Healthcare Business Process Management, Adaptive Case Management & Process-Aware EHR & Health IT Systems

Health IT

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.

*Top Ten Reasons EHR-BPM Tech Is Not (Yet) Widely Deployed in Healthcare

Blog Posts

Healthcare BPM

Barry, Can An EHR Workflow System Make Physicians "Happy"?

Unfortunately the term workflow has been too commoditized. It seems that if you can string together a serious of computerized actions you can call it workflow.

In many of the other systems, the physicians are choosing from menus, templates and options to figure out next steps. Each practice role player is on his/her own with their tasks, as if everybody is on their own island.

Since getting involved in this field way back in the late 90’s, I have looked at every EHR out there. What is now the XciteEHR, looks and works completely differently from every other type of EHR on the market.

In the XciteEHR once configured by the physician the way she/he likes to practice medicine, the workflow engine will present the right task screens, based on the action taken by the physician, to all relevant practice role players simultaneously and can be viewed and tracked on the Office View screen.(p> The XciteEHR is built on a strong history and experience of having been in the market for over 20 years—but its features currently surpass every other EHR on the market today—exponentially surpassing all others in one area. Happiness.

I believe that true EHR workflow, customizable to specialty and user needs and preferences, is the single most important key to dramatically increasing physician happiness (yes, happiness) to use an EHR.

[CW: Excellent, Barry! Thank you for working to improve healthcare workflow with information technology! In fact, I even have a special badge I give to the folks in the white hats, the cavalry, as it were, rushing to the aid of physicians ensnared in workflow-oblivious IT systems! See below...]





  1. A Multi-Specialty EHR Workflow System: 10 Questions For Barry Hayut, Xcite Health
  2. How did you end up in the primary care specialties EHR workflow system business?
  3. Could you discuss Meaningful Use 2 and why it’s important to be MU2 certified?
  4. Do you also sell a Practice Management system?
  5. What's the difference between EHR workflow systems and mere EHR systems?
  6. Would you share your workflow, writer, editor, publicist analogy?
  7. What does a true EHR workflow system *do* for physicians?
  8. Would you show us the XciteEHR Office View and explain its functions?
  9. What physician specialty practice areas does the XciteEHR cover?
  10. How will you educate the world about true EHR workflow systems?
  11. Thoughts, Barry? About EHRs, workflow, and physician happiness?

YouTube Of My "BPM & Case Management: US Healthcare Needs You!" At The BPM & CM Summit

[The final presentation has been given, uploaded to YouTube, and posted elsewhere one this site, one slide-per-blog post, plus transcribed speaker notes.]

This Monday I’m Speaking On BPM, Case Management and US Healthcare at BPM & Case Management Global Summit. I always like to rehearse presentations. So I rehearsed in front of the US Capitol wearing Google Glass to record it! It's a lot less formal than the final presentation, but also a lot more fun. Tourists wander by, wondering what I'm up to. Several times the wind almost takes off with my slides. Toddlers practically run between my legs! :)


Anyway, if you can't make it to the BPM and Case Management Summit, but are interested in workflow technology in healthcare, I hope you'll watch me (err, rather, the slides in my hands plus clouds scudding by the Capitol dome).

I've also turned all my slides into blog posts here on my Healthcare Business Process Management blog. I'll add extensive speaker notes after the official presentation. This is so I can "random access" specific slides and related material in the future. I'll link to them from other blog posts and comments. And, OF COURSE!, I be tweeting them all over the place.

Cheers --Chuck

Open Source Business Process Management Software For Healthcare?

I've been meaning to write about open source business process management software that could be used in healthcare. Been meaning to, meaning to... and then I got the following question through my contact page:

(published with permission)

Subject: Open source "Executable Process Model"?

Message: Hi Chuck,

I'm a clinical informatics engineer at the University of Washington's Clinical Informatics Research Group ( We've been developing an open-source computerized patient reported outcomes system ( for nearly decade. Our workflows can be complex (the system is used for both research, and clinical care), and we've considered using workflow engines in the past but have never found open-source systems that were 1) transparent enough 2) generalizable and 3) had the features we wanted. I really like your notion of an "Executable Process Model". I'm wondering, can you point me in the way of an open-source implementation, or other resource that might be helpful?

Many thanks,
Justin McReynolds
University of Washington


‎Hi Justin,

Fascinating work. Process-aware tech seems highly relevant!

I do have some suggestions.

As I'm trying to create interest in workflow tech in the health IT community using social media‎, may I quote you in a blog post? With any subsequent conversation via Twitter? (I'm @wareFLO).



Thanks for replying so quickly Chuck! Yes, fine to quote me in a blog post and twitter (I've been following your tweets for a couple years J); I'm @justinmcr.



Thank you for your question, the way you asked it, and your important work.

I especially like your three dimensions of comparison.

