Workflow Complexity: Complicated data and simple workflow is complicated. Simple data and complicated workflow is complicated. Healthcare's complicated data and complicated workflow is hypercomplicated.
No Cost Competition: In other industries, companies are forced to adopt technology to optimize workflow to minimize cost while maximizing flexibility.
Regulatory Environment: EHR and HIT vendors are stretched thin addressing Meaningful Use requirements.
Screens vs. Workflow: It’s easier to appreciate EHR screens (layout of data and controls over space) than workflow functionality (sequences of events over time).
Threat to Revenue Streams: Switching to new platforms is risky and threatens current revenue streams.
Billing Over Clinical Emphasis: As long as the right codes are generated to maximize revenue, nothing else matters.
Skeuomorphism: Misguided attempts to model EHR user interfaces on paper medical record forms.
Workflow Stereotypes: Workflow management systems and business process management once emphasized automating human users out of processes. Not true now!
Not Invented Here-ism: Most academic and commercial BPM activity occurs outside the US.
Paradigm Shifts: You stick with a paradigm unless you’re forced to change. Health IT picked a document-based, instead of workflow-based, paradigm.
Just in time for the Medical Group Management Association Annual Conference in Las Vegas, here is one of my increasingly infamous 10 question in-the-weeds interviews! This time about a remarkable multi-specialty EHR workflow system. It used to be named EncounterPRO, under which name it won the first three ambulatory EHR HIMSS Davies Awards. This EHR workflow system is now called XciteEHR and my interview is with Barry Hayut, of Xcite Health. By the way, Xcite is hosting a free webinar, featuring me! I'll talk about the difference between traditional EHRs and EHR workflow systems on November 5th at 12 Noon EST. Since I'm co-presenting with a pediatrician, the workflows will be pediatric. However, since a workflow system can execute different workflows (which is sort of the point!) my portion of the webinar is relevant to any specialist who wants their own specialty workflows reflected in workflows of an EHR. (Current XciteEHR workflow definitions cover Pediatrics, Family Medicine, Internal Medicine and Obstetrics/Gynecology.)
As a side note, this is a special interview for me because I was involved with the early design and implementation of this particular EHR workflow system. I expect many MGMA attendees may remember EncounterPRO (originally developed by JMJ Technologies) and will find this interview of special interest. Creating and customizing EHR workflows for our customers, when I was EncounterPRO CMIO, really drove home the importance of true workflow technology at the point of care. Some of the older posts on this blog, EHR Workflow Management Systems, are still about EncounterPRO. (If some of the following links don't work, I probably haven't published them yet! By the end of MGMA14 they should all be live! Keep clicking!)
Starting Sunday, I'll publish a series of blog posts about EHR workflow from my interview with Barry, and tweet his answers to my questions. On the MGMA conference #MGMA14 hashtag, so stay tuned! The very best way to make sure you don't miss any of this interview is to follow @XciteHealth and me (@wareFLO) on Twitter.
I was the CEO of a company that owned and managed multiple radiology outpatient centers. We experienced first-hand the needs of the physicians, office staff and patients for software that enhances productivity.
When we saw the EncounterPRO EHR’s superior workflow engine, Office View, and configurability, we decided to adapt it and integrate it with our Practice Management system and patient portal for seamless integration, productivity and ease of use.
Yes, Xcite Health also has an integrated cloud-based Practice Management System with the EHR. It has scheduling, registration, billing, revenue cycle management, provider credentialing and vaccine inventory management. All of the billing codes such as CPT codes, ICD-9 codes, and in the near future, ICD-10 codes, flow seamlessly into the practice management system from the EHR so, as the physician finishes charting the patient encounter, the billing information is finished and sent to the payers, as well.
XciteEHR is indeed Meaningful Use Stage 2 certified.
Meaningful Use 2 is a set of very ambitious standards implemented by the Office of the National Coordinator for Health Information Technology, designed to create robust digital clinical records, track Meaningful Use metrics and Clinical Quality Measures, increase interoperability among various vendors, create uniform standards for reporting data to health agencies, and create standards for the secure communication of electronic health data to patients. Certification of an EHR is tied to incentive payments from the government to physicians with Medicare and Medicaid patients and eventually is expected to be the standard imposed by health insurance companies for all physicians.
Let me first explain what we mean by workflow. As the leader in this area it is important that I explain how this ‘changes things forever’—for many physician practices! If you feel that, as a physician, you are constantly giving instructions to your staff—and always following up to ensure things have been done—then XciteEHR is for you. If you feel that you are being asked to change the way you practice medicine to adapt to the strictures of your EHR software, then XciteEHR is for you. Or, if you feel that you should not take a productivity hit when you implement an EHR and feel instead that your productivity should improve and finish charting as the exam is done, then the XciteEHR is for you This is what truly sets us apart.
Process Orchestration Engine (AKA workflow engine) to drive the progression of work in structured and unstructured processes or cases
Model-Driven Composition environment for designing processes and their supporting activities and process artifacts
Content Interaction Management supporting e progression of work, especially cases, based on changes in the content itself (documents, images and audio)
Human Interaction Management enables people to naturally interact with processes they're involved in
Connected Processes and Resources they control, such as people, systems, data, event streams, goals and key performance indicators (KPIs)
Continuous Analytics monitor activity progress, and analyze activities and changes in and around processes
On-Demand Analytics to provide decision support using predictive analytics and optimization
Business Rule Management systems guide and implement process agility and ensure compliance
Management and Administration monitor and adjust technical aspects of BPM platform
Process Component Registry/Repository for process component leverage and reuse
Cloud-Based Deployment of about features and functions across desktop platforms and mobile devices
Social Media Compatible external and/or similar internal activity streams integrated with workflows
*Adapted from Gartner