual operation. Nahm M. Duke University, 2012
Slide 15: Example: Manual Operation and Manual Input. Nahm M. Duke University, 2012.
Slide 16: Symbols for Data and stored data. Nahm M. Duke University, 2012
Slide 17: Data symbol example. Nahm M. Duke University, 2012.
Slide 18: Example of the Display symbol. Nahm M. Duke University, 2012
Slide 19: Example of the Connector symbol. Nahm M. Duke University, 2012
Slide 20: The Delay symbol. Nahm M. Duke University. 2012.
Slide 22: Annotations or "call outs". Nahm M. Duke University, 2012.
Slide 23: Example of Detail Level in flow charts. Nahm M. Duke University, 2012.
Slide 24: Example of appropriate and incorrect Flow in a chart. Nahm M. Duke University, 2012.
Slide 25: Flow: From top to bottom or R to L. Nahm M. Duke University, 2012.
Slide 26: Use of line in flow diagrams. Nahm M. Duke University, 2012.

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