Nov 5: My Free Webinar on EHR Workflow Engines, Editors, & Visibility

My webinar is at Noon, EST, Nov. 5. Here is the link to webinar registration page.

This webinar is not just for physicians. It’s for patients, providers, payers, policy wonks, and politicians too. Literally everyone, who comes into contact with healthcare workflows and processes, is affected by our workflow-oblivous information systems!

[Following tweets added 10/17. Skip the tweets!]

We (”workflowistas” on Twitter) are making remarkable strides in raising Health IT awareness about the importance of healthcare workflow and relevance of workflow technology. Unfortunately some of this progress is due to the unfolding tragedy of Ebola (missed) diagnoses and (mis) management. Whether or not EHR or human or some combination of workflow is to blame, EHR workflow has entered newspaper, cable news, and blogosphere headlines in a way not previously seen.


In this webinar, I’ll cover the basics:

  • What it workflow?
  • What is workflow technology?
  • What is a workflow engine?
  • What is a workflow editor?
  • What is workflow visibility?

And why healthcare so desperately needs the above, embedded in the EHRs and health IT systems we use daily.

Even if you already are a workflow expert, and know the above topics, I hope you’ll attend and show your support. I’m trying to make “workflow,” the problem, and “workflow tech,” the solution, into first-class health IT topics, up there with Social, Mobile, Analytics & Cloud.

Help coordinate and educate health IT about the process-aware angle on understanding and managing healthcare tangled workflow problems. Follow me on Twitter at @wareFLO or contact me with this blog’s contact form.

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Xcite Health Pediatric EHR Webinar Features Ex EncounterPRO CMIO Dr. Webster On EHR Workflow

(Webinar registration link!)


Here’s the official webinar description:

Award-Winning Pediatric EHR Workflow System is
Back and Better than Ever

(My original title was “3-Time HIMSS Davies MU Stage 2 Pediatric EHR Workflow System Is Back!” but it was deemed to wordy. In retrospect, I agree: boo-boo!)

Torn from the headlines: “EHR Workflow Flaw Led to Initial Release of Ebola Patient.” Workflow has suddenly achieved its place in Health IT’s sun that Charles Webster, MD, MISE, MSIS has always believed it should. Dr. Webster, “Healthcare IT workflow & Business Process Management expert,” is a frequently quoted in the news about health IT workflow issues. On November 5th, at 12 noon EST, he will layout the ABCs of EHR workflow tech: workflow engine, workflow definitions, and workflow visibility. Following, Pediatrician Dr. George Rogu will describe exactly how a true EHR workflow system dramatically increases his productivity and patient satisfaction. This webinar appeal to pediatricians and other primary care physicians, plus anyone interested in healthcare workflow and workflow technology.

Here’s the webinar background:

Very influential on my thinking about EHR and health IT workflow and workflow technology was my experience as Chief Medical Informatics Officer for an EHR called the EncounterPRO Workflow System. During the 90s I developed the first medical informatics curriculum to equally emphasize medicine, computers, and business. When my wife moved from Pittsburgh to Atlanta, a hotbed for health IT, I went to the HIMSS conference in Atlanta, resume in hand. I looked at dozens of EHRs (yes, there were that many!) but didn’t like any of them. They were all basically Microsoft Office clones. Too much clicking! But then I saw the EncounterPRO EHR — big buttons, automatically presented screens, user-customizable workflows — the Industrial Engineer in me (MSIE, Illinois) realized I was looking at a classic workflow management system.

I loved my time at JMJ Technologies and then EncounterPRO Healthcare Resources. It was the perfect match between my own background (Accountancy, Industrial Engineering, Artificial Intelligence, and Medicine) and the kind of true workflow automation that we see so little of in healthcare, until recently. Our customers won the first three ambulatory EHR HIMSS Davies Awards. (Unconfirmed rumor: judges picked us the fourth year too, but, well, you can understand how that made our competitors feel….)

