Work on the Operating Room of the Future at the University of Maryland Medical System in partnership with technical experts from PatientKeeper and the University of Tilburg, using approaches described above is the first known prototype implementation of a standards based workflow engine in an operating room suite to monitor, manage, and improve throughput, while enhancing patient safety and patient care.

Extensive implementation of heavyweight, proprietary systems in health care has created islands of automation that create excessive expense, high cost of technology change, crippled functionality due to lack of integration of disparate systems, extremely high rates of medical error, and low quality of patient care and patient satisfaction. It is possible to use low-cost, open source, standards-based approaches in the implementation of operating facilities information systems infrastructure. High levels of integration using a Web services bus and proven components can enhance functionality, reliability, performance, and patient safety.

The advent of new technologies including RFID, mobile/wireless technologies, automated business process management (internet workflow systems and intelligent agents), SOAs, and business process management (BPM) opens up new ways of automating business processes, overcoming barriers to technology adoption, and resolving problematic issues like patient, staff, and equipment location [25]. Total situational awareness of events, timing, and location of critical health care activities makes possible real time process improvement by (1) anticipating future behaviors of complex systems, (2) displaying the probable futures of complex operations to all affected personnel, (3) generating self-organizing change in behaviors of humans and machines, (4) erasing a possible negative future outcome, and (5) replacing it with a modified future outcome that meets organizational goals.

The RECIPE approach makes it possible to unobtrusively introduce real time process improvement into an operational health care environment through:

• RFID tracking of patients, staff, supplies, instruments, equipment—accumulating baseline data

• Analysis of patient flow bottlenecks and development of process improvements targets

• Manual testing of process improvements

• Integration of a standards-based workflow management system into the enterprise information technology infrastructure

• Small incremental process improvements introduced through the workflow engine with rapid fine-tuning

• Make disruption visible proactively

• Orchestrate human and machine behavior to anticipate and resolve problems

• Dynamic application generation: real-time support for workflow engine to obtain information needed at any step of process

The potential gains from this approach are enormous in terms of improved efficiency and patient safety. Simply understanding the process of workflow enhancement of clinical processes generated a 100% improvement in supply and instrument readiness in a large operating room suite. Full implementation of an automated workflow facility with integration into production clinical systems could induce a radical reinvention of clinical process integration, resulting in improved patient outcomes, an enhanced staff working environment, significant cost reduction, and enhancement of institutional revenue.

Even more important, effective implementation of the RECIPE approach would automate feedback mechanisms for routine, systematic, ongoing enhancement of clinical processes. Implementation of intelligent automated systems in other domains with computerized feedback loops have led to emergent architectures with higher adaptability, capability, extensibility, and maintainability than could be initially conceived by the original designers of such systems [9, 11]. By doing so, RECIPE open ups ways to move away from medical production systems, and facilitate ad hoc, autonomic workflows that are capable of adjusting themselves to new situations, monitor and recover from disruptions, and deal with attacks from anywhere.

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