2006 EHR WfMS Tutorial Slides 48-55: EMR EHR Usability Principles and Workflow: Flexibility

(Take me to the beginning of these slides!)

From Chapter 7: Natural Language Processing, Business Process Management, and Adaptive Case Management in Healthcare in How Knowledge Workers Get Things Done: Real-World Adaptive Case Management:

Business process management suites and adaptive case management systems are nothing if not flexible, compared to non-process-aware information systems. That said, BPM and ACM vendors frequently debate how to characterize flexibility and whose product is more (or less) flexible. For example, so-called traditional BPM systems are claimed to be flexible in the sense that processes are flexibly designed before execution. In adaptive case management systems, processes are more ad-hoc, flexibly directed and redirected during process execution. “Doing-by-design” versus “design-by-doing” captures the flavor of this debate. In any case, BPM and ACM systems have way more flexible workflows than most EHR and HIT systems. The importance? What if an EHR or HIT system is not natural, consistent, supportive and relevant? Then it needs to be flexible enough to allow users to create natural, consistent, supportive and relevant workflow. In other words, “Avoid frozen EHR workflow!”



  • “capable of being changed”
  • “able to adjust to different conditions”
  • “easily shaped”
  • “designs that can adapt when external conditions change”


The analogy to flexible customization of bicycle apparatus should be obvious. One does not need to go back to the bicycle manufacturing or assembly plant to adjust the position of a bicycle seat.


Similarly, one does not need to go back to the C programmer to flexibly customize many aspects of a word processor.


EHR Flexibility

  • Does EHR accommodate user differences: requirements, competence, preference?
  • Is it customizable at many levels: specialty, location, clinic, individual?
  • Can a user easily “program” the EHR without being a programmer?


EHR Flexibility

  • Degree EHR can accommodate user requirements, competence, and preferences?
  • Unnatural, inconsistent, irrelevant, and unsupportive behaviors…
  • …need to be flexibly changed to become natural, consistent, relevant and supportive.
  • “Flexibly changed” means without requiring a programmer to change the code, a tester to look for bugs, a release to schedule, downtime, and a trainer to demonstrate the new feature

[add material about flexibility at design-time versus flexibility at run-time and the traditional BPM vs intelligent BPM/dynamic case management/adaptive case management debate]


The next screen shot was animated. I grabbed individual intermediate animations from the 2004 tutorial below. The following comes from my speaker’s notes.


Here is a visual aid. You can think of an electronic health record as having an inventory of activities. Some of these activities are screens–entering or reviewing data or entering orders. These screens are like a pack of cards. You can select a subset of these screens and screenless activities such as the printing of educational material into a process definition. This process definition then is executed by the workflow engine during an encounter.


Animation Step 1


Animation Step 2


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Animation Step 7

(Take me to the beginning of these slides!)

Related links:

EHR/EMR Usability: Natural, Consistent, Relevant, Supportive, Flexible Workflow

TEPR 2004 EHR Workflow Management System Slides

Based on the slide deck used for three-hour tutorial at the 2004 TEPR conference in Fort Lauderdale.

TEPR 2006 EHR Workflow Management Systems Slides

Based on the slide deck used for three-hour tutorial at the 2006 TEPR Conference in Baltimore.

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