The Next Five Years: The EHR Network Effect

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Last week I gave an invited presentation to the Columbia chapter of the South Carolina Health Managers Association on EHR topics. Having never been to Columbia, or tasted the famous South Carolina yellow barbecue sauce, I went (as they say) with relish.

My presentation was “The Next Five Years:The EHR Network Effect” and I thought I’d summarize it here. (What it has to do with EHR Workflow Management Systems will become apparent towards the end.)


A network effect occurs when adding products or service increases the value of existing network products or services. The classical example is (a) one telephone is not worth anything, (b) two telephones connected to each other are perhaps worth a little bit, (c) but millions of networked phones are worth a whole lot.

There is much current discussion about health information exchanges (HIEs) and sustainable business models. To the degree that an HIE facilitates the creation of a network of EHRs a network effect may be to increase the value of each individual EHR. The more valuable a network of EHRs is, the more whoever benefits from that value will pay to sustain the HIE. Over the next five years (to pick an arbitrary planning horizon) exploiting the network effect will likely be key to creating financially sustainable HIEs.

The rest of my presentation consisted of examples of existing and potential EHR network effects. An obvious example is an EHR user relying on data from another EHR to provide patient care. If we expand our scope to the network effect of adding health information systems to a network, then there is the (again, obvious) value of EHR messaging: incoming lab results, refill requests, decision support, etc.; outgoing E-Prescriptions, disease and vaccine registry data, payment for outgoing quality data, etc.

However, the three network effect examples I focused on were:

1. Biosurveillance

Adding EHRs to a network of EHRs that participate in a biosurveillance program increases the ability to accurately red flag potential bio-terror events and this increased accuracy causes an increase in value that accrues to each member of the EHR network.

2. Population Management

Adding EHRs to a network of EHRs that participate in a population management program increases the quality of inferences about population health state which, when fed back to individual EHRs to affect patient care, increases the value of each participating EHR.

3. Process Benchmarking

EHRs generate considerable process data that is not part of the official patient record. This data includes who did what to whom, where, when, how and often even why. Much of this data is gathered for privacy and security audit trail purposes. Some, depending on the EHR, is actually a byproduct of internal task management mechanisms.

Chose an output metric or weighted combination of metrics; compare your EHR productivity to the average and the best productivity of other EHRs on a process benchmarking network of EHRs; now drill down and explain the differences between your productivity and that of other EHR installations. Use these explanations to change your processes and improve your productivity.

Of all of these EHR network effects, I believe that process benchmarking may potentially be the most compelling value proposition for a majority of medical practices. Of course, everything looks like a nail when you have a hammer, and this blog is titled “Electronic Health Record Workflow Management Systems…”

More on process benchmarking in a later post.

Oh, the yellow barbecue sauce at the Palmetto Pig near the Devine Street Bridge was…divine (and the hush puppies were the best I’ve ever had).


EncounterPRO User to Present At HIMSS

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Congratulations to Dr. Armand Gonzalzles of Riverpoint Pediatrics in Chicago (an EncounterPRO EHR user since 2000) for his upcoming presentation at the 2009 Health Information Management Systems Society Conference in Chicago.


Dr. Gonzalzles’ presentation “Workflow Management EMR Systems and the Primary Care Physician,” (Sunday, April 5, 9:45 AM – 10:45 AM in Room S403b at the McCormick Place Convention Center) will review how his Riverpoint Pediatrics practice in Chicago achieved practice transformation with workflow improvements with EHR adoption. Dr. Gonzales will review the steps required to change practice and physician workflows within the practice when adopting an EHR.

Attendees will learn to describe how a physician workflow changes are enhanced with EHR usage, explain the importance of workflow analysis when adopting an EHR for your practice, identify how to spend more quality time with patients instead of documenting the visit, and discuss how to improve overall practice administration.

Recently I had the pleasure of serving on an expert panel with Dr. Gonzalzles advising the Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation (ASPE) on “Assessing the Economics of EMR Adoption and Successful Implementation in Physician Small Practice Settings.”  Here is the final report (some very interesting observations about workflow management that I intend to highlight in a later post).

Dr. Gonzalzles is a past winner of the 2004 HIMSS Ambulatory Care Davies Award of Excellence (his winning application here).

 Congratulations again, Dr. Gonzalzles!


Welcome! (EHR + WfMS = EHR WfMS)

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Who Am I?

Charles (Chuck) Webster, MD, MSIE, MSIS

Why Am I Blogging?

I am blogging and tweeting, at @EHRworkflow [CW: now @wareflo], to connect with professionals and researchers interested in electronic medical records and electronic health records on one hand, and workflow management systems and business process management on the other. More specifically, I am blogging and tweeting to connect professionals and researchers interested in electronic medical records, electronic health records on one hand, workflow management systems and business process management. I’ll also likely blog and tweet about aspects of clinical natural language processing that support this integration and synthesis.

What Will I Be Blogging About?

I will be blogging about Electronic Health Record Workflow Management System (EHR WfMS) and Business Process Management (BPM) concepts, technologies and products.


I coined the term EMR Workflow Management System (now EHR Workflow Management System or EHR WfMS) sometime in 2002 in conversation and email. However, my first article on the concept was the earlier “Structured Data Entry in a Workflow-enabled Electronic Patient Record” which appeared in The Journal of Medical Practice Management, Volume 17, Number 3, Pages 157-161, 2001 and was reprinted (page 11) in the Medical Records Institute’s Health IT Advisory Report, Volume 3, Number 6, July 2002 (pages 11-15). As of the date of this post it has eight citations that Goggle Scholar knows of; OK, two were by me, but I am pleased that (a) someone noticed and (b) they cited their source.

My first public use of the phrase Electronic Medical Record Workflow Management System was the 2003 white paper “Electronic Medical Record Workflow Management: The Workflow of Workflow”, which appeared on the then JMJ Technologies website. In 2003 I wrote the workflow management criteria used in the EHR workflow management system survey used by Andrew and Associates and published in Advance for Health Information Executives as well as contributed the core EHR WfMS concepts discussed there. I subsequently tweaked the survey criteria in 2004 and 2005 for those surveys and as well as contributed additional conceptual material to follow on articles). Since then I’ve continued to develop these ideas and present them at a variety of regional, national, and international conferences as well as publish in conference proceedings, trade journals, and on the Web. “EHR Workflow Management Systems: Essentials, History, Healthcare” (TEPR Conference, May 19, 2004, Fort Lauderdale), “EHR Workflow Management Systems in Ambulatory Care” (HIMSS, February 14, 2005, Dallas), and this EHR Scope Fall 2007 article “What Makes a Great Pediatric EHR?” are representative.

In particular I hope to stimulate discussion between EHR, WfMS, and BPM professionals.

Blogs, even technical ones like this, need to lighten up occasionally, so I’ll post occasionally about kickbiking and other personal interests or add a vacation photo to my gallery.

When Will I Post?


Where will I post?

Here (

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