Amazon Simple Work Flow ( http://aws.amazon.com/swf/ ) is a programmable workflow engine. Workflows can create child work flows, etc. So, one could create a workflow that involves ordering a blood test, checking that it has been done, checking for normality, deciding whether to send a copy to the patient, or some other action, and perhaps triggering some checklist for patients who are diabetic if the test is a blood sugar. Actions can be performed by agents, or people, and from any device that has an internet connection. Would be a lot of work but would be interesting in tying everything together.