Workflow Engine

The workflow engine is the heart of the PSPAT. It understands the steps of the perioperative system design and beats as it executes perioperative processes step by step. It pumps information and moves it through various organ systems of the PSPAT. The organ systems provide services to the workflow engine that help it execute its tasks. The key service components of the workflow engine are (1) adapters to extract information from any human or machine source of essential data; (2) a virtual information repository to store the MER, along with process definitions and key information elements required for process execution; (3) a rules engine to do intelligence processing of essential information to answer questions posed by the workflow engine as to current state; (4) an alerting and messaging system to inform or request other parts of the health care system to perform tasks, request information, or advise on completion of critical tasks; (5) a reporting system to monitor timely task completion and provide summary data for outcomes analysis; (6) a logistics subsystem to manage inventory and ordering of supplies, instruments, and equipment; and (7) a Web-based telemedicine view of all data and process states for external human interaction and observation.

Workflow engines designed to streamline, automate, and re-engineer business processes are rarely deployed in health care. Here we assess the most prevalent initiatives in this domain. For this purpose, it is important to make a distinction between workflow management systems products of the 1990s, which were monolithic in nature, and current workflow engines designed to be embedded as a software tool in a service-oriented architecture [22]. The most advanced workflow engine prototype for health care designed specifically for Web-based integration with legacy systems was Big Workflow, developed at IDX Systems in the late 1990s in collaboration with computer scientists from IBM Watson Laboratories [28, 29, 32]. Several prototypes have been developed for clinical and administrative systems using the University of Georgia METEOR Workflow Management System [3]. Strategies for using workflow technology to capture legacy systems and repur-pose them for use with more current technologies are critical for health care and have been well documented [33]. Enterprise modeling for business process transformation in health care, serving as a basis for configuring medical workflow engines, has been examined in Singapore [13].

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