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 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. 

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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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