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

Welcome To The Healthcare Business Process Management Blog

Welcome to the Healthcare Business Process Management Blog!

I’ve been blogging and tweeting about BPM in healthcare for years, with 200+ blog posts on Electronic Health Records Workflow Management Systems at, over 32,000+ tweets from @wareFLO, and more than 1700 archived links at EHR.BZ. Not all of them are about healthcare BPM, but a majority are.

Physicians are often blamed for slow adoption of electronic health records. They're sometimes compared to Luddites, the workers who destroyed automated looms during the 1700s. This is indeed an ironic accusation, since these looms were precursors to the modern digital computer (they executed "stored programs", essentially punchcards). Luddites didn't like looms because they were too efficient and reduced the necessary amount of human labor to operate. Many physicians don't like workflow-oblivious EHRs and health IT systems because they are the opposite, not efficient enough, creating more workflow for their users. So I need to pivot from the “EHR” brand to the broader healthcare and health IT about workflow, efficiency and productivity I’m already writing about anyway.

Then there’s the “Workflow Management Systems.” Back when I first started writing about workflow automation in healthcare that’s what they were called. Now they’re called business process management systems or, increasingly, suites. Back then a workflow engine, process definitions, and means for a non-programmer to edit definitions to change workflow were all a system needed. At their heart, iBPM (for “intelligent” BPM) suites still have engines and definitions and editors. Now workflow engines are called orchestration engines. They are way down deep within suites of BPM modules adding lots of value.

On this blog, on your right, is one semi-canonical list of intelligent BPM components. On your left, on this blog, is a list of reasons it’s taken so long for workflow technology to diffuse into healthcare and health IT.  I’ve run this list past lots of folks familiar with both health IT and business process management. Most agree it’s a good list, though some will emphasize some obstacles over others (billing's a particular favorite). I’ve placed these two lists, one of problems and one of solutions, on every page and post of because the problem/solution design pattern is so prevalent in our can-do society. No matter what you read, it will be omnipresent in your peripheral visions. Call it overt subliminal advertising, if you will.

Recent increase in interest in workflow technology in healthcare is undeniable. I wrote about it in my recent #HIMSS13 conference trip report. Healthcare is poised to triple investment in BPM tech (above tweet).

In my view this higher rate of investment is the inevitable consequence of years of underinvestment. “Underinvestment”? Perhaps “non-investment” is a better description, as more than once on EHR Workflow Management Systems I’ve referred to a two decade lag in adoption of true workflow automation (such as today's iBPMSs) in healthcare.

We need to move to modern process-aware EHR and HIT platforms. I refer to this as a shift from structured document management systems to structured workflow management systems. The best examples are business process management suites today.

Luckily, many technologies flooding into healthcare IT -- social, mobile, analytics, cloud (so-called SMAC) -- also have workflow engines, executable process models, graphical editors, and other useful BPM-like capabilities. is part of the following strategy:

  • Influence the Influential: Use social media and complementary methods to get process-aware ideas and technology noticed, discussed, absorbed, and acted upon.
  • Highlight the Highlightable: Flush out hidden workflow engines, process definitions, and graphical editors among existing and new EHRs and HIT systems.
  • Reach out to the Reachable: Virtually every BPM professional I've met, in person or online, believes healthcare workflow is ripe for automation (where it can be automated) and support (where can't be automated) using modern BPM and case management platforms, systems, and expertise.

The time is ripe!

Welcome to my new Healthcare Business Process Management blog!

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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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