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The workflow is the unit of work
A workflow is more than a screen or task. It includes the trigger, the information required, the systems touched, the rules applied, the people responsible for exceptions, and the evidence retained afterward.
Healthcare work often crosses an electronic health record, a payer portal, a document queue, email, and internal operating tools. Automating only one screen may shorten a step while leaving the larger coordination burden intact.
A practical workflow model
Use this sequence to map the work before selecting technology.
- 01Receive a defined trigger
- 02Collect patient and operational context
- 03Retrieve payer or organizational requirements
- 04Identify missing information and exceptions
- 05Route judgment to an authorized person
- 06Execute approved actions
- 07Record the inputs, approvals, actions, and result
Illustrative model; actual workflows and obligations vary by organization.
Where automation can help
Collection
Retrieve information from approved systems and organize it for the next step.
Coordination
Move work between systems, queues, and people without losing its state.
Preparation
Assemble evidence or draft an action for review rather than making a protected judgment.
Follow-up
Track status, detect a stalled step, and escalate an exception to the right owner.
Questions to answer before building
- What starts and ends the workflow?
- Which systems and records are required?
- Where is human judgment required?
- What can fail, time out, or arrive incomplete?
- What evidence must be reconstructable later?
- Who can pause, approve, or reverse the work?
Design for exceptions
The normal path is rarely the whole operational reality. Missing records, changed portal interfaces, conflicting data, unavailable systems, rejected approvals, and ambiguous policy language should be part of the design from the beginning.
A reliable implementation treats exceptions as named states with owners and next actions. It does not hide them inside a generic error queue.
Sources
Authoritative references
Rules, standards, and guidance can change. The links below were reviewed on September 21, 2026.
- 1Centers for Medicare & Medicaid Services. CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F)
- 2Centers for Medicare & Medicaid Services. Interoperability and Patient Access Final Rule (CMS-9115-F)
- 3Assistant Secretary for Technology Policy / Office of the National Coordinator. Standards Hub
- 4HL7 International. FHIR specification