Workflow

Workflow automation is poised for an evolutionary leap as technology,
standards, vendors and hospital buyers come together to address needs
on a broader scale. Workflow automation has been evolving steadily for
many years in hospitals; clinical systems generate worklists for
caregivers and physicians, diagnostic systems track exams to hasten
report generation and improve efficiency. Now we have vendors who (with
varying degrees of awareness) are bringing workflow automation
solutions to market with unheard of breadth and scale.

Reader Tracey B. emailed with another great find, this time a story in Advance for Healthcare Information Executives on EHRs and enterprise-wide workflow automation.
Tracey proposes "[the] idea of a patient flow application being the
glue that holds various best-of-breed applications together and frees
hospitals from having to purchase large HIS systems (which often have
inferior functionality) in order to have the data flow they
require. Advance Healthcare talks about this on their site, and I
thought it was a really smart idea." I think so too. While this story
is focused on ambulatory settings with less complexity and narrower
scope than an acute care setting, there is much to recommend this
article. Thanks Tracey, for pointing it out. (Here's the vendor survey.)

In the absence of established (or even startup) hospital-wide workflow
automation management system vendors (WfMS), where are the early signs
for this "evolutionary change?" The Advance article
that Tracey mentions talks about electronic medical record (EMR) or
electronic health record (EHR) vendors for the ambulatory market
providing workflow automation in addition to documentation management.
There is a proverbial fly in the ointment:

EHR vendors differentiate their product by incorporating workflow management
capabilities directly into their EHR. However, there is a downside to this
trend: Most processes cross organizational, departmental and software
boundaries. For example, a patient’s visit to a doctor’s office may be supported
by a scheduling system, a lab system, an EHR system and a billing system. When
one process is managed by multiple systems, visibility and accountability for
overall process performance decrease and costs increase.

Surely the first tier health care IT vendors will offer monolithic
single vendor solutions. EMR/EHR vendors will continue to tout this
capability as a differentiator. Traditional ERP vendors may covet a
seemingly undeveloped new market and jump in. Nor would I rule out
someone like IBM to provide an open source WfMS to drive hardware and
services revenues. Another quarter with potential is the patient flow
automation market; here vendors address workflow across many clinical,
administrative and operations departments. There could also evolve a
new category of vendors targeting this application area specifically.
The only predictions I'm willing to make at this point are that there
will be the inevitable single vendor solutions and best of breed
solutions; and for the near term, many vendors will over promise WfMS
capabilities to sell their core products.

A basic WfMS application includes a rules engine, statistics and
analysis, data capture (for monitoring events, grabbing and assembling
data) and a messaging engine; this technology exists and is already in
use in different forms. To be successful, standards will have to evolve
to provide cost effective integration and communications between
disparate systems. But the big nut will be implementation. The effort
to document hospital wide workflow and configure a system will be,
ahem, considerable. Implementation costs could be several times the
cost of the application software. To hasten market adoption, costs must
be kept low and direct labor costs associated with implementation are
not very flexible.

A model for these changes might be the PACS market. With the adoption
and maturation of DICOM a new market segment evolved where workflow
engines became separate servers coordinating the flow of data between
order entry, archives, modalities, diagnostic workstations and report
generation.

UPDATE: Joseph makes some great observations in his comment below. The
concerns he raises will pose a significant challenge to vendors who try
to tie workflow too tightly to detailed patient care plans or clinical
pathways. Clinical systems should support patient safety approaches
like evidence based clinical practice. Workflow in an acute care
setting extends well beyond clinicians (which I think was Tracey's
point) and is more concerned with coordination, monitoring and alerting
workflow surrounding the patient than the patient's clinical condition.
This broader operational scope argues for an approach that comes from
outside deep clinical systems. In the end, Joseph's concerns represent
key challenges for EMR/EHR vendors; workflow automation challenges are
different.