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

Can Healthcare Have Consistent and Flexible Info Systems?

Short Link: From my recent chapter published in How Knowledge Workers Get Things Done: Physicians complain about having to hew to what their EHR vendor thinks their workflows should be. It ought to be up to users (or at least someone who knows their workflows) to decide how consistent or flexible they’d like their software to be. Workflow technology (Business Process Management, BPM) opens up the possibility of physicians owning their own workflows. They can make everyone’s workflow the same. They can also allow different physicians to have different preferred workflow.


There’s a stereotype of workflow systems turning users into cogs, with humans doing what machines cannot, instead of machines doing what humans prefer not. That said, defining and executing workflows is one way to influence user behavior, to get folks to do their work the way that medical practice or that hospital intends it be done. Instead of making it impossible for users to depart from intended workflows, the best approach is to make it as easy as possible for users to do their work intended ways, ideally ways that have been vetted and discussed and agreed upon by relevant personnel.

Consistency and flexibility are in natural contradictory tension. At one extreme is a physician, working with lots of physician assistants and nurses and staff, who’d like to make sure everyone does it his or her way. In organizational management-speak, customizable workflows enable greater span-of-control than otherwise possible. At the other extreme, multiple physicians can work together and each have their own workflow. Tension between consistency and flexibility is reduced by using rules and process definitions that non-programming users can understand. They, not their vendor, find the best compromise.

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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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