Day Two of Healthcare Business Intelligence Forum: Show Me More Workflow

I’m back for day two of the Healthcare Business Intelligence Forum in Washington DC! Here’s my report from Day One. I’m looking for even more workflow tech, and I find it.

Below is the venue, from the view of the stage, about a half hour before festivities begin.

Fantastic presentation by Glenn Steele MD of Geisinger Health.

Refer to the following tweeted link for an overview.

What I want to focus on is the idea that healthcare value and cost are not necessarily positively correlated. In fact, the opposite is true. The great thing about this is that it brings physicians on board relative to reducing cost as a path to increase value to patients.

So, how is it possible to reduce cost to increase value? Value Reengineering and then scaling and generalizing.

So, where’s the workflow tech? It’s under the hood. In fact, I happen to have a slide from a presentation given by the CIO (I believe) from Geisinger Health two years ago a National Library of Medicine. (It was sitting in a draft blog post I didn’t finish).

For me, the two best presentations were this one from Glenn Steele, MD and from Ray Hess yesterday. In both cases, the results of applying business intelligence to healthcare workflows were remarkable. And in both cases I happen to know they’re workflow automation, AKA BPM (Business Process Management) under the hood!

I enjoyed this presentation about the need to decrease healthcare data Semantic Incongruity — especially since it was an excuse to tweet a link to my From Syntactic & Semantic To Pragmatic Interoperability In Healthcare. My general point is basically that workflow tech can compensate for problems at the syntactic (transport) and semantic (meaning) layers. Workflow, or pragmatic, interoperability is the degree to which actual effect of a message matches its intended effect.

Issues regarding cost accounting systems have came up frequently. And here it is again. Activity-based costing is a form of micro-costing that can more accurately assign costs to specific healthcare workflows, such as an appendectomy. For a variety of technical reasons I won’t go in here (except to note I’m the only premed-accy major I’ve ever heard of) there’s a really great fit between ABC and workflow tech. In fact, I’d go as far as to say ABC won’t be practical without workflow tech. But that’s another blog post.

Now, finally, back to a bit of humor. Gus Venditto, emceeing the Healthcare BI Forum, mentioned me as a “Twitter Celebrity” so I just had to capture the moment using Google Glass. I grabbed 9 seconds and uploaded it on the spot.

This year’s Healthcare Business Intelligence Forum was a great conference!

I’ll be back!

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Day One of Healthcare Business Intelligence Forum: Show Me The Workflow

I am delighted to be attending the Healthcare Business Intelligence Forum here in DC. As usual, Industrial Engineer/MD that I am, I looked for workflow tech.

That’s an old tweet, from the recent HIMSS14 conference. But it’s a fitting start of this blog post.

I’ve written a lot about the workflow technologies necessary to support care coordination, so my ears perked up at the above reference to secret sauce.

If care coordination is the secret sauce of population health management and if (as I argue) workflow automation is the secret sauce of care coordination, then isn’t workflow automation the secret sauce of the secret sauce of health population management? I certainly believe it is.

Above reminds me of a complaint about EHRs. They have the data but they don’t help users do what they need to do NEXT. Managing population health means taking that data and turning it into actions at the point of care. And that’s what workflow tech does.

More examples of workflow automation style task management: populating work lists and alerting users to actions needing to be taken.

Now what I find so interesting about this slide is the way in which “care coordination” clearly occurs outside of the EHR. This too bad, but unfortunately it’s the situation today. I read recently that almost a half a billion of investment money has gone into care coordination companies during the last couple years. Some are leveraging the kind of workflow management tech I’m looking for evidence of here at the conference.

Again this tweet echoes the previous one about NOW, NEXT, LATER. Workflow tech reminds you to do something you told it to remind you about a month ago. Actually, if you set up the workflow definitions right, it can figure out what it needs to remind you about when and where without you explicitly telling it to do so! Saves a lot of work that way.

BREAKING: workflow! :)

I walk around with Google Glass at health IT conferences and conduct what I call One-Minute Interviews. There’s just one question and I upload and tweet on the conference hashtag literally on the spot.

