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.

So while the challenges of capturing the model are daunting, the benefits make selective use of this technology well worth it.

What goes into a workflow management system

To be effective, the workflow technology solution requires electronic interaction with multiple information systems. The pattern of interaction is “read-mostly,” that is, the workflow management system generally pulls data in. These systems include, of course, the EHR, but also other frontline systems such as Anesthesia Record Keepers, physiologic monitors, labs, PACS, RTLS, RFID and others.

The ideal system will grow with the hospital. For example, a hospital might automate the flow of patients from the preoperative area (PreOp) into the operating room (OR) via a coordinated system of touchscreen tablets. Later, the hospital might decide to invest in RTLS (real-time locating system), providing finer granularity information as to location of patients, equipment, and even staff. A well-designed workflow management system will support smooth integration of this new source of knowledge, enhancing its accuracy and utility.

While integrated information is important, integrated people sharing a common operating picture of the workflow process requires coordinating the interaction of multiple participants – helping everyone stay on the same page. This coordination requires advanced visualization and alerting technology. The workflow management system should provide kiosk displays that are purpose-built to the exact care context. For example, caregivers preparing patients for surgery need to focus on the hospital’s mandatory checklist for this stage of the process.

By automating the flow of patients, caregivers, staff, equipment and supplies, the ideal workflow management system keeps each patient’s journey on the correct path. This yields optimal care at efficient cost, improving access to the hospital’s expensive operating rooms. With proper integration, the EHR and the workflow solution stay in sync, automatically. Manual data entry is reduced, staff satisfaction increases, and the multi-million dollar investment in the EHR begins to pay off.

Jeff Robbins is president and CEO of LiveData, Inc. located in Cambridge, MA. Contact Jeff at


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