Cross-Enterprise Workflow Management

1. Cross-Enterprise Workflow Management Brief Profile Proposal for 2009/10 presented to the IT Infrastructure Planning Committee Charles Parisot, GE Healthcare October 7th, 2009

2. The Problem • Care coordination among care providers, social workers and family support requires fuzzy workflows: • Parties and steps are not known when initiated, • Evolve over time, branch in unexpected directions, • Deeply influenced by patient choices • May never formally be concluded. • Many of the classical workflows managed so far by existing IHE profiles are two-party workflows (order/results, referral mgt) or fixed multi-party workflows. • Responds to various proposal/needs to IHE ITI, Laboratory, Pharmacy, Patient Care Coordination. Rejected as too narrow solution, stretching the current profiles beyond their primary intent (lab orders as documents, links between documents, certain use of folders, document versus message debates, etc.).

3. Use Case • A lab test request when the patient who may choose the laboratory where testing will be performed. • A patient has been prescribed some medication but the pharmacist feel would like to suggest to the prescribing physician an alternate medication, but not proceed without approval. • A patient is being prescribed a check-up, involving three different clinics, which in turn involve a couple specialists. The primary care physician, seeing the patient, adds a few more diagnostics tests given some of the partial check-up results. • A patient with multiple chronic conditions is treated by different care teams that need to be able to account not only for the current care progress, but also the planned care and contact some of the care providers. • Nighthawk radiology reading services offer their services to a community hospital. A radiology examination has been performed in this hospital and need to be urgently read by any of these reading services. Upon this read, the emergency physician would like like to engage a second opinion.

4. Proposed Systems Patient A Patient B Patient C A workflow Management Object RetrieveWorkflow Objects CreateWorkflow Objects RetrieveWorkflow Objects Workflow Client Query Workflow Objects Query Workflow Objects Workflow Client Notify UpdateWorkflow Object Workflow Client

5. Proposed Standards • This would be a new IHE profile: workflow management infrastructure. It would leave the profiling of the “workflow content” objects for a separate profile. • As this profile proposal proposes to address the workflow management infrastructure candidates may be ebRS V3.0, DICOM-UPS and some of the Grid WS. • Note: As workflow management objects should be managed, irrespective of the “content” of these workflow management objects (standards such as BPEL are not within scope).

6. Discussion • IHE has been successful to approach interoperability problems with a clear separation of concerns between clinical content and infrastructures to share content. By developing this profile, ITI should has a unique opportunity to establishing a a patient centric (rather than organization centric) workflow mgt infrastructure for a variety of workflows, especially those loosely defined fuzzy workflows among a flexible number of parties where the specific content of the workflow could be specified independently. • The level of effort is medium • Profile editor: Charles Parisot, GE Healthcare