In the following video Christina remarks that one of the presentations emphasized that traditional business intelligence (dashboards, reports) is not enough. Business intelligence has to reflect, and in turn drive, actual, executable workflows. This approach is called Business Process Management, or BPM (though in a medical context, search engines sometimes think it means Beats Per Minute). I maintain an entire blog on Healthcare BPM.

It’s great to see a rep from a BPM vendor, especially Appian, at a health IT conference!

This tweet also echoes an earlier one about not knowing the true cost of healthcare. Which is another way of saying we don’t know the true cost of healthcare workflows. Well, healthcare workflow is made up of tasks. The most expensive resources to accomplish these tasks are people. And we don’t know how long which people spend on which tasks (see, I told you I’m an Industrial Engineer). And (I know, that’s the second “and”), I don’t think we’ll be able estimate the costs of these workflows without workflow technology to automatically measure these durations. Healthcare cost accounting systems are hobbled by lack of input from time stamped data about resources used to accomplish specific workflow tasks. See: Show me the workflow tech!

Rogers Diffusion of Innovation Curve was used to explain adoption of EHR tech. But I include it here because it also describes diffusion of workflow tech into healthcare.

By the way, the rest of the tweeted slides in this blog post are quite geeky. You have been warned.

Interesting: Core Applications and Workflow/Automation…

If you look up what this means (in the small print on the next slide), it “orchestrates execution of the activities of care coordination.” Wow! That sounds pretty important. In fact, this is the secret sauce of the secret sauce angle I riffed on earlier.

The above “marketecture” is sufficiently important that I’m not satisfied with its resolution (in other words, I can’t read the small print!). So here is the original photo. There are five main components.

  1. Connectivity, Security and Interoperability (dark blue line)
  2. Data Integration and Management in purple (including a Natural Language Processing inset in red)
  3. Data Analytics and Content in yellow
  4. Core Applications and Workflow/Automation in green
  5. Physician/Patient Engagement in red

My point here is to highlight the importance of workflow automation to the entire scheme. If you look up #4, here is what the small print says: Core Applications and Workflow/Automation: Orchestrates the execution of activities that constitute the care continuum, gathering contextual information from the transactional systems as well as the data warehouse.

Anyway, the first day of the Healthcare Business Intelligence Forum was just great. I’m seeing exactly what I hoped to see: workflow automation closing the loop from clinical and financial data back to executable workflows at the point of care. Exactly where is should be.

I’m looking forward to more of the same tomorrow, the second and closing day of the Healthcare Business Intelligence Forum!


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Complex Event Processing, Business Intelligence, and Business Process Management From Siemens Healthcare

Siemens Healthcare was and is a pioneer in use of business process management software at or near the point of care. I’ve written about them frequently and tweeted about them even more.

As a educator about process-aware tech in healthcare (workflow management systems, business process management, and dynamic/knowledge-based/adaptive case management software), I keep an eye on Siemens workflow-related white papers, product brochures, YouTube videos, conference presentations, and webinars.

Recently I attending a webinar sponsored by Siemens: How can Complex Event Processing, Business Process Management, and SWIM Help to Improve Performance, Quality, and Efficiency of Patient Care? SWIM stands for SWIM Workflow Initiative in Medicine — yes, a recursive acronym! :) At about the same time I discovered some wonderful new (to me, but seem very recent) product brochures and case studies.

I’ll summarize this content here, but I should mention I have no financial relationship with Siemens Healthcare. I just think that a rising healthcare BPM tide raises all boats, so to speak. By boats I mean People and Organizations improving Workflow with Health Information Technology. I even have a directory of #POWHIT profiles in where I award web badges!

“dynamic care plans, integrated within the embedded business process management technology, deliver patient-specific messages for evidence-based interventions at every point in the care workflow. An underlying workflow engine monitors the care plan activities for completion or deviations, triggering timely patient-specific interventions and event-based alerts, as well as escalating missed tasks to a specified care team member.” (ref)

Note the important role BPM and workflow engines play!

