The Future of EHR Workflow Management Systems: 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

EHR workflow management systems constitute a new paradigm within healthcare, one which will prompt investigation and product development in a variety of new, intriguing, and productive directions.


Workflow management systems are sophisticated but also complex. They have their own terminology. Here William Andrew and Robert Bruegel’s yearly Workflow Management Survey of EHR vendors (ghost written by myself!) [6] plays a critical role in educating the vendor and user community, and in identifying important trends and progress. Detailed reports on EHR workflow management systems specific functionality will appear [7, 8].

Workflow management is the workflow of workflow, in a sense, meta-workflow. Electronic health record systems with meta-workflow functionality are more tailorable to specific users, user goals, and environmental contexts than traditional electronic health record systems that evolved primarily as do- cumentation systems. However, adding workflow manage- ment system functionality to existing electronic health record systems is not a matter of just adding a new EHR feature (such as email messaging, patient tracking, or backend connectivity). Adding a workflow management system to an ex- isting EHR is akin to adding a foundation to a skyscraper or a hull to a large ship. The only practical way to “add” a workflow management system to an EHR is to recreate the EHR, perhaps from scratch, on a workflow management system foundation.

Workflow management is about users (or at least someone intimately familiar with the users, their goals and environ- ment), creating exactly the right workflows to facilitate their work-a-day interactions by creating exactly the right process definitions. Messaging, connectivity to other applications (such as laboratory and pharmacy systems), and patient track- ing are sometimes referred to as workflow management—they are not—they are merely examples of workflow. Messaging facilitates person-to-person coordination; application-to- application coordination is also obviously important; and pa- tient tracking is about coordinating the most important resource of all. So, all of these can be used to coordinate resources, and coordination is certainly a central theme of workflow management. But all of these examples are still just lower level activities. Workflow management is about them; they are not about workflow management. Conceptually, workflow management operates at a higher, or meta-, level; practically, it is the workflow management system that puts everything together in the form of process definitions and executes and monitors them.

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! Interruptions and Exceptions in IT Enabled Healthcare Workflows: Process-Aware HIT.

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