Healthcare Business Process Management, Adaptive Case Management & Process-Aware EHR & Health IT Systems

"Adaptive Case Management" Style EHR Workflow Definition Editor

[The following workflow editor is "simpler" than the previous editor, with all those icons and arrows. However, is no less sophisticated. It's simply further away from structured workflow, and towards unstructured workflow. It's an example what's come to be called adaptive case management (sometimes called dynamic case management). Instead of representing clinical workflows in detail, it represents medical office ambulatory workflow at a general level (vitals, meds, ROS, exam, etc.) and emphasizes task state visibility (called "radar view" by usability engineers) to the care team). Users can easily jump off the happy path -- postponing, forwarding, escalating, cancelling, etc. -- but return to take-up previously interrupted tasks.]

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Now, I want to compare that classic workflow editor with a simpler workflow editor. In this scene … slide, it doesn’t look that simple but it will look simpler in a moment. If you can think of a health information system or in this case, an electronic health record, as a set of screens but also the little dotted lines, those are screen-less tasks. These screens allow users to review data from previous patient encounters, to enter more data that will be useful in making decisions at later points, as well as order entry screens in which assessments and diagnosis and treatments such as things that’ll send prescriptions off to the pharmacy. 

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Now, the screen-less tasks are also saving a lot of time and effort and money in user dissatisfaction. They’re automatically going to see if there are clinical labs and downloading them and then putting a list, an item in a work list. They’re printing educational materials at the printer that’s closest to the person who’s responsible for the patient. They’re creating automatic reminders based on schedules interacting with business rules or clinical decision rules so that obviously saves a lot of time and effort. 

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Where did it come from this workflow that I’m talking about? Well, we’re going to grab a bunch of those and we’re going to create a workflow. 

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Over on the left hand side, we have … it’s only eight steps, a typical encounter might be twenty steps but we will see what these are because we can look at the pick list that represents the workflow. 

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We  have “get patient,” so the nurse walks into the room, says, “I am bringing John Doe into room C,” and then the  next couple of screens pop up automatically. The nurse doesn’t have to go and navigate some complicated and clumsy menu hierarchy. 

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We’re going to collect some vital signs….

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…ask about allergies…

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…ask about medications…

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…We’re going to conduct a review assistance and that review assistance will be the right one based on whether it’s a child or an adult, whether that nurse likes … has a favorite review systems or it may be based on the physician that nurse works for and different specialists have different review systems. These systems can be very parameterized so that at each point of step and execution, they do the right thing.

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The examination step can be an entire other workflow definition, such as a screen to enter history of present illness, a screen for physical exam observations, then assessments and order entry for treatments. 

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…Finally, you get down to the billing steps … [note that we skipped the Evaluation and Management coding step: users are not cogs in workflow machines, they can cancel workflows, skip steps, postpone them, forward them to other members of the care team and so on]

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By the way, there’s something I call the litmus test for frozen workflow. After you see the demo of a system, say, “I’d like to see that demo again except I want you to make one change. I want you to bring up something that will allow you to edit the workflow.” It might look like that old-fashioned workflow editor with all the arrows and diagonal boxes or it might look like this or it might look like something else. 

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What I want you to do is go in there and change one thing, delete a step, change the order of a step and then I want you to go and do the demo again. If that system has an actual workflow engine that is consulting some kind of representation of workflow, it will do what you would expect it would do if it’s executing that recently edited model so in this case, it should skip the step of checking for allergies, asking the nurse ask the patient about allergies.

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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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