User-Centered, Human-Centered Process-Aware Health IT

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 concepts mesh with research initiatives to improve EHR usability. For example, Human- Centered Distributed Information Design [6] (there applied to EHR usability issues) distinguishes four levels of distributed analysis: user, function, task, and representation, which correspond well to workflow management architectural distinctions.

Distributed user analysis can be interpreted to include allocation of tasks, relationship between roles, and task-related messaging, all of which are important workflow management concepts.

Distributed function analysis involves high-level relationships among users and system resources. From a workflow man- agement perspective, this includes who reports to who and who is allowed to accomplish what.

Distributed task analysis roughly corresponds to the creation of process definitions that in turn drive EHR behavior: What is to be accomplished by whom, in what order, and what needs to happen automatically.

Distributed representational analysis corresponds to some- thing that workflow management systems intentionally do not address. Workflow management system design tends to be agnostic about how information is displayed to, transformed, or collected from the user. The underlying workflow engine is intended to be a general purpose tool that can be used to sequentially launch whatever screen or initiate whatever behind the scenes action that the implementer of the workflow system deems most apt as part of workflow analysis and design. However, by remaining orthogonal to the choice of screen, by not mandating or hard coding, the designer/implementer is free to bring to bear the powers of representational analysis to use whatever screen and attendant representation is most appropriate.

Thus, workflow management concepts are consistent with human-centered distributed information design, an important emerging area of medical informatics research. “Task- specific, context-sensitive, and event-related displays are ba- sic elements for implementing HCC [human-centered computing] systems,” (p. 46 [6]) and they are the basic elements provided by EHR workflow management systems, too.

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. Nonetheless, I think it is 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.


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! Process-Aware Workflow Management Systems With Healthcare Characteristics: Process-Aware HIT.

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