From 2004 to 2006 I gave an annual three-hour tutorial about EHR Workflow Management Systems (WfMSs). While some terminology is dated (for example, WfMSs are now called Business Process Management Systems), the concepts are even more relevant today. P.S. I’ve been a HIMSS Social Media Ambassador for six years in a row. Join me on Twitter at @wareFLO to to help spread the the message: Viva la Workflow! (Take me to the beginning of these slides!)
From (EHR) Workflow Management: Models, Methods, and Systems.
Workflow management systems (and now business process management) ideas, terminology, and technology are finally beginning to gain traction in the health information technology industry. A great deal of credit for this progress is due to Soarian from Siemens, which is based on the TIBCO Staffware workflow management/business process management platform. Soarian’s use has won a major award from the Workflow Management Coalition.
A Major EHR WfMS
“Soarian embeds workflow management technology, providing means to coordinate services between departments, and across the institution. If orchestrates care, coordinating all the services provide to each individual patient, and making optimal user of people and resources.” (electronmedica 69 (2001) no. 2)
Siemens Soarian
- Smart User Interface
- Workflow Engine
- Embedded Analytics
[connect smart to intuitive and intelligent]
Smart User Interface
“Soarian permits intentional and optimized workflow process designs. It provides an intuitive graphical environment for designing reengineered workflow processes.” (electronmedica 69 (2001) no. 2)
Workflow Engine
“Soarian enforces the execution of these reengineered processes. It tracks the progress of individual work steps, and automatically escalated failed or expired work steps to the appropriate individuals.” (electronmedica 69 (2001) no. 2)
Embedded Analytics
“Soarian provides embedded analytics. It automatically gathers detailed information regarding process execution throughout the institution. This information enables the detailed analysis needed for further process refinement, and the completion of the Quality Cycle.” (electronmedica 69 (2001) no. 2)
[see my process mining post, paper, and video]
Siemens on Workflow
“At Siemens, we define workflow as the process of moving patients, resources and information across the healthcare continuum… Our solutions track the sequence of next steps by eliminating manual tasks and departmental lines and handoffs. They proactively push information such as coverage and medical-necessity issues to people who need it, while driving clinical tasks — delegating work to the right person and the right time.”
Retrieved from (now broken link):
Finally, here is Soarian’s graphical workflow editor. You can see that it resembled MS Visio, but with a major difference. Diagramed workflows are executable. This is what I mean when I refer to executable process model [link] elsewhere. Instead of a Java or C# programming writing code that is incomprehensible to users who best know their workflows, the “code” is this is based on this diagram, which iscomprehensible to users who best understand their workflows. The workflow is constructed from clinical workflow domain specific terminology:
- Triage Patient
- New Neuro Deficit
- Nurse EHR Evaluation
- Nurse TPA Assessment
- Thrombolysis Candidate?
- Physician Eval
- STAT CVA Eval
- CVA Confirmed?
- Thrombolysis Panel
- CT Head r/o CVA
- Stat IV
- Hemorrhage
- Physician TPA Decision
There’s a great potential fit between user-centered design and workflow-centered design (as I note at the end of my “straw man” article User-Centered EHR Design Considered Harmful (Try Process-Centered Instead)) Note the important role of psychologists and linguists in user-centered design of Soarian in the following passage.
A team of industrial psychologists, linguists, physicians, medical informatics and communication and indus- trial graphic designers developed the user interface for Soarian – its page, language and navigation design…The result is an interface that…will be easy to use and will require little training. The use of a common look and feel facilitates access from any device and supports collaboration across clinical disciplines. Soarian’s user-specific workflow design intents to present screens and data appropriate for each user’s job function and work to be performed…The main-goal of Soarian’s ‘smart user interface’ is to deliver a transparent user interface, which supports the users accomplishing their tasks. That means, ideally the users’ focus attention is only targeted at the task, not how to handle a system…The Soarian process has been added with the principles of user centered design methodology in addition to the wide spread object-oriented-approach (36, 37). This process allows task-oriented soft- ware design rather than feature/function driven…the task-oriented user interface work accompanies the whole solution lifecycle right from the beginning rather than being sent to a usability test after the design already took place…The ‘smart user interface’ is technically divided up in two aspects: the user interface concepts & design [and] the contributions of the workflow engine…This concept is in accordance with the modern understanding of workflow supporting systems and does not create any additional burden of learning or changes on the clinical end users.
From 2004 to 2006 I gave an annual three-hour tutorial about EHR Workflow Management Systems (WfMSs). While some terminology is dated (for example, WfMSs are now called Business Process Management Systems), the concepts are even more relevant today. P.S. I’ve been a HIMSS Social Media Ambassador for six years in a row. Join me on Twitter at @wareFLO to to help spread the the message: Viva la Workflow! (Take me to the beginning of these slides!)
TEPR 2004 EHR Workflow Management System Slides
Based on the slide deck used for three-hour tutorial at the 2004 TEPR conference in Fort Lauderdale.