  • transparency (ease-of-use, usability, intuitability, etc. correct?)
  • generalizability (reduced custom software development effort, am I right?)
  • features (list of options and functionality available to the user)

As you well know, these dimensions can exist in tension with each other, such as when too many features can reduce transparency.

My short answer is that I don't know whether the right software exists and which one is the best for your purposes.

However, I follow (and, I am honored to say, am sometimes followed back by) some of the top experts on the planet when it comes to workflow management systems, business process management suites, dynamic and adaptive case management systems. That is why I asked if I might publish your question, with an eye toward generating conversation in the Twitter- and blogosphere.

I used to routinely search for, download, install, and explore free open source workflow management system. Eventually there were more systems, and each system had more functionality, than I could systematically track. "Back in the day" I checked out YAWL, Bonitasoft, and several others. Since then new systems emerged and the older systems have added new and interesting modules and interfaces, both machine and user. Some commercial BPM systems have added community versions, evaluation versions, educational versions, etc.

Anyway, off the top of my head (with the aid of Google)...








Did I miss anyone's favorite free and open source BPM product?



Have you tried any of these products? Which ones? What worked? What didn't?

Let me know if you think I ought to add software to this list.

P.S. I'd like to put in a plug for my 2010 MedInfo paper Process-aware EHR BPM Systems: Two Prototypes and a Conceptual Framework with its Patient Class Event Hierarchy and Seven Advantages of Process-Aware EMR / EHR BPM Over Process-Unaware Alternatives.

P.S.S. Note: I'm seeing more and more software in healthcare that's not called healthcare BPM software, but which has, under the hood, process-aware technology. While not officially referred to as workflow platforms (though sometimes they are), they represent healthcare workflows using some sort of representation that is both understandable by human users and are mechanically interpretable by computation and communication engines.

New Book: IT-based Process Management in Health: Methods and Tools for Students and Practitioners

Translated from the back cover of the German edition:

Increasing cost pressure and the pressure to improve the efficiency of health care workers have become reality. Many facilities have to streamline their workflow, while improving the quality of their services. The book explains basic principles and selected methods of process management, which can be used in healthcare facilities (hospitals, health insurance companies and health insurance). The technical focus is on the cross-departmental documentation, analysis and optimization of processes in the health sector with the aim to increase transparency and to increase the effectiveness and efficiency. Using case studies, the use of modern information and communication technology is presented as a tool for process improvement. Numerous review questions and exercises make the work a learning and work book, not only for students but also for experienced practitioners in health care.

  • Basics
  • Business Process Management in Health Care
  • Documentary, modeling and analysis of business processes in healthcare
  • software use in the healthcare
  • Special Topics
    • IT Governance
    • IT Strategy
    • Simulation
    • Big Data
    • Cloud Computing

Target Group:

Students in bachelor's and master's degree programs in the health sector and business Administration with specialization in health industry practitioners in health care (doctors, nurses, administrative staff, management).

Author Prof. Dr. Andreas Gadatsch is a professor of business administration, computer science industry in particular, at the Bonn-Rhein-Sieg in Sankt Augustin. He has extensive experience as a consultant, project manager and IT manager.


It sure would be nice if some German-speaking reader were to buy this, what appears to be excellent, topical book about BPM in healthcare, and give use a review in English! Even better, I hope we see an English translation of IT-gestütztes Prozessmanagement im Gesundheitswesen: Methoden und Werkzeuge für Studierende und Praktiker some time in the near future!

Open Source vs Proprietary EHRs vs Open, Transparent and Systematically Improvable EHR Workflow

Inability of current health IT tech to reduce healthcare cost is due more to lack of open, transparent, and systematically improvable workflow, than proprietary software. Ironically, a proprietary workflow management system has more open and transparent workflow than a traditional open source EHR.

For example, here I describe use of a proprietary BPM system to improve hospital care and reduce cost.

EHR and HIT Workflow and Usability at #HIMSS13

Ideally, I'd love for everyone to have their cake and eat it too: open source EHR workflows implemented on open source BPM systems (which do exist). So, in the long-run, BPM vs open source is a false choice. Anyway, EHRs need to be more like BPM systems, such as I describe at the following link (it's not a health IT conference, but health IT needs to import some good ideas and tech from other industries)

AppianWorld 2012 Trip Report, Just In Time For AppianWorld 2013 (Plus Ten Questions)

Another way to think about open source workflow running on proprietary healthcare business process management systems is in terms of open vs closed (proprietary) operating systems vs applications. Open source application software (such as PHP) can run on proprietary operating systems software (such as Windows). Alternatively, closed source application software (such as Oracle) can run on open source operating systems software (such as Linux). The same can be true at the application software level. Open source process definitions can run on either proprietary BPM systems (such as Appian) or open source BPM systems (such as BonitaSoft). 

To make EHR and health IT workflows more open, transparent and systematically improvable, we must move from structured document-based management systems to better structured-workflow management systems...

...regardless of whether these health information management systems rely open or proprietary application and operating systems software. 

My Next Speaking Engagement!


BPM Solutions

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

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