chapter two

2 EHRs and clinical workflows

 

This chapter covers

  • Defining the EHR as an active workflow engine rather than a passive digital filing cabinet
  • Applying the "Actors, State, and Data" model to architect machine-readable clinical events
  • Analyzing how federal policies like HITECH and Meaningful Use established the technical baseline for modern EHRs
  • Implementing Finite State Machines (FSMs) to manage clinical workflow logic and ensure data integrity
  • Navigating the gap between "clinical truth" (the patient's story) and "transactional truth" (structured system data)

Beginners to health IT often picture an EHR as a digital filing cabinet where paper-based patient records are stored in electronic form. Imagine a database that also features a UI component through which clinicians and other health-care providers can input patient data. While this image captures one component it falls short in understanding the critical role and place the EHR has in healthcare today. EHRs are more than just passive repositories of health data but the active, digital architectures upon which clinical workflows are now built.

2.1 From Paper to EHR: Clinical Workflows

2.1.1 A clinical workflow at a glance

2.2 The EHR as a workflow engine

2.2.1 Stage 1: EHR Adoption and Electronic Data Capture

2.2.2 Stage 2: From electronic data capture to data movement

2.2.3 Clinical Workflows and Data Events

2.2.4 Developer’s-eye view of a clinical order

2.3 The shape of EHRs today: Incentives and takeaways

2.4 Summary