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

Process-Aware Info Systems Come to Healthcare: BPM in Healthcare


Process-Aware Information Systems Come to Healthcare:
Business Process Management in Healthcare

Mobile, social, cloud, big data, etc. move over: PAIS.

Process-aware information systems (PAIS) ideas and technology -- workflow management, business process management (BPM), and adaptive case management systems -- are diffusing into healthcare from other industries. A Process-Aware Information System is "a software system that manages and executes operational processes involving people, applications, and/or information sources on the basis of process models." The best known PAIS is a business process management system or suite. BPM suites include many of the following technologies:

  • Executable process models
  • Codeless development
  • Groupware-based collaboration
  • Event-driven processes
  • Process intelligence and monitoring
  • Simulation and optimization
  • Business rule management
  • Process component archives

Some of these technologies have counterparts in healthcare IT. Others are just beginning to appear. Regardless of maturity of individual technology, perhaps the BPM suite's greatest value is as a model for how all of these technologies can fit together.

In some instances, process-aware ideas inform new solutions from health IT vendors. PAIS platforms developed outside healthcare are imported and adapted. Key PAIS components, such as workflow engines and process editors, are embedded in new health IT systems or retrofit to existing HIT systems. A cursory search for "workflow engine" AND "EMR" OR "EHR" in Google turns up increasing hits.

After a short history of process-aware systems, I’ll present a meta-analysis of twenty-five de-identified BPM in healthcare case studies. The de-identification prevents incidental, but unnecessary, commercialism. By “meta-analysis" I simply mean I’ll contrast and combine results from different case studies to identify patterns, disagreements, and aspects of interest to a health IT audience. Cases will be compared and contrasted relative to where in healthcare they occurred (hospital vs. ambulatory, back-office vs. point-of-care, and so on), who sponsored the case (academic vs. vendor), and claimed results (both qualitative and quantitative).

I’ll close with...

  • developing and deploying workflow via cloud (including Amazon and Google),
  • mobile workflow (including cross-platform),
  • structured versus unstructured data and workflow, and
  • how to incorporate social into the mix.

As healthcare avails itself of new platforms-as-services, it will find PAIS under the hood and along for the ride.

Takeaways include a powerful new idea (the executable process model), examples of successful applications of PAISs in healthcare, and a positive but skeptical attitude useful for further investigation. This presentation will be the first place many attendees will hear the next big idea in healthcare IT: process-aware information systems.

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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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