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

Head of BPM Research at Perceptive SW on Healthcare BPM

Short Link: http://ehr.bz/profbpm Last week, during #HIMSS13, I tweeted out individual questions and answers from the following interview with Prof. Hajo Reijers, runner up for “BPM Personality of the Year” in the Netherlands. Here is the combined interview. I've included the original tweets so you can retweet answers to individual questions....

From Prof Hajo Reijers’ personal home page:

“I am a full professor in the AIS group of the Department of Mathematics and Computer Science of Eindhoven University of Technology (TU/e) as well as head of Business Process Management (BPM) Research at Perceptive Software…. My research and teaching focus on process-aware information systems, business process improvement, and process modeling. I am closely cooperating with companies from the services and healthcare domains”

If you read this blog, EHR Workflow Management Systems, or follow me on Twitter at @EHRworkflow, you know how delighted I feel to engage Professor Reijers (Hajo!) in this interview. The good professor is also on Twitter… twitter-profile2

Prof. Reijers, 1. Splitting your time between academia (TU/e) and industry (Perceptive Software) do you ever feel pulled in multiple directions? How are you integrating and synthesizing across roles and subjects? Unexpected advantages?

"Yes, the difference of pace in these domains is what it makes it a bit challenging sometimes. Industrial issues need to be solved yesterday, but an academic puzzle may easily span months. What I try to do is to find a balance between working on what is urgent and what is important. For example, we are looking into a new style of process modeling and need to know how usable it is. So, I am having a lightweight workshop next week with a handful of professional modelers within Perceptive Software, which gives me some tentative insights. Concurrently, I am setting up a much more rigorous experimental comparison that involves a hundred modelers, but will run in a couple of months .

Unexpected advantages? Well, I found out that in industry people seem to take you more seriously when you have an academic affiliation. But that advantage is almost completely negated by those academics who take me less seriously because I do practical stuff!"

2. You’ve authored, or co-authored, over 150 papers, reports, chapters, etc., plus two books. Roughly speaking, how many are directly about healthcare? How would you characterize the current state of the art, regarding relevance of process-aware, BPM-style technology to healthcare and its information management problems?

I would say that 10% of my work is related to healthcare and that this ratio is increasing. The healthcare domain is probably the most underdeveloped area with respect to the use of process-aware technologies. I simply cannot think of a domain that is more functionally oriented, which is an enormous obstacle for the uptake of BPM. I am mildly positive that this situation will improve, though. You can see the influence and positive experiences with clinical pathways, which bring a process focus to the work floor. For example, in China each hospital is required by law to implement IT systems that support healthcare professionals in adhering to clinical pathways. Also, given the enormous pressure on healthcare institutes to reduce costs, handle more patients, and improve safety, I think it is inevitable that process-aware technologies will become widely adopted. It's a pity that it takes so much time and that the current focus is purely on records.

3. When and how did you come to become Perceptive Software’s Head of BPM Research? From your unique perspective, one foot in research and one in industry, what are you most excited about in Perceptive Software’s product pipeline?

I started in this new role in September 2012. Perceptive Software offers a wide suite of products, which include tools to search through large amounts of data, tools to turn unstructured information into a manageable form, a wide set of process management tools, and content management tools (for which it is best known for). What thrills me are the opportunities that there are in combining the data that is collected and managed by what were once separate tools. Process management, for example, will become more effective through deeply understanding the data context of the activities that are being managed. Also, access to historic and contextual data will help to better predict the nature of new cases and how they can be managed best.

4. In an earlier role, I had the opportunity to work with process mining technology that is now part of Perceptive Software. I’ve blogged processing mining of healthcare event data. What is the key to productizing this amazing, and potentially very useful, technology in the healthcare space?

There are some things that have to be in place, of course. The technology must be powerful and accurate; it must also be easy to use and configurable by its target users. Once you have that, what is needed most are success stories. And I think they are coming in fast. One of the postdocs in our group, Ronny Mans, is carrying out a lot of these projects. We have recently used process mining to investigate dental implantology and are turning to eye surgery now. It's amazing what we find out and I think that these insights are hard to get by in any other way.

5. Going beyond process mining how about todays modern business process management suite. I’ve written about why BPM has been slow to defuse into healthcare. What is it going to take, to get the workflow out of hardcoded Java and C# code and into formats more easily created, understood, edited, and improved?

