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

BPM, TQM, Six Sigma, Lean, EHRs, and Health IT


Now, I imagine we may have some healthcare process improvement folks out there and so what is the relationship between BPM and the healthcare process improvement? Back when I got my masters in industrial engineering, the management engineers that worked in hospitals and elsewhere, they were involved in both sides of an equation. They were creating and implementing many of the first information systems.


I worked in a hospital information systems department where the payroll system had been developed and implemented and managed by a management engineer, an industrial engineer. Then what happened is a bunch of folks went off and they started developing electronic health records and other health IT systems and you’ve got this research behind it, which is medical informatics. I don’t think they spent enough energy and time thinking about workflow problems and workflow theories and creating workflow tools.


Meanwhile, over on the other side, we’ve got the total quality management folks, Six Sigma and Lean. They’re finding the causes of errors. They’re finding the sources of variation and eliminating it. They’re figuring how to do the same amount of work but with less waste. Well, the problem is, is that more and more work is actually done in a kind of a mind-meld with the software. We really need to knit together these two traditions and I think that the healthcare business process management hybrid is a way to do that.

Healthcare BPM Is Catching Up With Other Industries


I go to many health IT and business process management conferences and I have seen many impressive case studies, insurance, banking, manufacturing, energy, hospitality, transportation, trade associations, where’s healthcare? Well, until recently, it’s not been present a lot but it is showing up and those case studies are very impressive. I’ve written about them and I have descriptions of a variety on my blog.


Healthcare is catching up! (in use of business process management technology)


There was survey recently of IT professionals asking which vertical they were in, which industry they were in and whether they were using business process management or not. Six percent in healthcare were using BPM. Most of these systems are in the back room. They’re used for human resources and for healthcare insurance but that’s moving out of the back room as people see the potential for this kind of technology closer and closer to the point of care. In fact, almost 20% plan future investments and I think that percentage is actually going to be much higher.

Social, Mobile, Analytics, Cloud, Bringing Process-Aware To Healthcare


Okay, healthcare. Healthcare is like a very large insular country that’s been closed off from the rest of the world for a long time but now it’s opening up. The same forces that are affecting many other verticals, such as social, mobile, analytics and cloud, particularly, are also affecting healthcare. These technologies and these new industries, if you look under the hood, often the most successful platforms have workflow automation, workflow engines, the ability to draw out a workflow or to systematically improve the workflow with the data, possibly big data.


That is essentially kind of like an epidemiological vector. It is bringing into healthcare workflow automation, which is not to say that workflow automation hasn’t always existed in healthcare, however, it’s not been widely prevalent or appreciated or understood. I think the profile is dramatically rising because of this confluence of these internally developed workflow automation systems and the ones that are being brought in by the social, mobile and analytics cloud platforms.

Use Case ≈ Workflow + Definition



Point of care workflow automation, let’s look at a use case.



What is a use case? In Wiki, it says, “A use case is a list of steps to finding interactions between a role, such as a physician or a nurse or someone in the health records department, and a system, such as an information system, to achieve a goal.”



That sounds kind of familiar to me, sounds a lot like my definition, a workflow is a series of steps consuming resources, which I think is implied by a use case, to achieve a goal. The difference is, the use case is a list of steps, whereas workflow is the steps themselves.



Well, what about a workflow definition? A definition is a short description of a thing by its properties. The most essential definition of workflow is the list of steps. A use case and a workflow definition are approximately similar to each other and that’s part of the secret to the sauce, the fact that a use case could be a drawing of stick figures interacting with a system over time or a pseudo-English description. It’s also a workflow definition, which can be executed and improved by a computer.

Classic Workflow Definition Editor Looks Like Traditional Flowchart



Here’s the classic-looking workflow editor. If you’ve ever used Visio from Microsoft, it looks kind of familiar. I’ve drawn this kind of thing. I’ve been in a boardroom where all four walls were covered by butcher paper and it was covered with Sharpie pen-written workflows. The problem with those kinds of workflows is after you have it, you have a pretty picture but you can’t turn around, turn a crank and turn it into a computer program.

Now, in this case, just to ground it a little bit in the clinical side, we’ve got a patient coming in and they have had a possible cerebral vascular accident and these decision points, the little yellow diagonals, are decisions that have to be made. Should we check the neurological status? Is this a thrombolysis candidate? Have we confirmed that there was an accident? What about hemorrhage? Then a decision. These little icons here, the nurse, physician and so forth are dragged and dropped to create it.

My Next Speaking Engagement!


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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