By Eric Andrew Kristof, RN, CAHIMS | Healthcare IT Professional | HIMSS Arkansas Chapter Member
About This Series: The HIMSS Word of the Day is a running blog series drawing from the HIMSS Dictionary of Health Information and Technology Terms, Acronyms, and Organizations, 6th Edition (2025) — the authoritative reference for healthcare IT professionals and the primary study resource for CAHIMS and CPHIMS certification. Each post paraphrases the term in plain language, grounds it in real-world healthcare IT context, and adds a bedside nursing perspective you won’t find in a textbook.
📖 The Term: Workflow
Source: HIMSS Dictionary of Health Information and Technology Terms, Acronyms, and Organizations, 6th Edition (2025)
🔍 Plain-Language Definition
A workflow is the series of steps people take to get a piece of work done, including who does each step, in what order, with what tools, and what information passes between them.
The HIMSS Dictionary describes a workflow as a sequence of tasks, events, and interactions that make up a work process, involve at least two people, and create or add value for the organization. It distinguishes two patterns. In a sequential workflow, each step depends on the step before it. A parallel workflow lets several steps proceed at once.
Healthcare is full of both. Medication administration is largely sequential: an order is written, verified, dispensed, and given. Admission is often parallel: registration, nursing assessment, medication history, and provider evaluation can happen at the same time.
| Workflow Concept | What It Means | Healthcare Example |
|---|---|---|
| Current State | How the work is actually done today | A nurse documents vitals on paper and enters them later |
| Future State | How the work will be done after a change | Vitals flow from the monitor to the flowsheet after nurse validation |
| Handoff | A point where work or information passes between people or systems | Pharmacy verifies an order and releases it to the eMAR |
| Decision Point | A step where the path depends on a condition | If the blood pressure is low, hold the medication and notify the provider |
| Bottleneck | A step that slows the whole process | Waiting for a transport team before a discharge |
| Workaround | An informal path around a barrier in the designed process | Scanning a copy of a patient’s barcode taped to a cart instead of the wristband |
⚠️ Exam Alert: A workflow is the sequence of work across people and tools. A process map or swimlane diagram is a picture of that workflow. A use case describes how a user interacts with a system to reach a goal. A workaround is an unplanned deviation that usually signals a design or resource problem. Questions often ask what to do before configuring a system; the answer is usually to analyze the current workflow and design the future state.
🌐 Why It Matters: Real-World Healthcare IT Context
Health IT changes work. When an EHR, a medication system, or a new device is introduced, it rearranges who does what, when, and with what information. If the new design does not match clinical reality, people find ways around it, and those workarounds can undo the safety benefits the technology was meant to provide.
A well-known example comes from barcode medication administration. A 2008 study in JAMIA by Ross Koppel and colleagues identified 15 types of workarounds at five hospitals, such as patient identification barcodes attached to carts, doorjambs, or nurses’ belt rings instead of to patients. The authors traced them to 31 types of causes, including unreadable barcodes, damaged wristbands, malfunctioning scanners, failing batteries, and unreliable wireless connections, and concluded that shortcomings in design, implementation, and workflow integration encouraged the workarounds.
Human factors engineering offers a framework for avoiding that trap. The SEIPS model (Systems Engineering Initiative for Patient Safety), described by Pascale Carayon and colleagues in 2006, views care as a work system made up of people, tasks, tools and technology, the organization, and the environment. Those elements shape care processes, which in turn shape outcomes for patients, staff, and organizations. A later version, SEIPS 2.0, added attention to the work patients and families do and to how systems adapt over time.
Workflow analysis is a core informatics skill. It usually combines direct observation, interviews, process mapping, and data from the EHR itself, such as timestamps and audit logs, to see how work really happens.
Common workflow design mistakes:
- Designing from policy documents instead of observing real work
- Copying the old paper process into the new system without rethinking it
- Ignoring night shifts, weekends, and low-staffing situations
- Adding documentation steps without removing any
- Leaving out roles such as unit clerks, transporters, or pharmacy technicians
- Treating workarounds as noncompliance instead of feedback
Practices that produce better workflows:
- Observing work in the actual setting before designing
- Mapping current and future states with frontline staff
- Testing future-state workflows in realistic simulations
- Checking every step for who, what, when, where, and with which tool
- Measuring after Go-Live and adjusting quickly
- Building feedback channels so staff can report friction
🏥 The Nurse’s Perspective: Clinical, Bedside, & Workflow
Nurses carry workflow knowledge that rarely appears in policy manuals, which makes them essential partners in health IT design.
