IHE IT Infrastructure is defining an integration profile called Cross Enterprise Document Workflow (shortened to XDW). This is truly infrastructure. There is no clinical content, and the workflow management component is very thin on management. Really it provides tracking of the workflow state of various tasks, and provides for a mechanism to update state. Any associated clinical content that works with this profile would be developed by a clinical domain (e.g., radiology, cardiology, patient care coordination, labs, et cetera).
Each step in the workflow is described by a short set of metadata and the workflow also has a set of metadata. All of the steps (and their metadata) in the workflow are recorded in a single document.
We (PCC) spent a bit of time in IT Infrastructure today to outline some of the requirements for the step and workflow metadata, and how this could work with the existing XDS infrastructure without change. One of the key principles of this profile is that applications using it would manage workflows, rather than having them be enforced by a workflow management engine. It doesn't preclude the use of such an agent once we get into the specific clinical workflows, but it does provide a vastly simpler scope that makes the profile broadly useful.
My next step is to do a little investigation into existing standards for describing workflows and steps, to see if there are any good candidates to include in this profile for representation of the workflow.