Can Healthcare Really Have Both Consistent and Flexible Information Systems?

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From my recent chapter published in How Knowledge Workers Get Things Done:

Physicians complain about having to hew to what their EHR vendor thinks their workflows should be. It ought to be up to users (or at least someone who knows their workflows) to decide how consistent or flexible they’d like their software to be. Workflow technology (Business Process Management, BPM) opens up the possibility of physicians owning their own workflows. They can make everyone’s workflow the same. They can also allow different physicians to have different preferred workflow.


There’s a stereotype of workflow systems turning users into cogs, with humans doing what machines cannot, instead of machines doing what humans prefer not. That said, defining and executing workflows is one way to influence user behavior, to get folks to do their work the way that medical practice or that hospital intends it be done. Instead of making it impossible for users to depart from intended workflows, the best approach is to make it as easy as possible for users to do their work intended ways, ideally ways that have been vetted and discussed and agreed upon by relevant personnel.

Consistency and flexibility are in natural contradictory tension. At one extreme is a physician, working with lots of physician assistants and nurses and staff, who’d like to make sure everyone does it his or her way. In organizational management-speak, customizable workflows enable greater span-of-control than otherwise possible. At the other extreme, multiple physicians can work together and each have their own workflow. Tension between consistency and flexibility is reduced by using rules and process definitions that non-programming users can understand. They, not their vendor, find the best compromise.

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  1. Cheryl Morgan
    Posted May 16, 2014 at 8:19 am | Permalink

    Dr. Webster as a PhD candidate, my research is in failure of EMR and EHR implementations. What are your thoughts on failures. Heeks (2006) describes a gap in literature regarding failures. Most literature paints a picture of success, when number of failures are actually greater than successes.

  2. chuckwebster
    Posted May 16, 2014 at 10:19 am | Permalink


    Suspect the gap exists. Same as in drug studies. Tend to report successes more than failures. Most current EHR implementations are exercises in re-engineering. Bit more here.

    Automate Your EMR Cow Paths *and* Reengineer Them Too!

    Thank you for your excellent comment!


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