2006 EHR WfMS Tutorial Slides 98-102: More Workflow Definitions (No Pun Intended) Applied to Patient Encounter – Healthcare Business Process Management Blog by Chuck Webster, MD, BSA (Accountancy), MSIS (Intelligent Systems), MSIE (Industrial Engineering), #HIMSS18 Social Media Ambassador

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Get it? Sorry. “Workflow Definition” could refer to either process definitions, executed by a worklflow engine, or a definition of some word or phrase related to EMR and EHR workflow such as workitem, enactment, etc.

The following table is adapted from the associated 2004 proceedings paper EHR Workflow Management Systems: Essentials, History, Healthcare, TEPR Conference, May 19, 2004, Fort Lauderdale.

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Glossary of EMR / EHR Workflow Terminology

Phrase	Definition	Medical Example
Work Item	Task to perform	Vitals signs awaiting performance during a patient encounter
Workflow/ Process Definition	Description of a process detailed enough to drive EMR / EHR behavior. van der Aalst refers to this as a formal process model, that is, one that can executed.	Get the Patient, Take Vitals and a Chief Complaint, Review Allergies, Review Medications, Review of Systems, Examination Screen, Evaluation and Management, Billing Approval
Worklist	List of tasks to perform	A nurse’s To-Do list
Case	Particular application of a EMR / EHR workflow management system / business process management suite	A particular patient’s encounter managed by EMR / EHR workflow management system /business process management system
Process	Order (though not necessarily sequence) of tasks to be performed and resource requirements	A Well Child pediatric visit
Resource	Something that accomplishes tasks (often a user)	A physician, nurse, technician
Role	Set of related skills accomplished by a resource	The role of nurse or physician
Routing	Types of routing include sequential, parallel, conditional, or iterative task execution	Routing a recording to a transcriptionist and the report back to the physician
Task	Unit of work carried out by a resource	Obtain vital signs
Trigger	An event that changes a work item into an activity	Starting to accomplish the task of responding to a phone message by selecting a To-Do list item
Workflow	A process and its cases, resources, and triggers	The tasks and people involved in accomplishing a patient encounter
Workflow/ Process Definition Editor	User application or interface for creating workflow/ process definitions	An ordered picklist or flowchart diagram representing Get the Patient, Take Vitals and a Chief Complaint, Review Allergies, Review Medications, Review of Systems, Examination Screen, Evaluation and Management, Billing Approval
Activity	Performance of a task	Obtain vital signs within a patient encounter

Related to this table is the Electronic Health Record Workflow Management Systems Features & Functions Survey that I wrote for the 2003 Advance for Health Information Executives EHR Workflow Management Systems Survey.

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Definition of Workflow: Workflow Management Coalition

“The automation of a business process, in whole or part, during which documents, information or tasks are passed from one participant to another for action, according to a set of procedural rules.”

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Definition of Workflow Management System: Workflow Management Coalition

“A system the defines, creates and manages workflows through the use of software, running on one of more workflow engines, which is able to interpret the process definition, interact with workflow participants and, where required, invoke the use of IT tools and applications.”

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This slide is from the 2004 slide deck [link].

Practical Distinction

If you don’t have an EHR workflow management system…
…you can’t change or manage your EHR workflow system…
…and everyone’s workflow is different!

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Process Definition

A network of activities and their relationships, criteria to indicate the start and termination of the process, and information about the individual activities, such as participants, associated IT applications and data, etc.

From EMR Workflow Systems vs. EHR Workflow Management Systems:

Just as workflow management systems are used to create and manage workflow systems–as discussed in Prof. van der Aalst’s book on workflow management systems–EHR workflow management systems are used to create and manage specialty-specific EMR workflow systems. This is similar, by analogy, to the way in which database management systems are used to create and manage database systems. Your baseball card collection database is a database system; it was a database management system, such as MS Access, that created and manages it.

“A workflow management system is a software package for the implementation of a workflow system. The term refers to a universally applicable system; in other words, a workflow management system is not customized to a specific business situation. By configuring such a system, it is turned into one which supports specific workflows. Unlike a workflow system, a workflow management system is a generic application.” (Page 357, Wil van der Aalst, Kees Max van Hee, Workflow Management: Models, Methods, and Systems, MIT Press, 2004.)

“A workflow system is one that supports the workflows in a specific business situation. Unlike a workflow management system, a workflow system usually consists of a workflow management system plus process and resource classification definitions, applications, a database system, and so on. We can compare the difference between a workflow management system and workflow system to that between a database management system and a database system.” (Page 357, Wil van der Aalst, Kees Max van Hee, Workflow Management: Models, Methods, and Systems, MIT Press, 2004.)

When you fill an EHR workflow management system with specialty-specific content (such as specialty-specific picklists of symptoms, physical findings, assessments, treatments and so on), add specialty-specific screens for (using pediatrics for example) immunization management, growth tracking, developmental checklists, rely on pediatric-specific functionality such as pediatric dosing and data norms, *and* create the necessary pediatric-specific workflow definitions (also known as process definitions), the result is a pediatric EMR workflow system. Different specialty-specific picklists, screens, other functionality, and workflow results in a different specialty-specific EMR workflow system.

So far I think I’ve done a good job of posting about the general (that is, universal) characteristics of EHR workflow management systems (for example, “What’s So Special about EHR Workflow Management Systems?” and “Litmus Test for Detecting Frozen EHR Workflow”) while touching on EHR business process management as well. However, while EMR customizers (“customizers”, not “customers”) interact directly with an EHR workflow management system (three words!), physicians, physician assistants, nurses, technicians, and administrative staff typically do not. They interact directly with the EMR workflow system (two words!) that pops out when you turn the crank on the EHR workflow management system.

That’s the difference between an EMR (or EHR) workflow system and an EHR (or EMR) workflow management system.

Glossary of EMR / EHR Workflow Terminology

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