“Workflow’s Unique Contribution to Healthcare”: Let’s Make These Quotes from 1996 Come True Before 2016

It’s a truism in healthcare IT that we lag behind automation progress in other industries. Why can’t we access patient data anywhere as securely as we check our bank accounts? Why can’t EHRs be as easy to use as consumer electronics? Highly automated factories produce much more today with many fewer resources, why can’t healthcare do the same?

In fact, when I go to IT conferences aimed at other industries, as I occasionally do, and I tell techies I’m from healthcare, they often shake their heads sadly in pity. Despite high-tech advances in such areas as medical imaging and medical chemistry, we have a reputation as an IT backwater. Sigh.

This is not to say that health IT does not have allure that other IT verticals lack. I’d rather design software to prolong life than shorten it, which may not be the case with otherwise cool technology with military uses. Medical data has characteristics that make it more interesting than financial data (and I have an undergraduate degree in Accountancy, so I have some passing familiarity). I’m also fascinated by the philosophical, cultural, and ethical problems confronted, implicitly and explicitly, by healthcare information systems designers.


There is one area in which healthcare lags most egregiously: use of workflow automation (AKA workflow management systems, business process management, adaptive case management, process-aware information systems).

For years I’ve toted around a yellowing article titled, “Workflow’s Unique Contribution to Healthcare.” It appeared in a supplement to Healthcare Informatics (Document Information Management and Workflow Solutions in the Healthcare Enterprise, Healthcare Informatics, 1996 Aug;13(8):S2-35.), written by Jamie Mendez (who I’ve looked for on the Web, Twitter, etc., with no success). She wrote:

Workflow systems depend on two fundamental capabilities: automating manual process steps and distributing information to members of the workgroup.

Members of the workgroup add value by adding more information or by making judgements based on the information information available to them through the application. Workflow systems also provide a context in which work is performed and bring resources together across organizational boundaries. These can be separate departments, different sites, or even different companies to create an environment that functions like a “virtual organization.”

Locally customizable: A workflow system must adapt readily to fit business processes for multiple users and organizations.

Process adaptability: Modular construction of the workflow applications should permit straightforward changes to the system such as adding fax or paging services to improve the workflow.

Flexible logic: The flexibility to support ad hoc process logic is important for directing actions, routing sequences, and distribution lists…This allows exception-driven activities based on knowledge-based decisions embedded in the process flow.

Workflow systems have the potential to do for healthcare processes what just-in-time manufacturing has done for production processes. An effectively planned workflow system leverages an organization’s information resources to improve interactions between people and create a virtual organization. In almost not other business does information play such a great part as it does in healthcare. When information flows efficiently, healthcare organizations not only improve delivery of patient care, but reduce costs and improve customer satisfaction at the same time.

I’ll often deconstruct a series of quotes to make a point. Sometimes I replace general phrases such as “information systems” with “EHRs” (for example, see Well Understood, Consistently Executed, Adaptively Resilient, and Systematically Improvable EHR Workflow). Sometimes I agree with parts of a quote but quibble with other bits (for another example, see Efficient and Moral Market-driven EMR and EHR Usability Innovation).

This time I’ll let the above quotations stand on their own. Except to say: In four more years, in 2016, these words will be twenty years–two decades–old. Let’s make them come true before it can be said that healthcare IT is literally decades behind in adoption of workflow automation.