Process-based systems -mostly using emergent technologies like workflow engines, XML standards and so on, are becoming part of organisational life. Yet in automating, or shaping organisational processes, they are making subtle but profound changes in culture, knowledge creation, and knowledge management. This paper will contend that the process of acquiring and managing data is itself a knowledge building process. It will also assert that the process of creating a patient's health record is a dynamic one, which adds to the sum knowledge of the organisation, not just in terms of the accretion of data, but in the understanding and opportunities for reflection which it creates. Finally, the paper will argue that such dynamic knowledge can be used, not only to deliver better healthcare, but to improve the organisational structure and behaviour in order to improve the means by which healthcare is delivered.