I’ve moved on. I now do for an entire industry what I used to do for EncounterPRO, educate and market about healthcare workflow and workflow technology. I sometimes refer to myself as a CMIMO: Chief Medical Informatics Marketing Officer! :)

So I was delighted when I learned that the EncounterPRO Workflow System was rebranded as the XciteEHR from Xcite Health. And, (important), EncounterPRO/Xcite EHR just achieved Stage 2 Meaningful Use certification. If you know me, you know I have mixed feelings about MU (I can hear a couple chuckles out there). Nonetheless, Stage 2 MU certification is still an impressive technical and marketing achievement. Congratulations Xcite Health, for polishing a diamond-in-the-rough and the certification.

OK! That’s the background!

On November 5th, at 12 noon EST, I’m keynoting a webinar from Xcite Health. Basically I’ll be talking about what I always talk (and blog and tweet) about: workflow and workflow tech in healthcare. I’ve been convinced for years that “workflow” will join SMAC (Social, Mobile, Analytics, Cloud) as a “Big Idea.” But I didn’t know how: Ebola.

Inadvertent release of a patient infected with the Ebola virus was blamed on EHR workflow. Suddenly “EHR workflow” was everywhere on social media and health IT trade journal websites. As Dr. Workflow on Twitter, lots of folks contacted me for comments about what may have happened. You can read my series of blog posts here. So, what I’ll be talking about during my webinar with Xcite Health will be the ABCs of EHR workflow technology and their relevance to EHR workflow in the news. Then George Rogu, MD, pediatrician specializing in international adoption, will then talk about using a true EHR workflow system in pediatric practice.

P.S. I’m very active on Twitter at @wareFLO, where I tweet about healthcare workflow and workflow technology, and cat videos. If you’re a fellow or fellowess twepe, be sure to tweet me just before my webinar. I’m hoping to give a shout out! :)

P.S.S. Here’s the portrait version of the above banner announcing my webinar. Feel free to grab either and plaster them on your blog or tweet them out. Be sure to let me know, so I can return the favor. We Workflowists gotta stick together! Viva la workflow!


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Mr. RIMP Is Looking For Few Good Pediatricians & Child Life Specialists: Robot-In-Your-Pocket!

Mr. RIMP is a Bluetooth-controlled, user-customizable, animatronic “pocket-protector” for pediatricians and child-life specialists to entertain patients. We’re looking for a few good beta testers to help make @MrRIMP smarter, funnier, and nicer! You can contact us though this blog’s contact form or through my or @MrRIMP’s Twitter accounts.


Here’s a video of @MrRIMP 2.0 (yes, he has a Twitter account!) that @HIMSS blasted out to 50K+ twepes! Thanks @HIMSS!

I’m hard at work on @MrRIMP 3.0. Here’s 2.0 and a 3D-printed prototype body for 3.0. I control @MrRIMP from Google Glass (so can do a ventriloquist act) but intend for him to be controllable from iPhone and Android smartphones too.

If your interested in more demos and a longer explanation of what I and @MrRIMP are up to, here is my 15 minute standup routine at the Wearable Technology In Healthcare Conference. (Turn your sound up!)

October 21st @MrRIMP and I will also be appearing at the Wearables+Things Conference in Washington DC .


My long-term goal is to make @MrRIMP smaller, smoother, rounder, smarter, funnier, and nicer. We’re looking for a few good pediatrician and child life specialist beta testers! You can contact us though this blog’s contact form or through my (@wareFLO) or @MrRIMP’s Twitter accounts.

P.S. Feel free to use the Robot-In-My-Pocket logo and link back here! Or to Mr. RIMP’s website, when its available.


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A Pediatric EHR Workflow System: 10 Questions For Barry Hayut, Xcite Health

Just in time for the American Academy of Pediatrics National Conference in San Diego, here is one of my increasingly infamous 10 question in-the-weeds interviews! This time about a remarkable pediatric EHR workflow system (also used by other primary care specialists). It used to be named EncounterPRO, under which name it won the first three ambulatory EHR HIMSS Davies Awards. This EHR workflow system is now called XciteEHR and my interview is with Barry Hayut, of Xcite Health. By the way, Xcite is hosting a free webinar, featuring me! I’ll talk about the difference between traditional EHRs and EHR workflow systems on November 5th at 11 EST.

As a side note, this is a special interview for me because I was involved with the early design and implementation of this particular pediatric EHR workflow system. I expect many AAP attendees may remember EncounterPRO (originally developed by JMJ Technologies) and will find this interview of special interest. Creating and customizing EHR workflows for our customers, when I was EncounterPRO CMIO, really drove home the importance of true workflow technology at the point of care. Some of the older posts on this blog, EHR Workflow Management Systems, were about EncounterPRO.