Well, perhaps a certain generation of healthcare professionals needs to die out first. My experience is that many of the younger doctors are more open-minded to the use of technology and are really interested in holistic approaches to improve the quality of care, including BPM. I have seen this during my long-lasting cooperation with a group of Dutch dermatologists, who are willing to try out any good idea. Come to think of it: They are all women as well, by the way--not sure whether this plays a role. And we need people like you, Chuck, who spread the word 24/7. Keep it up.

6. Europe has been, and is, ahead of the US in exploiting workflow management systems and business process management suites. Netherlands appears, to this observer on US side of the pond, to be the largest and most influential center of process-aware thinking and technology in Europe. What are the historical roots of how this came to be?

Here is my ten cents. In many European countries, there is a tradition of purely documenting how work is being done. Perhaps this is still a relic of all these bureaucratic empires we had here. I am not saying that mere adiministration is always that useful but capturing existing operations is at least the basis for thinking about processes and re-thinking them. In the US, there is much more emphasis on direct results. And I admit that it is hard to answer the question of what the ROI is of modeling a process or how it will contribute to quarterly results. Europeans seem more receptive to the idea that you may need to invest in something that pays off in the long run. At the same time, I am still flummoxed about a highly efficient people as the Americans not being interested more in BPM.

7. I understand that you recently came in second place in a contest to chose the “BPM Personality of the Year” in the Netherlands. You mention this during the open session of the recent BPM Round Table in Eindhoven, Netherlands. Have you gotten over this loss?

Ouch, thanks for reminding me. No, I will not get over that.

I grabbed the following shot of a slide shown during your introduction. conference That’s an interesting list of topics:

  • Healthcare
  • Process Improvement
  • Data and Process
  • Visual Analytics
  • Harmonization
  • Public Sector
  • Process Architecture
  • Process Modeling
  • Process Mining
  • Model Management

I arranged them in order from familiar to unfamiliar to a health IT professional. Even “Harmonization” should resonate, since there’s been efforts to harmonize among different healthcare data standards. But one gets toward the bottom of the list it’s less familiar. Those last four terms, process architecture, modeling, mining and management. What are they and why should they interest a health IT professional?

Process architecture is about how processes relate to each other and becomes increasingly important once you start working in a process oriented manner. After all, processes interact in different ways, most notably because people may work in different processes. This topic is about how to capture and manage the relations between processes.

Modeling is mostly about graphical ways to describe processes. Pictures are really liked by people and simplify communication between them about processes. I think it's the most widely researched topic by BPM academics, too.

Process mining deals with techniques to infer from historic records how operational processes actually work. A guy you previously interviewed, Wil van der Aalst, is the godfather of this area.

Finally, model management is about how to deal with large collections of process models. In Europe and Australia, we see that large companies now have repositories of thousands of process models. These are real treasure toves for these companies. Just think how you can use such a collection to identify redundant work and find opportunities to standardize work.

8. What question do you wish that I’d asked? How would you have answered?

That's easy: "The next time you are in Washington DC, Hajo, will you come with me and visit the Smithsonian together? I will give you a personal tour." I would have said: "Gladly."

9. I believe we connected through Twitter. Did I find and follow you first? You’re lots of fun to follow, by the way. Links you share are interesting. And you are very interactive, retweeting and replying and so forth. I’m sure you’d agree that Twitter is fun. But is it useful?

I recall that I found you. You were Tweeting long before I started. Yes, it's highly useful, I would say. First, I thought that Twitter is mainly used by people who wanted to share things like: "Just taken a shower" , "Off to work", and "Busy with stuff". I found out that when you follow the right people that this is an efficient way of becoming aware of great content. In other words, I most value the filtering function Twitter provide me with.

10. This is a request, not a question. Perceptive Software will have a booth at the Health Information Management Systems Society Conference in New Orleans, March 3-7. They were a very active tweeter at last year’s conference in Las Vegas. I hope you’ll monitor the #HIMSS13 hashtag and retweet, reply, etc. Could you tweet an introduction to yourself so I can embed the tweet here, as well as retweet it during the conference?

Thank you Hajo. That was fun!

My pleasure, thanks for having me!

Best Chuck

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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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