Multi-Specialty, Multi-Site, Multi-Encounter Workflow Management: Process-Aware HIT

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

Here is another set of dimensions for understanding and comparing EHR workflow management systems.

Workflow management systems for ambulatory medicine must (eventually—to be maximally effective) span time, space, and subject matter. These dimensions correspond to multi-encounter, multi-site, and multi-specialty workflow management. Multi-encounter workflow management results from process definitions that span en- counters (useful for chronic disease management). Multi-site workflow management spans sites (for example, medical offices in different parts of town). Multi-specialty workflow management allows a workflow engine to coordinate the flow of tasks among multiple specialists (both in the sense of routing between specialists, but also in the sense of different specialists having their own specialty-specific process definitions).

Multi-encounter workflow management includes, for example, the following: follow-ups, in which a step in one process definition triggers the application of a future process definition (such as returning for a specialized test); referrals, in which a process definition triggers a future review of an intervening external consultation; and re- curring activities such as screening tests and chronic disease management.

Now consider multi-site workflow management. The same specialist may be at one medical practice location one day but at another the next. Can specialty process definitions be shared across sites, eliminating the need for creating separate process definitions for each site? Alternatively, can different sites create their own site specific process definitions? Can each site track its own patients, but can a supervisor also easily see what is happening at another site? (“Hey! I’m calling from the Eastside office to ask why Mr. Smith has been waiting an hour for his vitals?”) Can process definitions span sites, so that a patient can be seen in one office but show up at another office for testing only available there?

One way to think of multi-specialty workflow is in terms of an analogy to rail mass transportation in a major city. Subway lines start in different places, end in different places, stop in different (but also the same) places along their way, but work together in a globally coherent system. Each specialty has its own collection of proc- ess definitions, whose constituent tasks may or may not be shared with each other (like subway stops, to con- tinue the analogy). Patients enter one workflow (subway line) but may switch to another workflow during the course of consultation between specialists. Specialty workflows start and stop in different places while sharing resources and working together in a globally coherent system.


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.

Take me to the next blog post in this series! A Survey of EHR Workflow Management Productivity Survey: Process-Aware HIT.

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