  1. How did you end up in the pediatric EHR workflow system business?
  2. Could you discuss Meaningful Use 2 and why it’s important to be MU2 certified?
  3. Do you also sell a Practice Management system?
  4. What’s the difference between EHR workflow systems and mere EHR systems?
  5. Would you share your workflow, writer, editor, publicist analogy?
  6. What does a true EHR workflow system *do* for physicians?
  7. Would you show us the XciteEHR Office View and explain its functions?
  8. What physician specialty practice areas does the XciteEHR cover?
  9. How will you educate the world about true EHR workflow systems?
  10. Thoughts, Barry? About EHRs, workflow, and physician happiness?

By the way, Barry, congratulations on making the XciteEHR is a Complete MU2-certified EHR! You must be mighty proud of your certificate!

Starting Saturday, I’ll be updating and tweeting answers to the above questions on the AAP conference hashtag #AAP14. Stay tuned!

1. Barry, could you tell us a bit about how you ended up in the business of selling the award winning pediatric and primary care XciteEHR workflow system?

I was the CEO of a company that owned and managed multiple radiology outpatient centers. We experienced first-hand the needs of the physicians, office staff and patients for software that enhances productivity.

When we saw the EncounterPRO EHR’s superior workflow engine, Office View, and configurability, we decided to adapt it and integrate it with our Practice Management system and patient portal for seamless integration, productivity and ease of use.

2. In choosing an EHR for a physician practice, can you discuss Meaningful Use 2 and why it’s so important to be MU2 certified?

As you mentioned, XciteEHR is indeed Meaningful Use Stage 2 certified. Thank you.

Meaningful Use 2 is a set of very ambitious standards implemented by the Office of the National Coordinator for Health Information Technology, designed to create robust digital clinical records, track Meaningful Use metrics and Clinical Quality Measures, increase interoperability among various vendors, create uniform standards for reporting data to health agencies, and create standards for the secure communication of electronic health data to patients. Certification of an EHR is tied to incentive payments from the government to physicians with Medicare and Medicaid patients and eventually is expected to be the standard imposed by health insurance companies for all physicians.

3. Do you also sell a Practice Management system? (Scheduling, Billing, Accounts Receivable, etc.)

Yes, Xcite Health also has an integrated cloud-based Practice Management System with the EHR. It has scheduling, registration, billing, revenue cycle management, provider credentialing and vaccine inventory management. All of the billing codes such as CPT codes, ICD-9 codes, and in the near future, ICD-10 codes, flow seamlessly into the practice management system from the EHR so, as the physician finishes charting the patient encounter, the billing information is finished and sent to the payers, as well.

4. Talk to me about what it means to be an EHR workflow system, in contrast to a mere EHR system.

Let me first explain what we mean by workflow. As the leader in this area it is important that I explain how this ‘changes things forever’—for many physician practices!

If you feel that, as a physician, you are constantly giving instructions to your staff—and always following up to ensure things have been done—then XciteEHR is for you.

If you feel that you are being asked to change the way you practice medicine to adapt to the strictures of your EHR software, then XciteEHR is for you.

Or, if you feel that you should not take a productivity hit when you implement an EHR and feel instead that your productivity should improve and finish charting as the exam is done, then the XciteEHR is for you

This is what truly sets us apart.

5. I love your workflow system / writer, editor, publicist analogy! Could you please share?

Our EHR workflows drive action, ensure consistency, and increase visibility by connecting your people with relevant tasks and information. It helps you rapidly transform your practice—with applications that connect the right people to the right information and the right work.

Other systems may claim to be “workflow systems.” However, a TRUE workflow system has 3 components—much like an author who needs three things to be successful. An author needs a writer—himself, an editor, and a publicist.

With a true workflow system:

  • YOU are the author, deciding how you practice medicine, and the XciteEHR was built to allow you to author the fine details of how workflow works in your office.
  • You need an editor to perfect and optimize the way you work and on-the-fly workflow editing tools allow your practice to fine-tune your office workflow.
  • And then you need a publicist – to PUBLICIZE this information to your whole staff—so they know ‘when and how’ to do their work – thereby meeting your expectations!

