Process-Aware Workflow Management Systems With Healthcare Characteristics: 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

Evident throughout this article is a tension between straightforward, predictable, repetitive, high volume episodes of patient care versus more complex, less predictable, one-of- a-kind episodes, each of which is unique and therefore infrequent, but all of which taken together constitute a significant and important part of the ecology of health care. Traditional workflow management systems excel at what has been called ‘straight through processing’ (STP) in the banking and finance industries. For example, an order to sell shares in a publicly traded stock should ideally happen in a very short interval (that is, before the stock price changes materially). STP seeks to eliminate the human element that slows down stock trades, to only rely on humans for handling exceptional circumstances, and to reduce exceptional circumstances to an absolute minimum (if not altogether!). However, in health care exceptions happen all the time. Medical care is exception rich because abnormal states are, in effect, normally encountered occurrences.

Healthcare processes, and especially core patient-driven processes, are rife with exceptions—from the appointment no-show to the abnormal laboratory value to the undeniably unique history of present illness. And yet, these are in a way predictable and therefore categories and rules and workflows can be defined to facilitate execution of core clinical and administrative processes. Workflow management in health care, especially in and around the EHR, will be workflow with healthcare characteristics. While this may seem obvious, it also means that workflow management systems technology and concepts borrowed from other industries must necessarily be considerably adapted to become successful components of the next generation of electronic health records.


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! The Future of EHR Workflow Management Systems: Process-Aware HIT.

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