On Sun, 8 Dec 2002, Eric Browne wrote: ... > There is a huge leap in functionality in moving from a "passive" > recording system to an "active" workflow management system.
Eric, I don't understand what you mean by a "passive" recording system. All information systems describe information processing workflows. In this way, all "recording systems" are "active". As I mentioned in the "future-proof" presentation at OSHCA 2002 (http://www.txoutcome.org), there are pre-defined workflows that are hard-coded into the application. Then, there are user-definable workflows that can be subsequently re-defined. For monolithic systems (using Thomas Beale's language), changing a system's information schema (including workflows) is rather hard. However, a "future-proof" system provides the infrastructure tools to facilitate adaptation/change in data schema (GEHR archetypes / OIO forms) and workflows. All applications enact workflows - a workflow engine merely modularizes the workflow enactment functionalities so that alternative workflow specifications can add to or replace existing ones. I was not sure whether Thomas thought of this as part of his "future-proof" design. I know this aspect of "future-proof" is quite important since we have encountered several use-cases that require workflow re-design. Some of these use cases are contributed by users of the OIO system and available through the open-outcomes-general list archives. > Traditionally, WfMs deal with highly repeatable processes, utilising > pre-defined static process schemas. Traditional workflows can be quite complex - with many splits, alternative paths, conditional branching and checks. The process schema is pre-defined - but modifiable through run-time conditional steps, and over time as needs change. > They depend on a rich organisational model, incorporate sophisticated > notification mechanisms, and possess the ability to relate and alter > participant workload across cases. Sounds good - these attributes are also quite useful for health-related applications. > Their routing primitives are usually simple and their schemas are > applied to deterministic processes. I am sure the "deterministic process" bit cannot be a strict requirement. :-) Unexpected things can always happen. > The object of a case is normally only subject to one Wf schema ( > contrast with comorbidity in health ), in one organisational setting. I am not sure how this is relevant. Nothing in this world happens in isolation. I am sure it is not uncommon for multiple workflows or workflow steps acting in parallel to achieve a given target state. I fail to see how healthcare related workflows are any different. > Whilst it might be possible to store per-patient dynamically changing > Wf schemas in a health record, How did you arrive at the conclusion that health-related workflows require "per-patient dynamically changing workflow schemas"? Perhaps the enactment of pre-defined _fixed_ workflow schema for similar patients could also be useful? (e.g. an appendectomy workflow for those with acute appendicitis). > the ability to make use of such schemas via sophisticated Wf engines > is a problem orders of magnitude more difficult. But it is interesting > to see openEHR approach the challenge for a simple recall system. > > I have a web site devoted to Workflow in Healthcare. In particular > I refer you to :- > > http://workflow.healthbase.info/wf_in_healthcare.html Thanks for the very useful reference. You listed 5 healthcare "domain-specific" hurdles in your writing. While I don't agree that they are truly domain-specific, they do serve as a highly useful "features list" to guide our implementation plan! As we continue to implement OIO's workflows module, I will reference our progress with regards to your list. :-) > and > http://workflow.healthbase.info/monographs/index.html There are two papers here. The first one is about patients, environment, and workflow states. My own musing about states and workflows is that it is up to the workflows to specify the state descriptions that are required, at each step during enactment. Do you think that would work? Best regards, Andrew --- Andrew P. Ho, M.D. Assistant Clinical Professor, Department of Psychiatry Harbor-UCLA Medical Center University of California, Los Angeles OIO: Open Infrastructure for Outcomes www.TxOutcome.Org
