Workflow Management Systems in Healthcare: Complex Interventions

Guest post by Jeff Robbins is president and CEO of LiveData, Inc.

Jeffrey Robbins
Jeffrey Robbins

It is no secret that many of today’s best hospitals are still enmeshed in implementing and fine-tuning new, enterprise-wide electronic health record (EHR) systems. With purchase prices in the tens or even hundreds of millions of dollars, the EHR is a focal point of bringing technology to bear on the various challenges of delivering consistent, high quality care to an increasing number of patients.

Yet many hospital administrators and caregivers are finding that the level of effort (and expenditure) isn’t moving the needle as much as was expected. It turns out that this isn’t because of any specific failing on the part of the EHR vendors. Rather, it is because of a missing layer in today’s EHR technology stack.

This missing layer, workflow management systems, is software designed to coordinate specific action, create consistency, and deliver visibility by automatically connecting caregivers with relevant tasks and information. The EHR, by necessity, is focused on creating a heads-down log of all encounters. Workflow technology adds the missing heads-up displays, alerts and analytics that help drive use of the EHR during patient encounters.

One of the more complex interventions in healthcare is surgery. The choreography involving patients, caregivers, equipment, supplies and operating rooms at a busy hospital is demanding, and the added manual data-entry burden of new EHR implementations paradoxically adds to the risk of variability.

Perioperative workflow

Workflow technology can mean many things. At the planning level, one common device is using whiteboards and Post-It notes to create a basic map of tasks. This data gathering approach is an excellent team activity, and allows many stakeholders to collaborate and share knowledge about interdependencies.

The challenge posed by the complexity can be summarized as, “Where do we go from here?!” It is tempting to picture using a computer-based workflow diagramming tool to capture and enact this diagram. While the “state diagram” is a useful technology tool, the complexity of even this small detail should help highlight why the myriad states, conditions, and rules that could be brought to bear to deliver workflow technology benefits to complex interventions is, in a word, complex.

Where do we go from here?

Workflow technology, delivered via a workflow management system, is intended to implement the workflow processes built on the activities and preferences of stakeholders. By making aspects of these human processes “executable,” via executable process models, healthcare workflow technology can provide a form of power-assist to caregivers.

But, as we have seen, creating a computerized process model of a complex process will, of necessity, have to mirror some of that complexity, or risk oversimplification and the potential for harm to patients. This model is executed or consulted, in conjunction with caregivers, when they deliver care. These executable process models are at the heart of what distinguishes healthcare workflow technology from today’s EHR. Healthcare workflow technology drives workflow to achieve the consistency and quality required by our society’s burgeoning healthcare spend.

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