Multi-Specialty, Multi-Site, Multi-Encounter Workflow Management: Process-Aware HIT

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Here is another set of dimensions for understanding and comparing EHR workflow management systems.

Workflow management systems for ambulatory medicine must (eventually—to be maximally effective) span time, space, and subject matter. These dimensions correspond to multi-encounter, multi-site, and multi-specialty workflow management. Multi-encounter workflow management results from process definitions that span en- counters (useful for chronic disease management). Multi-site workflow management spans sites (for example, medical offices in different parts of town). Multi-specialty workflow management allows a workflow engine to coordinate the flow of tasks among multiple specialists (both in the sense of routing between specialists, but also in the sense of different specialists having their own specialty-specific process definitions).

Multi-encounter workflow management includes, for example, the following: follow-ups, in which a step in one process definition triggers the application of a future process definition (such as returning for a specialized test); referrals, in which a process definition triggers a future review of an intervening external consultation; and re- curring activities such as screening tests and chronic disease management.

Now consider multi-site workflow management. The same specialist may be at one medical practice location one day but at another the next. Can specialty process definitions be shared across sites, eliminating the need for creating separate process definitions for each site? Alternatively, can different sites create their own site specific process definitions? Can each site track its own patients, but can a supervisor also easily see what is happening at another site? (“Hey! I’m calling from the Eastside office to ask why Mr. Smith has been waiting an hour for his vitals?”) Can process definitions span sites, so that a patient can be seen in one office but show up at another office for testing only available there?

One way to think of multi-specialty workflow is in terms of an analogy to rail mass transportation in a major city. Subway lines start in different places, end in different places, stop in different (but also the same) places along their way, but work together in a globally coherent system. Each specialty has its own collection of proc- ess definitions, whose constituent tasks may or may not be shared with each other (like subway stops, to con- tinue the analogy). Patients enter one workflow (subway line) but may switch to another workflow during the course of consultation between specialists. Specialty workflows start and stop in different places while sharing resources and working together in a globally coherent system.


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Take me to the next blog post in this series! A Survey of EHR Workflow Management Productivity Survey: Process-Aware HIT.

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