Making workflow engines work for you

'Use the right tool. Don't use a hammer to pound in a screw.'
By Mike Miliard
07:44 AM
Flow chart

While workflow engines are common in other industries, healthcare has so far made limited use of them. At RSNA 2014 on Tuesday, one Mayo Clinic radiologist made the case for these efficiency tools, and showed how a changing medical landscape may soon see them finding favor – in radiology departments and beyond.

[See also: PACS performance tied to workflow]

"In healthcare we're very risk averse; we don't want to have patients drop off our radar," said, Bradley J Erickson MD, associate chair for research in Mayo's radiology department. "Having very good error handling is critical to success."

And workflow tools, wisely deployed to manage patient information and exam results are critical to make that happen, said Erickson, whose presentation at RSNA sought to illustrate how workflow engines, despite being a "technology not widely used" in healthcare, offer many advantages compared to databases alone.

[See also: Imaging IT heads toward new phase]

Commonly put to work in process-oriented industries such as manufacturing, workflow engines should soon gain more of a foothold in radiology and other departments across healthcare as value-based care puts a premium on clinical efficiency and evidence-based medicine, he said.

In the meantime, too many departments rely on databases for managing their patient encounter information. There's a big difference: "Workflow engines use databases, but they add layers on top of those that do the rule processing and exception handling," said Erickson. "That's magic sauce of work engines, compared to doing databases for workflow."

A workflow engine, simply defined, is an application that manages process – it sets the parameters of rules governing decisions around that process, and routes data accordingly. The tool offers much more functionality than a database.

"There is a database sitting there, but it is not visible to the user," said Erickson. "The main point here is that workflow engines become more valuable when workflow is more complex. Databases are designed for storing and retrieving data, and they do a great job of that. But workflow engines are designed for workflow."

Still, too many healthcare professionals are using databases for workflow, he said. "Why aren't we using workflow engines for workflow? Use the right tool. Don't use a hammer to pound in a screw."

When it comes to radiology, for instance, "in the case of RIS or PACS-based workflow, you assume a simple, linear workflow," says Erickson. "You have an order come in, you schedule the exam, you complete the exam, you interpret the exam … and as long as your workflow is simple like that, that's great."

But sometimes changes in patient flow – or in the type of patient, or the type of test, and how it needs to be interpreted – require a tool that's more robust, has more agility, more visibility, more availability to clinical staff.

Workflow engines allow processes to be mapped graphically, Erickson pointed out, and their approachability allows non-programmers to design workflow, with "subtle details" incorporated that might not be there otherwise.

End-users can build in rules, for instance, related to the routing of medical images.

"Once the examination is acquired, a lot of exams require things to go out into the 3D lab," he said. "To make sure those images get transferred, rather than rely on the CT tech who's busy running the CT scanner, there should be a way to figure out that this is a CTA exam." A workflow engine could help set the parameters to ensure that transfer takes place.

Erickson said the basic benefits are four-fold: improved productivity, increased visibility, greater agility and more accountability.

"It allows automation on everything that can be automated," he said. "It allows managers to see, agree and document processes. "It allows businesses to change/update processes faster and more efficiently. It makes collection of timely data for these processes very easy to do."

Still, "if you look at the applications in medicine, they're relatively few," said Erickson. "It's widely used in manufacturing but minimally in healthcare."

"Humans are expensive, and we're all being crushed to cut our costs," he said. "Humans should be used for the tasks they do best: They're much better, generally, at interacting with humans than with computers."

A workflow engine, on the other hand, "should assist in measuring and improving efficiency," said Erickson. "It should help you minimize errors" and "keep the workflow in the pattern of how your practice works – on the rails – and assure proper handling when something outside of the parameters of performance occurs."