At the Bedside
A nursing shift is a set of overlapping workflows: medication passes, assessments, admissions, discharges, procedures, family communication, and constant interruptions. A system that requires the nurse to return to a desktop to document something that happens at the bedside adds steps and delay, and it invites documentation from memory hours later.
Nurses also adapt in real time. When a scanner fails, a supply is missing, or a patient’s condition changes, nurses reorder their work to keep patients safe. Those adaptations show where the designed workflow is fragile.
In Clinical Workflow
Workarounds deserve curiosity before judgment. A nurse who documents on paper and enters data later may be dealing with too few workstations. A nurse who overrides a scanning step may be responding to a wristband that will not scan. Informatics teams that ask why a workaround exists usually find a fixable problem with equipment, design, or staffing.
Nurse informaticists often lead workflow analysis because they understand both the clinical reality and the system’s capabilities. Their role is to translate what clinicians need into build decisions and to explain to clinicians why certain steps exist.
In EHR Implementation (Go-Live Perspective)
During an Epic implementation, workflow walkthroughs and integrated testing compare the future-state design with real scenarios before Go-Live. Even with careful preparation, Go-Live reveals gaps: a step that takes longer than expected, a report nurses need but cannot find, or a handoff between departments that no one owned.
At-the-elbow support analysts see those gaps first. Capturing them as specific, reproducible issues, such as which role, which screen, and which step, helps optimization teams fix the workflow instead of simply retraining users on a design that does not fit.
🎓 CAHIMS / CPHIMS & HIMSS Perspective
CAHIMS Exam Domain Mapping
Workflow is one of the most frequently tested concepts across the CAHIMS domains:
| CAHIMS Domain | How Workflow Appears |
|---|---|
| Healthcare & Technology Environments | Roles across the care team; how technology changes clinical and business work |
| Clinical Informatics | Workflow analysis, process redesign, workarounds, human factors, usability |
| Healthcare Information & Systems Management | Requirements gathering, system configuration, testing, optimization |
| Management & Leadership | Change management, stakeholder engagement, process improvement, measuring adoption |
Key Terms to Know Alongside Workflow
- Workflow Analysis — the study of how work is performed in order to understand and improve it
- Process Map — a diagram showing the steps, decisions, and handoffs in a process
- Swimlane Diagram — a process map that separates steps by the role or system responsible for them
- Workaround — an informal method used to get around a barrier in a designed process
- Human Factors Engineering — the discipline of designing systems that fit human capabilities and limitations
- Future State — the planned design of a workflow after a change is implemented
HIMSS Organizational Position
HIMSS emphasizes workflow as central to usability and clinician experience. Its Nursing Informatics Community and its work on reducing documentation burden both focus on designing technology around real clinical work. Members can find related education and research through the HIMSS Resource Center.
🔗 Explore Further: External References
- Carayon et al. (2006), Quality and Safety in Health Care — Work System Design for Patient Safety: The SEIPS Model https://pubmed.ncbi.nlm.nih.gov/17142610/
- Holden et al. (2013), Ergonomics — SEIPS 2.0 https://pubmed.ncbi.nlm.nih.gov/24088063/
- Koppel et al. (2008), JAMIA — Workarounds to Barcode Medication Administration Systems https://pubmed.ncbi.nlm.nih.gov/18436903/
- AHRQ PSNet — Human Factors Engineering https://psnet.ahrq.gov/primer/human-factors-engineering
- ONC — SAFER Guides https://healthit.gov/clinical-quality-and-safety/safer-guides/
- HIMSS — Nursing Informatics Community https://www.himss.org/networking/communities/nursing-informatics/
Term source: HIMSS Dictionary of Health Information and Technology Terms, Acronyms, and Organizations, 6th Edition (2025). All definitions in this series are paraphrased for editorial purposes. Readers are encouraged to consult the primary source for exact language.
Eric Andrew Kristof, RN, CAHIMS is a Healthcare IT professional and HIMSS Arkansas Chapter member based in Hot Springs Village, AR, with hands-on Epic Go-Live experience and a diverse healthcare and IT background. He writes at kristof.org at the intersection of clinical care and healthcare technology.
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