(EHR) Workflow Management: Models, Methods, and Systems

Short Link: http://j.mp/6lbvOW

One of the most important researchers and writers about workflow management systems and business process management is Wil van der Aalst of the Eindhoven University of Technology. In 2002 Prof. van der Aalst and Kees van Hee published a book through MIT Press titled Workflow Management: Models, Methods, and Systems (WM:MMS) that has been remarkably influential.

(And no, I do not collect a commission if you click through and purchase this excellent book from Amazon!)

In WM:MMS, van der Aalst and van Hee present a history of software application architecture that places workflow management systems in historical context and argues that software applications will increasingly become workflow management systems or incorporate workflow management system features. While WM:MMS does not specifically address EHRs, I see no reason why EHRs would be exceptions to this predicted evolution. WM:MMS goes on to describe a notation for modeling workflow processes (called Petri nets), workflow management system functions and architecture, case studies, workflow management system development methodology, and a glossary of workflow management definitions.

Interestingly, Prof. van der Aalst gave one of the main keynotes at the 2004 MedInfo conference in San Francisco where he said that while he had looked through the two thick volumes of 300 hundred or so medical informatics papers and saw the word “workflow” a lot, it did not seem to be used in the way in which it is usually understood within workflow management systems research and industry. (By the way, I did catch up with Prof. van der Aalst afterward to confirm that my paper and poster did indeed discuss workflow in the workflow management systems sense.) This is consistent with my own experience. After a presentation on EHR workflow management systems, someone from the business process management industry will sometimes come up and say the same thing as Prof. van der Aalst. They’ve attended presentations about workflow but very few used the word “workflow” in a manner consistent with the way in which the word is used in the WfMS/BPM industry.

However, 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.

Workflow management systems have also been used for a variety of “paper shuffling” purposes by hospital administrators and healthcare payers, but not so much in ambulatory medicine. This is too bad, since workflow engines uses workflow, or process, definitions to drive task execution and minimize what industrial engineers (I am one, or at least have a degree in IE) call cycle time and to maximize throughput. Workflows can be changed as circumstances require by editing these definitions (instead of requiring a programmer to rewrite and recompile computer code, and all the other associated tasks of testing, redeploying, retraining, and so forth). EHRs based on workflow management systems platforms would have much more usable workflow than many current EHRs without workflow engines and process definitions.