I’ll start with a couple slides and then an outline of the entire webinar. After that I highly workflow tech-related material from the recent brochures and use cases. Please, by all means, view a video of the webinar: It’s free!

The webinar included two presenters on related topics. Bradley Erickson, MD, PhD, of Mayo presented “SIIM Workflow Initiative in Medicine (SWIM) Lexicon: Measuring and Improving Workflow.” Marc Overhage, MD, PhD, presented on Business Process Improvement and Directions.

bpm-tech

Nice overview of BPM benefits for healthcare workflow!

workflow-engines-catch-up2

So true! It is finally begin to happen though, I’m happy to report.

And here is my distilled outline of the entire 50 minute presentation.

  • How to Improve Workflow
  • How to describe workflow
    • Steps
    • KPIs
  • Standard for collecting/accessing workflow events
  • Time, EventID, SystemID, Additional info
  • Future
    • Collect workflow data from population
    • Determine optimal workflows by department
    • Use workflow engines to support optimal workflows
  • Workflow Engine for brain tumor protocol
  • We need event data
    • What exists
    • What doesn’t but is needed
    • “Harmonization” (match ids, sync times)
  • “Workflow engines are widely used outside of medicine. We need to catch up.”
  • Business Process Management Technology
    • Manage clinical processes from beginning to end
    • Identify clinical workflow problems
    • Monitor clinical workflow execution
    • Calculate effectiveness & efficiency measures
  • “Process = series of actions performed to achieve an intended result”
  • “Workflow = In healthcare, either a sub-process performed by a single individual or a process”
  • Simple processes
    • Linear
    • Predictable
    • Short
    • Departmental
    • Static
  • Complex Processes
    • Predictable & unpredictable
    • Many steps
    • Multiple paths
    • Nested processes
    • Many participants
    • Many interfaces
    • Interdepartmental
    • Change frequently
  • Stroke Process Example
  • Process Types
    • Process vs Knowledge Workers
    • Simple vs Complex Processes
    • BPM -> CEP/BPM -> “Contextualization”
  • Care Teams Need
    • Reliable
    • Flexible
    • Efficient
    • Satisfying
  • Contextualizing a model process
    • Tweak executing BPM process every time one of the following changes
      • Patient
      • Time
      • Setting
  • Process monitoring prompts “re-contextualization”

The following is supplementary material I’ve been able to find in a series of product brochures and case studies. Again, I embolden specific references to workflow tech.

Workflow Technology: The Right Information at the Right Time

“the Soarian® system’s embedded workflow technology is critical in supporting improved care delivery and team collaboration. Any care delivery process includes many steps, creating multiple opportunities for variability and potential human error. The workflow engine helps the care team eliminate process variability, which in turn supports patient safety and positive outcomes. EMH also leverages the workflow technology to guide clinicians in addressing or completing time-sensitive care interventions. “The workflow engine works behind the scenes to gently remind and guide our teams to care for patients in a manner consistent with the evidence.”

soarian-mrsa

“The fundamental advantage of the workflow engine over a rules engine is the level of sophistication. Being able to support a highly complex clinical process, monitor patient progression across the continuum of care, notify the appropriate clinician(s), and escalate if needed not only drives out variability in care but improves patient outcomes. The workflow engine is really helping us transform the way we care for patients at EMH.”

“EMH plans to use Soarian and its workflow capabilities to address future challenges and opportunities. “With healthcare reform, there are growing requirements for transparency and accountability,” says Wray. “We are highly focused on getting our IT solutions in place and optimized to support these changes.”

Physician Engagement Supports Workflow Efficiencies

“Like most community-based facilities, PVHMC physicians are independent. It was, therefore, imperative to align with the workflow demands of those who practice at different facilities with different EHRs and other systems.”

“I believe Soarian has much less ‘clutter’ on the screens, making the physician experience more streamlined and simpler,”

“Soarian’s clinical summary [as a rounding tool] allows us to view the most pertinent information in one location without having to search throughout the patient record. The way orders are set up not only makes it quick and easy to identify orders and results but to see if they have been completed or not.”

