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

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.


0 #1 Robert Gimbel 2014-06-26 07:52
Check out for an open source BPMN web modeler and toolkit.


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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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