As you can see, these questions are proactive and transcend both clinical and non-clinical activities. For example, in order to discharge a patient at a targeted time, say 11 a.m., we need to make sure the usual ancillary tests are completed and related results are available to the physician doing rounds. In addition, and more often overlooked, are many non-medical services that must be completed at an appropriate time, or the target time will be missed. Operational services such as transportation, patient education, referral requests and service approvals (rehab, hospice, nursing home, etc.), finance, social services, nutrition consults, and others cannot be ignored.

There are many other patient centric examples such as chronic disease management, enterprise access, case management, and sometimes just routine daily care where a patient needs to be seen by multiple ancillary and other care givers and workflow coordination is critical.

A single workflow failure causing a delay of service - such as a rescheduled surgery resulting from an antibiotic medication not administered because the patient was delayed in radiology - can result in unhappy physicians and patient dissatisfaction, both of which will negatively impact revenues.

Systems designed around workflow and patient processes use the data from an EMR and HIS as needed, and usually employ at least the following tools:

• Workflow documentation tools

• Workflow analysis and simplification tools

• Data extraction / integration tools

• Process re-engineering tools

• Intelligent forms

• Document imaging and storage

• Simulation / modeling optimization tools

• Work Portals

Commercial industry has applied these concepts and tools for decades. They are incorporated in management programs as Six Sigma and Lean. Healthcare has seriously lagged behind in this effort. Maybe it's because we have tried to adopt classic HIS tools when we should have been using more workflow systems tools.

ARRA has mandated that we must achieve ‘meaningful use’ of our systems. In summary, workflow systems focus on the future (what should be happening now and next), while the EMR tells us what happened yesterday. Which is more meaningful? Both will be needed if we are to cut our operating budgets by $200 billion.