These three components: an engine, an editor, and a publicist, to provide visibility, are critical to having a blockbuster success when you implement an EHR.

XciteEHR is an easy-to-use tool built on top of a workflow engine that maximizes your success; it makes your team more efficient, your life easier, and your practice more profitable!

6. OK, that’s a true EHR workflow system *is*; what does a true EHR workflow system *do*?

Simultaneous processes take place as physicians and staff naturally and seamlessly interact with the program.

As an example, when physicians order vaccines from inside the exam room, the system simultaneously displays the tasks involved in completing the order on the office view screen prompting the appropriate staff members to respond wherever they may be.

While the physicians are finishing in the exam room, the nurses are already preparing to give vaccines. Not only that, the system is automatically queuing up the desired authorization forms and education materials as workplan steps. Before physicians walk out of the exam room, nurses can be ready to complete the necessary paperwork and administer the shots. Precious minutes are shaved off of the time that the exam room is occupied. Patients spend less time in the waiting room and less time in the exam room. The efficiencies yield happier patients and higher revenues.

There is no other system that has this sort of workflow. Because of this simultaneous processing, we are able to improve overall efficiency—and make the workday fly by—and end on time!

7. I know that the most visually striking feature of the XciteEHR is the Office View. Could you show us a screenshot (with de-identified data, of course!) and explain what we’re seeing—and its benefits?

The office view screen is what really sets us apart and is the heart of the office workflow.


The first thing you’ll notice on the office view screen is that it’s tailored to each individual office, with the exam rooms shown on the screen.

Also, each user or role is assigned a color for his or her task bars. For example, this doctor is assigned green and knows immediately that he/she has a patient waiting in room (4).

Each task is time-stamped in real time, so the user knows exactly how long the patient has been waiting for that particular task to be completed.

On the left taskbar, you’ll see that the patient has been waiting in the room for 9 minutes. And, on the right taskbar, it shows that the patient has been waiting on the physician to perform an exam for 3 minutes.

In reality, this prompts the physician to go and see the next patient, or to perform the next urgent task. The patient in room 8 is waiting on the nurse to give a vaccination. This is what I mean by simultaneous tasking—allowing for increased efficiency and a smoother work day and far, far greater coordination and patient satisfaction!

8. What physician practice areas does the XciteEHR cover?

We currently market to and are exceptional in the primary care areas of Pediatrics, Family Practice, Internal Medicine and Obstetrics/Gynecology. However, our workflow engine could be adapted to any medical specialty.

[CW: I'd like to interject here. The ability to customize workflow is critical for multi-specialty pediatric practices. See my Why Specialists Need Speciality-Specific EMRs That Understand More Than Their Specialty.]

9. I think it’s fantastic to see the kind of physician’s practice clinical workflow technology that the XciteEHR represents stepping into the health IT limelight, especially now that there’s health IT social media. How are you planning on educating the world about this type of award-winning EHR workflow technology?

We want to teach physicians to demand true workflow management technology from their EHR vendor. There is no excuse for lost productivity when a medical practice adopts an EHR. With true workflow management technology, a practice should see an increase in productivity in the first three to six months of use, not a decrease. Physicians do not know what to demand because they do not understand the efficiencies that a true workflow system can deliver to them.

We are going to conduct a series of webinars and marketing campaigns to educate physicians about how to make the EHR system to work for them and NOT how the physicians and their staff must conform to the EHR system.

10. Last thoughts, Barrry?

Unfortunately the term workflow has been too commoditized. It seems that if you can string together a serious of computerized actions you can call it workflow.

In many of the other systems, the physicians are choosing from menus, templates and options to figure out next steps. Each practice role player is on his/her own with their tasks, as if everybody is on their own island.

Since getting involved in this field way back in the late 90’s, I have looked at every EHR out there. What is now the XciteEHR, looks and works completely differently from every other type of EHR on the market.

In the XciteEHR once configured by the physician the way she/he likes to practice medicine, the workflow engine will present the right task screens, based on the action taken by the physician, to all relevant practice role players simultaneously and can be viewed and tracked on the Office View screen.