- Slide 1-2: What (Exactly) is EMR EHR Workflow Management? Introduction
- Slide 3: Five EMR EHR Workflow Usability Principles
- Slide 4: Natural Workflow: Five EMR EHR Workflow Usability Principles
- Slide 5: Relevant Workflow: Five EMR EHR Workflow Usability Principles
- Slide 6: Supportive Workflow: Five EMR EHR Workflow Usability Principles
- Slide 7: Consistent Workflow: Five EMR EHR Workflow Usability Principles
- Slide 8: Flexible Workflow: Five EMR EHR Workflow Usability Principles
- Slide 9: Definition of Workflow: Workflow Management Coalition
- Slide 10: Definition of Workflow Management System: Workflow Management Coalition
- Slide 11: EMR EHR Workflow System vs. EMR EHR Workflow Management System
- Slide 12: Cooking Analogy Workflow Reference Model
- Slide 13: Cookbook: Cooking Analogy Workflow Reference Model
- Slide 14: Manual vs Automated Activities: Workflow Reference Model
- Slide 15: Patient Encounter: Workflow Reference Model
- Slide 16: Entering & Reviewing Data, Entering Orders: Workflow Reference Model
- Slide 17: Four Types of EMR EHR Workflow: Time vs Users
- Slide 18: Different Time & Different User: Four Types of EMR EHR Workflow
- Slide 19: Same Time & Different User: Four Types of EMR EHR Workflow
- Slide 20: Different Time & Same User: Four Types of EMR EHR Workflow
- Slide 21: Same Time & Same User: Four Types of EMR EHR Workflow
- Slide 22: EMR EHR Workflow Engine Uses Process Definitions to Reason About…
- Slide 23: EMR EHR Workflow Engine Presents Right Screen & Data & Order Entry Options…
- Slide 24-30: Process Definitions Adapt EMR EHR Screen Presentation to Task Structure
- Slide 31-39: EMR EHR Workflow/Process Editor Authors & Revises EMR EHR Workflow
- Slide 40-41: Example: Deleting Task Changes EMR EHR Workflow Without Reprogramming
- Slide 42-43: Example: More Complex Process Definition “Peds Visit, Well Visit, New”
- Slide 44-45: EMR EHR Practice Survey: Usability, Revenue, Expenses, Time & Quality
- Slide 46: EMR EHR Practice Survey: Overall Usability
- Slide 47: EMR EHR Practice Survey: Effect of Usable Workflow on Revenue
- Slide 48: EMR EHR Practice Survey: Effect of Usable Workflow on Expenses
- Slide 49: EMR EHR Practice Survey: Effect of Usable Workflow on Time & Quality
- Slide 50: EMR EHR Practice Survey: Good Things Increased, Bad Things Decreased
- Slide 51: Why Did Patient Volume Increase? Why Did Encounter Length Decrease?
- Slide 52-58: Fewer Non-Value-Added EMR EHR Activities (animation snapshots)
- Slide 59-65: More Parallel Value-Added EMR EHR Activities (animation snapshots)
- Slide 66: Need Better Real-Time Coordinated EMR EHR Activity Delegation
- Slide 67: EMR EHR Workflow Engine Makes Possible Real-Time Task Tracking & Management
- Slide 68: EMR EHR Workflow Engine Enables Fewer Non-Value-Added Activities
- Slide 69: EMR EHR Workflow Engine Enables More Parallel Value-Added Activities
- Slide 70: EMR EHR Workflow Engine Enables Better Coordinated Activity Delegation
- Slide 71: People Plus Technology: Share, Distribute, Improve
- Slide 72: Patient Charting & Evolution of the EMR EHR
- Slide 73: Paperless Office & Evolution of the EMR EHR
- Slide 74: Workflow Management Systems & Evolution of EMR EHR
- Slide 75: You May Ask Yourself…
- Slide 76: Who or What is the EMR EHR Workflow Engine?
- Slide 77: Who or What is the Workflow Engine? If the Answer is “Who”…
- Slide 78: Who or What is the Workflow Engine? If the Answer is “Who”…Bad!
- Slide 80: Who or What is the Workflow Engine? If the Answer is “What”…Good!
- Slide 81: EMR EHR Workflow Management Systems Do More With Less
TEPR 2006 EHR Workflow Management Systems Slides
Based on the slide deck used for three-hour tutorial at the 2006 TEPR Conference in Baltimore.
- Slide 1-2: Workflow Management Systems: Key to EMR EHR Usability
- Slide 3-10: Some Workflow Definitions – Some Usability Definitions
- Slide 11-14: What Do Experts Say About Healthcare Workflow?
- Slide 15-22: EMR EHR Usability Principles and Workflow: Introduction
- Slide 23-29: EMR EHR Usability Principles and Workflow: Naturalness
- Slide 30-35: EMR EHR Usability Principles and Workflow: Consistency
- Slide 36-41: EMR EHR Usability Principles and Workflow: Relevance
- Slide 42-47: EMR EHR Usability Principles and Workflow: Supportiveness
- Slide 48-55: EMR EHR Usability Principles and Workflow: Flexibility
- Slide 56-58: EMR EHR Usability Principles and Workflow: Conclusion
- Slide 59: Intermission Time, Folks!
- Slide 60-63: Eliminating EMR EHR Non-Value Added Workflow Steps
- Slide 64-66: Parallelizing EMR EHR Value-Added Steps
- Slide 67-71: Doughnut Baking Automation Analogy, Workflow Reference Model, Patient Encounter
- 2006 EHR WfMS Tutorial Slides 72-79: EMR EHR Workflow Survey: Usability, Revenue, Expense, Time & Quality
- Slide 80-81: Why Did Patient Volume Increase? Why Did Encounter Length Decrease?
- Slide 82-89: Hospital EMR/EHR BPM: Usability, Workflow, Analytics
- Slide 90-97: Hospital EMR/EHR BPM: A Case Study
- Slide 98-102: More Workflow Definitions (No Pun Intended) Applied to Patient Encounter
- Slide 103-108: To Be, or Not to Be (the Workflow Engine) That is the Question