“The care team also uses Soarian’s embedded workflow engine capabilities to prompt clinicians about care interventions that are due or overdue. For example, nurses and clinicians receive real-time alerts when a patient has a documented risk of falling (via use of screening/risk assessment tools). Depending on the patient’s level of risk, the appropriate interventions populate the clinician’s worklist, further supporting documentation completion. Having optimized processes in place and information readily available helps the care team respond quickly, which can lead to more positive patient outcomes. “The prompts the workflow engine provides to staff, as well as the actionable worklists, contribute to timely execution of patient care interventions,” says Pam Crawford, PhD, MSN, RN, vice president of nursing and chief nursing officer. “The workflow engine is like a ‘helper’ for the nurses, ensuring those time-sensitive activities are completed.”

“Physician Affinity

“The Soarian system helps physicians streamline their work by providing anytime, anywhere access to a patient’s complete medical history. “The ability of physicians to check their results, receive alerts via the workflow engine, and use CPOE capabilities all support physician affinity,”

How It Works.The Soarian workflow process.

“The Soarian system offers an embedded workflow engine that helps your organization coordinate and manage processes as well as clinical data from beginning to end—across departments, disciplines, and care settings—to help improve operational efficiencies and quality of care. From acute myocardial infarction to infection control management, care processes become more manageable with a solution that helps synchronize and automate activities. As illustrated in the MRSA example below, the workflow engine simultaneously manages numerous handoffs, notifications, and next steps to ensure the right person is performing the right task at the right time. You can further improve outcomes and care delivery by adapting and optimizing your own processes with the workflow engine in Soarian, using parameters that match the unique needs and goals of your organization. Parameters can include clinical roles, care protocols, quality benchmarks, and timing of notifications and escalations.”

“It leverages existing Soarian capabilities such as embedded workflow technology, a flexible service-oriented architecture, a superior user interface, and powerful analytics. Soarian Ambulatory supports cross-continuum capabilities like clinical worklisting and interdisciplinary plans of care to help synchronize care activities.”

Embedded workflow engine helps synchronize clinical activities, supporting greater transparency, accountability, and adherence to evidence-based practices.”

“ Soarian workflows have become an essential part of how we provide care at Lake Health. Our end users, managers, and Quality department not only depend on them but are routinely thinking of new uses for the workflow functionality.”

“ The use of Soarian and the workflows has helped us address our patient safety initiatives and quality of care we deliver. We now have the data to support our decisions and the communication among care providers is improved.”

Connecting people to connect care: Soarian Clinicals

Soarian for Clinical Care: Connecting people to connect care.

Conclusion

Siemens Healthcare was and is a pioneer in use of business process management software at or near the point of care. Siemens’ workflow-related white papers, product brochures, YouTube videos, conference presentations, and webinars play an important role in educating the health IT industry about enormous potential for business process management systems in healthcare.

Thank you Siemens Healthcare!


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Tweeting #HCBizIntel at the Healthcare Business Intelligence Forum

I’m attending, tweeting (and Google Glassing) the upcoming Healthcare Business Intelligence Forum here in DC on April 16-17.

hcbizintel

This blog post is sort of a repeatedly updated running commentary before, during, and after #HCBizIntel. A place to embed tweets, Glass videos, and links to my own posts about clinical business intelligence.

In particular, as always, I’ll be looking for the workflow and workflow technology connection to clinical business intelligence…. as you know I would, must, and will. :)


And more to come!

P.S. I created a list of #HCBizIntel speakers, speaker organizations, and exhibitors. Here are their tweets!


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10 Top Uses For Google Glass In Health IT Marketing and PR

I can’t attend the Health IT Marketing and PR Conference now in its second day in Las Vegas, due to a long planned beach vacation. However, monitoring its tweets certainly stimulated a lot of ideas! Yesterday I wrote Wishing I Was At #HITMC (Pssst: Hey buddy, wanna buy some workflow?).

Since then I’ve been using my Google Glass to monitor and respond to tweets containing the #HITMC hashtag. That got me to thinking about the intersection between Glass and health IT marketing.

