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

Number One (Mostly) in Google for Ten Years


Now what do I mean by “big workflow?” Well, about 10 years ago, I wrote a white paper on healthcare workflow that’s been number one in Google, at the top of the first page almost for ten years and I used a phrase there, which is “the workflow of workflow.”

[Yeah, year, pretty thin, I know. It was just a rhetorical device. Remember, this is a transcript of me talking... On the other hand, I did write Cutting Through The (Healthcare) Big Data Hype at #BigDataTechCon.)

Workflow Is a Series of Steps, Consuming Resources, Achieving a Goal


Let’s start with the definition workflow. I’ve looked at hundreds and this is my distilled definition. It is simply a series of steps consuming resources that achieve a goal. I’ve seen simpler definitions like series of steps and I’ve seen many much more complicated definitions but we’re going to work with this one.

The Workflow of Workflow Is Improving Workflow


Here’s the visual representation of workflow. We have a series of states. Transitions between those states, that’s a workflow. They achieve the goal of of the workflow.


Now, let’s think about improving that workflow. Well, that’s a workflow, too. The workflow of workflow is improving workflow. To get from workflow to better workflow into even better workflow is a series of steps and obviously, one wants to creates a virtuous cycle in which you’re improving all aspects of workflow, both reducing errors, reducing variability, increasing speed, reducing cycle time, the amount of time it takes to get from the beginning to an end of a workflow and if you do that, you usually can increase volume of transactions. You’re trying to hit that goal, hit that target and do it with the least amount of resources.

Cat. Dog. Tree. Workflow Engine. Definition. Editor.


My wife, right about now, says, “Chuck, cat, dog, tree.” It’s all very Zen. I realized after a while what she meant was, “What is the simplest set of simple ideas that can only fit together in one way that achieves my goal or communicates my point.

I kind of like the way the question marks are over this dog because he’s wondering how things are going to turn out. Well, I think most of us stereotypically would know that this is the way it’s going to turn out. The cat’s up the tree, the dog’s at the base of the tree. I kind of like the way the question marks are over this dog because he’s wondering how things are going to turn out.


Well, I think most of us stereotypically would know that this is the way it’s going to turn out. The cat’s up the tree, the dog’s at the base of the tree. Well, I’m going to turn cat-dog-tree into a verb and I’m going to cat-dog-tree workflow.


“Engine!” That’s what’s the thing that does the work. In the real world, this is a corvette engine. It does a lot of physical work. In the software world, workflow engines do work for users. They do digital work. Well, how do they know what to do? How do they know which task to hand to which person or which data to download from which database automatically without requiring anybody to click on anything?


Well, a workflow engine follows a definition, a workflow definition. Down at the bottom here, we have the definition of definition, speaking of meta. This is from the 1755 dictionary of the English language. It was the first one of a comprehensive nature by Samuel Johnson. He described definition as “a short description of a thing by its properties.” Well, you can describe workflow as a list of steps and a list of resources that are consumed and a goal that is achieved.


Well, where does that workflow definition come from? It traditionally comes from a human, someone who understands the work’s domain. Here we have the harried editor, the person understands the domain. They create this process model, a model of the workflow and then that is fed to the machine, to the engine to execute. While it is being executed, things are being tweaked. You’re observing. You’re adjusting the carburetor. If it runs out of gas, you put gas in so there’s kind of a real-time management of the workflow system as well.

The Power of (Executable) Process (Models)


Well, this is an actual, simplified workflow definition of a patient encounter. Here we have a set of screens. The screens are popping up automatically. A nurse, in the red role, is going to collect some vitals information, enter that into a screen, either by touching things or using speech recognition. Then there is a sequence of screens to well, “Are you on any new meds recently? Should I take any off the list? How about allergies, what are you allergic to?”

Then down here in the blue role, we have a physician may conduct several steps, such as doing an exam and then making an assessment and ordering some treatment, such as a prescription that’ll be sent someplace. Then there’s cycle of steps here in the green role (naturally) in which you try to get the money from the insurance company.

Someone who understands the patient encounter can model that patient encounter, can create a description of it, a workflow definition. This can be executed by the workflow engine putting the right screens in front of the right person so that they don’t have to click a lot. A lot of folks complain about “click-arrhea,” my analogy to diarrhea, too much clicking. Plus, it can accomplish things automatically in the background, saving a lot of time and, of course, it’s consistent because it’s a computer.


The really cool thing from the point of view of meta workflow, the workflow of workflow, big workflow, is while that engine is working, it is generating immense amounts of timestamped data. Up here at the top, we see that 85% of the time, the nurse, and I’m going to bring up my little cursor here, 85% of the time, the nurse chooses to go collect meds and allergies through the template but 15% of the time, she goes over and uses speech recognition to generate a note. Then down here, it converges. You can use this information along with the time of eight minutes between vitals in the note to spot bottlenecks and go and ask the nurse, “Well, why did you take so long and why did you do it this way?” She can explain and you can then change and improve the workflow. Okay.

More Articles...

  1. Business Process Management's Tools To Improve Workflow
  2. The Process Optimization Process: Design, Model, Execute, Monitor, Optimize
  3. Global BPM & Health IT Market Size & Growth Rate
  4. Healthcare Needs Business Process Management: 600 Billion Dollars Worth
  5. EHRs & HIT Efficiency, Effectiveness, User Satisfaction Problems & BPM
  6. BPM, TQM, Six Sigma, Lean, EHRs, and Health IT
  7. Healthcare BPM Is Catching Up With Other Industries
  8. Social, Mobile, Analytics, Cloud, Bringing Process-Aware To Healthcare
  9. Use Case ≈ Workflow + Definition
  10. Classic Workflow Definition Editor Looks Like Traditional Flowchart
  11. "Adaptive Case Management" Style EHR Workflow Definition Editor
  12. Third Example Workflow Editor (Non-Point-Of-Care Workflow Automation)
  13. Workflow Engine Executes Workflow Definition (Non-Point-of-Care Example)
  14. True Workflow Automation Increases Productivity, Alternatives Don't
  15. Next Steps: List High Value Workflows
  16. First Steps: List Low Complexity Workflows
  17. Automate High Value, Low Complexity Workflows, Then High Value, High Complexity Workflows
  18. Vendor-Specific Best Practices: Your Vendor Knows Best
  19. (In The Long Run) Improving Big Workflow Requires Big Data
  20. The Future is Bright for Healthcare Business Process Management
  21. What's Your Story? People and Organizations improving Workflow with Health Information Tech
  22. Thank You!,, The Healthcare BPM Blog, and @EHRworkflow
  23. Who Needs To Be The Champion of Workflow? Physician? Nurse? Administration? IT?
  24. Are There Specific Examples of High Value, Low Complexity Workflows?
  25. How Do You Manage "But we're special" Pushback Most BPM Theory Get's From Clinical Care Teams
  26. Could You Comment on Similarities & Differences At BPM Within vs Across Organizations
  27. How Do We Use BPM When Apps Like ER, Bed & Utilization Management Are Un-Integrated?
  28. Is Lean A Good First Pass For Healthcare Entities Looking to Explore BPM?

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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