The XciteEHR is built on a strong history and experience of having been in the market for over 20 years—but its features currently surpass every other EHR on the market today—exponentially surpassing all others in one area. Happiness.

I believe that true EHR workflow, customizable to specialty and user needs and preferences, is the single most important key to dramatically increasing physician happiness (yes, happiness) to use an EHR.

[CW: Excellent, Barry! Thank you for working to improve healthcare workflow with information technology! In fact, I even have a special badge I give to the folks in the white hats, the cavalry, as it were, rushing to the aid of physicians ensnared in workflow-oblivious IT systems! See below...]

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Ebola, EHRs, and Evidence-Based Workflow: We Need Open and Transparent Healthcare Workflows

Thomas Eric Duncan, the Ebola patient released from Texas Health Presbyterian Hospital, died this morning at 7:51 a.m. The hospital first blamed a flaw in EHR workflow, but then retracted that claim the next day. Social media has been fractious. Basically, whether you like EHRs, as currently designed and implemented (”See, I told you so!”), or dislike EHRs, as currently designed and implemented (”Statement retracted, no flaw, case closed.”), predicted most reactions.

Unfortunately, I fear, we well never know for sure, the answer to the question, “”What did the EHR users know and when did they know it?” Barring some enforced Epic EHR contractual gag clause, accounts will be forthcoming. But, given the variety of strong biases many stockholders bring to the subject of EHRs and EHR workflow (and I am one of them), it seems unlikely that all will be satisfied. There are too plausible reasons why hospitals, EHR vendors, nurses, and physicians might be reluctant to potentially admit culpability.

We need an evidence-based workflow account of the complete who-what-why-where-when-and-hows sequence of EHR-mediated user activity that may, or may not, have contributed to Mr. Duncan’s release. The problem is, even if a blue-ribbon panel of experts, akin to the Rogers Commission that investigated the Challenger explosion, takes up the matter, current EHRs, of which Epic is emblematic, don’t represent workflow in a way that allows us to make the necessary inferences to explain what when wrong and who or what is to blame.

What do I mean by “represent workflow”? What I mean is, just as current EHRs represent data about patients and drugs and procedures and such, EHRs need to explicitly represent sequences of tasks (data gathering, order entering), the resources consumed (time, money, user attention), and, most important of all, the goals the tasks are intended to together accomplish. Why is representing goals so important? Because goals go to intent. Why was the nurse or physician trying to do when they clicked that button or spoke that command?

What I have just described — the explicit representation of tasks, resources, and goals — is how workflow management system work. True workflow systems, sometimes also known as business process management or dynamic and adaptive case management systems, execute or consult models of work and workflow to automatically do for users what would normally require users to do for themselves. Since these models are easier for clinical users to understand than computer code (Java, C#, Mumps, etc.) it’s easier for users to tell analysts how to design their preferred workflows. Sometimes precocious users even start tweaking workflows themselves. It makes them happier, to make workflow fit their work than make their work fit programmers workflow.

But here’s the important thing, EHR workflow systems leave a detailed, time-stamped trail of who-what-why-where-when-and-how users interacted with the EHR workflow systems. Right now, this kind of data is either absent, locked up in opaque event logs, or misleading, even if one were to be able to extract it. The very best event logs are generated by workflow management and business process management systems.

Even more important than open source and open data, is open and transparent workflow. I call this kind of EHR workflow “figureoutable” and “buildonable.” Mere mortals, who are not programmers, can figure it out and leverage it in ways that the original programmers might not have specifically imagined. These mere mortals include investigators trying to piece together what went wrong.

I’ve written several other blog posts about how process-aware EHR and public health IT systems might have operated to prevent Mr. Duncan’s release (see below). But even if even they will have failed us, they’d at least leave a trail of time-stamped workflow context from which to reconstruct past workflow and improve future workflow. So they won’t fail us the next time.

We, as a nation of patients, providers, payers, policy wonks, and politicians need more evidence-based workflow data, to create more effective, efficient, and safer workflows. We need the kind of open and transparent workflow that will only result from what academics call process-aware information systems.

If you’d like a well-received short course on workflow technology in healthcare, I can’t do any better than suggest my own five-part series:

BPM-based Population Health Management & Care Coordination: Workflow, Usability, Safety & Interoperability Perspectives

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