10. Monitor #HITMC and Respond to #HITMC Tweets While At the Beach

This is called a vignette. Whatever you happen to be looking at through Glass when you snap a photo can be embedded in the photo.

9. Stream Live Video From #HITMC Using LiveStream (Anyone at #HITMC have Glass? Use it!)

I’d love to be a fly on the wall, flitting from Glass headset to headset, listening to all the wonderful conversations at #HITMC!

8. Use Glass as a Shiny Object to Attract Attention and Traffic

While it may seem completely gratuitous, wearing Google Glass, especially a bright blue headset like mine, really does punch through the noise!

By the way, yes, I do have blue eyes. And, yes, my wife does say I look great in Glass. But the, well, she’s my wife, and she would say that, but that doesn’t stop me from feeling flattered (or writing about it here!).

7. Tweet One-Minute Video Interviews At Health IT Tradeshows

My favorite HatCam (now retired for Glass) video is my interview with a sleeping @TechGuy!

What a hoot, or snore, er, you know what I mean!

6. Pivot From Glass In Healthcare Angle To Your Product or Service

I actually think it’s hard to think of any area of healthcare where Glass cannot be of some interesting use. For an overview of the many areas where Glass can be used to improve healthcare workflow see my Slides, Notes, and Tweets for Google Glass and Healthcare Information and Workflow Presentation.

Regarding pivoting from Glass to your product, service, or idea, consider my own efforts to popularize workflow technology in healthcare. In an InformationWeek column, I compare Glass intelligent workflow to autocorrect, which, while sometimes funny (see below), actually save people lots of time and effort.

That’s exactly what workflow technology does, it saves users time and effort, and that’s exactly why healthcare needs workflow technology so much! See, that’s my pivot.

Just imagine whatever you care about can be improved with Glass. Write about it. Tweet about it. Get your hands on Glass to try them out and to stimulate your imagination. They’ll be out soon, retail and less expensive. Get a jump on your healthcare IT marketing and PR competition!

5. Record First-Person Point-Of-View Videos of Your Product or Service

For example, here is my first-person point-of-view experience of using a 3D printer (which I’d just assembled from a kit).

Notice what I’m printing: #HITsm. This is the hashtag for the weekly (Friday, noon EST) tweet chat about health IT. It stands for Health Information Technology Social Media.

4. Record Short Videos of @TechGuy On Social Media and Health IT

This is what I meant when I referred to product, service, or *idea*. In my case the idea is healthcare workflow technology. I’m trying to sell an idea, not just a product or service. But that’s just me. You may be the next big idea in healthcare. Use Glass to market it!

3. Learn from Google Glass Marketing: Combine Testing with Social Media

Some folks have criticized Google’s “marketing” of Glass. Early access “Explorers” are dorky. Glass looks dorky. Etc. Ignoring the idea that dorky is the new black, compare Google’s limited access release of Glass with Google’s limited access release of Gmail ten years ago. That limited release was, in retrospect, praised as “one of the best marketing decisions in tech history”.

Time will tell whether similar can be said of Glass. It is, after all, TWO YEARS OLD! And it’s STILL not available via consumer retail channels.

All I can say is what my Dad told me, “Plan the work, and work the plan.” As far as I can tell, looking in from outside, but as a member of the Glass beta testing “team”, even Glass’s inevitable bumps in the road seem to be being accommodated by Google slow-go, trim-the-sails-we-go beta testing and Gmailesque marketing strategy.

2. Write A Blog Post About Glass and Health IT Marketing and Tweet On The #HITMC Hashtag!

After all, you’re an elite health IT influencer, and you’re reading this blog post!

I love “meta” stuff. For example this blog post is really about itself…

1. Your call! What Is The Number One Use For Glass in Health IT Marketing and PR?

That’s what why this blog’s comments are for… I hope you think of something absolutely off-the-wall fantastic!


P.S. I’d like the thank @TechGuy and @ShahidNShahid for an incredible conference on Healthcare IT Marketing and PR. Even from three time zones away, on the opposite coast, it’s having a big effect on everyone monitoring it from afar.

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