Process-Aware EHR Workflow Management Systems: Essentials, History, Healthcare (Written In 2004!)

The following preamble and table of contents is for surfers who randomly land here and may benefit from a bit of orientation. Skip to the content!

In 2003 and 2004, I wrote a series of white papers about workflow-centric, instead of data-centric, EHRs. It’s taken 13 years, but much of what I wrote is finally becoming true. This is one of a sequence of blog posts adapted from those white papers and (republished) during HIMSS16. Terminology has evolved, but the ideas are as relevant now, if not more so, as then. (Take me to the beginning of this series of blog posts!)

  1. EHR Workflow Management Systems: Essentials, History, Healthcare (Written In 2004!)
  2. The Critical Difference Between Workflow Management Versus Mere Workflow: Process-Aware HIT
  3. The Critical Importance of Executable Model Of EHR Workflow: Process-Aware HIT
  4. Different Versus Same Person Versus Time EHR Workflow: Process-Aware HIT
  5. Multi-Specialty, Multi-Site, Multi-Encounter Workflow Management: Process-Aware HIT
  6. A Survey of EHR Workflow Management Productivity: Process-Aware HIT
  7. EHR Productivity Survey Discussion: Process-Aware HIT
  8. Workflow Management and EHR Usability: Process-Aware HIT
  9. User-Centered, Human-Centered Process-Aware Health IT
  10. Process-Aware Workflow Management Systems With Healthcare Characteristics: Process-Aware HIT
  11. The Future of EHR Workflow Management Systems: Process-Aware HIT
  12. Interruptions and Exceptions in IT Enabled Healthcare Workflows: Process-Aware HIT
  13. Clinical and Administrative Healthcare Workflow Patterns: Process-Aware HIT
  14. Process Mining Time-Stamped Health IT Data: Process-Aware HIT
  15. Capacity Management Implications of Healthcare Workflow Technology: Process-Aware HIT
  16. The Roots of Task-Workflow Pragmatic Interoperability: Process-Aware HIT
  17. Who Or What Is The Workflow Engine: That Is The Question: Process-Aware HIT
  18. References for EHR Workflow Management Systems: Process-Aware HIT
  19. Glossary of EHR Workflow Management Systems Terminology: Process-Aware HIT

In 2003 and 2004, thirteen years ago, I wrote a series of white papers, and presented them at the now defunct TEPR (Towards an Electronic Patient Record) and 2005 HIMSS conference in Dallas. In that series I laid out a dramatically different EHR architecture. It was workflow-centric, whereas todays EHRs are data-centric. I was remarkably prescient. However, it’s taken more than a decade so see much of what I predicted to finally begin to come true. Every year, since 2011, I search every HIMSS exhibitor for workflow and workflow tech-related content. We are finally seeing a remarkable search in workflow tech, such as workflow engines and business process management (BPM) highlighted defusing into healthcare and health IT. So, for this years HIMSS16 conference I sliced-and-diced that original series and white papers and am tweeting those bits during this years HIMSS16 conference. (Skip the “Table of Contents” and go directly to original 2004 material. Skip both the TOC and 2004 contents and go to HIMSS16 commentary.)


(also see the 2005 HIMSS05 paper EHR Workflow Management Systems in Ambulatory Care)

EHR Workflow Management Systems: Essentials, History, Healthcare

Charles Webster, MD, MSIE, MSIS


Workflow management system technology promises critically important increases in electronic health record (EHR) usability and productivity. This paper describes the characteristics of electronic health record (EHR) workflow management systems (WfMSs): the difference between workflow management and mere workflow, the workflow reference model, the central role of the process definition, various frameworks within which to understand workflow, a productivity survey, the importance of workflow management to EHR usability, and future research and development directions.


Workflow management systems, electronic health records.


Electronic health record systems are evolving from patient documentation systems into tools for physicians to accomplish their many tasks and to manage others with whom they work in close conjunction: to document, to direct, and to delegate. EHRs used in this way must have customizable workflow—to specialty content, to local clinical and administrative processes, and to user preferences. If an EHR can be instructed (that is, customized) in what to do—automatically— based on who, what, why, when, where, and how, the EHR is not just a patient documentation system, it is an EHR workflow management system.

Throughout this article I will rely on a series of frameworks to present the components, behaviors, and advantages of EHR workflow management systems. These different frameworks are not mutually exclusive (occasionally making the same point in different terminology), however, used together, they provide a broad description of EHR workflow management systems components, behaviors, and advantages (over non-workflow management system EHRs).

Much of what I wrote about in this 2003-2004 series of white papers is indeed coming into existence today. The basic idea of building workflow-centric health IT systems is indeed gaining steam. Many of my tweets during HIMSS16 are about companies embedding workflow engines in their products. In addition, we are seeing a surge of Business Process Management technology in healthcare and health IT. Terminology varies. Sometime they are called Healthcare or Care Management Systems. What they have in common is a “process-awareness” that has been mostly missing to day in recent medical informatics and health IT history. This new layer of cloud-based workflow engines addresses thorny issues of EHR and health IT usability, productivity, safety, and interoperability. Indeed, since my 7000-word, 5-part series, Achieving Task and Workflow Interoperability in Healthcare , was published in 2015, I’ve seen considerable progress. Also see my recent 10,000 word, 5-part series on Pragmatic Interoperability published on HL7Standards immediately before HIMSS16.

It is still useful to look back at my 2003 and 2004 series on EHR workflow management systems for seminal ideas that are only now being realized in products and driving results. In many instances, I have written considerably more material on various subtopics.

Today, “workflow management systems” has been superseded by “Business Process Management” systems (BPM). Though you will notice I do mention Business Process Management in this 2004 paper. You may also be interested in my more recent BPM-based Population Health Management & Care Coordination: Workflow, Usability, Safety & Interoperability Perspectives.

Take me to the next blog post in this series! The Critical Difference Between Workflow Management Versus Mere Workflow: Process-Aware HIT.

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