White Paper: Electronic Health Record Workflow Management Systems: The Next Step in EHR Evolution

Short Link: http://j.mp/727OEr

Many thanks to the Technology Association of Georgia for publishing one of my white papers on EHR Workflow Management Systems.


TAG has many excellent resources on their web site, and I had them in mind when I recently wrote:

“Atlanta is a sophisticated medical and information technology market….To do well in Georgia, whether you are a pediatrician or develop and market a pediatric EMR, is to do well in a state that does a lot of things rather well. We are both a beneficiary of, and contributor to, Atlanta and Georgia’s unique workforce, infrastructure, and business climate:

Best Managed State in the Southeast

No. 1 in U.S. for Workforce Training

Most Inexpensive U.S. City to Do Business

Second Fastest Growing City in America

Fastest–growing Port in the US (that’s sea, not internet, port!)

To which I’d like to modestly add:

Home of the Best (and Only) Pediatric EMR Workflow System”

Most of our product website focuses on EMRs for pediatrics and related primary care specialties. This blog is more opinionated and predictive about where I think healthcare is going (application of business process management to process-aware EMRs). The white paper states the more general (not pediatric-specific) case for EMR/EHR workflow management systems while maintaining focus on more immediate benefits.

Below is the beginning and end of the white paper. If you want to fill in the gap (”…”) you can download the complete document here.

Electronic Health Record Workflow Management Systems:
The Next Step in EHR Evolution

Nov 1, 2009

Charles Webster, MD, MSIE, MSIS
Chief Medical Informatics Officer
EncounterPRO Healthcare Resources, Inc.
Atlanta, Georgia

Implementing an Efficient Electronic Health Record

Electronic Health Records (EHRs) are becoming more than just electronic patient documentation systems; they are evolving into tools that assist physicians in managing the patient care tasks they perform for major types of patients they see. These systems allow providers to analyze, manage and optimize the work that has to be performed, as well as to direct and to delegate it to others. EHRs based on a Workflow Management System (WfMS) accomplish this by offering a way for the user to customize workflow to practice specialty, to local clinical and administrative processes and to user preferences. If an EHR can be instructed to do tasks in a customized sequence - automatically - based on who the patient is, why they came to the office, what care needs to be provided, when and where care needs to be provided, and how it best fits the office staffing, the EHR is not just a patient documentation system, it is an EHR Workflow Management System.

Workflow Management versus Mere Workflow

Most EHRs have basic task management functionality, yet very few are built upon a user-controllable WfMS “engine.” “Workflow systems” and “Workflow Management Systems” are frequently confused and poorly differentiated, yet there is an important distinction. This distinction is particularly important to know if a physician is planning to automate his or her office and is in the market for an EHR. A Workflow Management System is a software application that stores and executes workflow (or process) definitions to create and manage workflow processes by facilitating interactions among users and applications. Users usually interact with workflow systems, not the WfMSs used to implement them. It is the underlying WfMS that allows a workflow system to be flexibly tailored to local processes and user preferences, and to be easily monitored and maintained by the user, not the computer software vendor. The less a user is dependent upon their EHR software vendor, the faster changes can be made and the less maintenance cost there will be.


The earliest EHR systems were developed primarily to automate patient charting functions. If an EHR cannot chart patient data, then it scarcely seems to qualify as an EHR at all. Next, additional functions and capabilities were added in a drive to eliminate paper (except for that which must be scanned in from the outside world or printed in order to communicate). However, even when the paperless office is achieved, this does not mean that the paperless office is efficient. The availability of WfMS-based EHRs brings us to that next step in the evolution of the EHR development, in which we have not only gotten rid of paper but inefficiencies as well. EHR WfMSs have already begun to impact the EHR market. Each of the first three Health Information Management and Systems Society’s Davies Awards (2003, 2004 and 2005) included physicians who relied on a WfMS-based EHR (the EncounterPRO EHR) to achieve remarkable improvements in volume, billing, cost, and convenience – for themselves and their patients.

When looking at an EHR, one may wonder whether or not it is an EHR WfMS; simply ask this question: Who or what is the workflow engine? If the answer is “who”, this is bad, because “who” is a person; a potentially expensive professional who should not be wasting their time pursuing non-value-added EHR activities. If the answer is “what”, this is good, because “what” is a much less expensive inanimate object; the computer. If the computer can accomplish non-value-added activities and help coordinate value-added activities, then workflow is likely being automated by a true Electronic Health Record Workflow Management System.

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