Who Or What Is The Workflow Engine: That Is The Question: 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

CONCLUSION

Table 2 is this author’s mental model of the evolution of the electronic health record toward the EHR workflow
management system. First, systems were developed for patient charting. If an EHR cannot chart patient data, 14
then it scarcely seems to qualify as an EHR at all. Then, additional functions and capabilities were added in a drive to eliminate paper (except for that which must be scanned in from the outside world or printed in order to communicate back). However, even when the paperless office is achieved, this does not mean that the paperless office is efficient. EHR workflow management systems take us to that next step in the evolution of the EHR, in which we have not only gotten rid of paper but inefficiency as well.

evolution

EHR workflow management systems have already begun to make their mark. Each of the first two HIMSS pri- mary care Davies Award (2003 and 2004) include pediatricians who relied on an EHR workflow management system to achieve remarkable improvements in volume, billing, cost, and convenience—for themselves and their patients.
When you look at an EHR and wonder whether or not it is an EHR workflow management system, ask yourself this question: Who or what is the workflow engine? If the answer is “who”, this is bad, because “who” is a per- son, a potentially expensive professional who should not be wasting their time pursuing non-value-added EHR activities. If the answer is “what”, this is good, because “what” is a much less expensive inanimate object, the computer. If the computer can accomplish non-value-added activities and help coordinate value-added activities, then workflow is likely being automated by a true EHR workflow management 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! References for EHR Workflow Management Systems: Process-Aware HIT.

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