Patient Eligibility Verification 10-Part Interview: Vishal Gandhi of ClinicSpectrum, Booth #301 at HBMA

After the resounding success of our recent 10-Part medical practice workflow Interview with Vishal Gandhi of ClinicSpectrum, well, why not do it again?!

However, even I, a glutton for workflow punishment, couldn’t do *another* 10-part interview about workflow with the same, undeniably smart and multi-faceted person, such as Vishal! So I let V. pick the topic: Patient Insurance Eligibility Verification. Back when I was CMIO for an ambulatory EHR vendor for over a decade, we dealt with eligibility verification, but boy has it gotten complicated since then! So I learned so much during this, intentionally in-the-weeds, interview with Mr. Gandhi.

I’m sure Vishal would appreciate me adding, he and his company, ClinicSpectrum, is located in booth #301 at the Healthcare Billing Management Association Conference in September 14-16 in Las Vegas. :)

By the way, I’ve left the words and phrases IN ALL CAPS exactly I as got them from Vishal. :)

  1. The 2014 Consumer Health IT Summit is happening September 14 (same day as the HBMA Conference) in Washington DC. It’s about empowering patients with their digital data and technology. So my first question is: From a patient engagement perspective and the patient’s point-of-view what are benefits of a well-run medical office patient insurance workflow?
  2. What are typical limitations of EHR/Practice Management systems? And how does ClinicSpectrum eliminate them?
  3. What kinds of information about a patient’s eligibility verification are NOT available through software technology interfaces?
  4. What are some Do’s and Don’ts when calling to inquire about covered vs. un-covered procedures?
  5. Once you know a patient’s eligible benefits (high deductible, non-covered, max caps, etc.) what are appropriate action plans?
  6. What are typical percentages of denials due to eligibility issues? How much can these percentages be reduced through a more proactive approach?
  7. Tell me about your medical office Micro Finance Company analogy. What are some workflow management implications?
  8. As deductibles go up, how can medical practice begin to manage their patients’ “viability” of paying their portions of the bill?
  9. What’s is best and most cost effective manner to follow up on balances through a “soft” collection method?
  10. Where do you see Eligibility/Benefit Verification going years from now? How will it fit into larger population health and care coordination landscape?
  11. I love animations of workflow (use to create them myself!). Any cool patient insurance workflow animations?

Into the weeds!

The 2014 Consumer Health IT Summit is happening September 14 (same day as the HBMA Conference) in Washington DC. It’s about empowering patients with their digital data and technology. So my first question is: From a patient engagement perspective and the patient’s point-of-view what are benefits of a well-run medical office patient insurance workflow?

A well-run medical office patient insurance workflow results in a lower cost of care by health plan and a lower cost for patient. Plus, patients don’t like to be surprised with lot of medical bills unpaid by their health plans! So, a clear idea of health plan benefits, covered and uncovered tests/procedures in outpatient and inpatient set up is of utmost necessity. Excellent patient insurance workflow contributes to a healthy relationship among the patient, their clinical needs and heath insurance coverage in today’s changing healthcare space due to ACA and ACO.

[I'll be tweeting the remaining questions tomorrow, September 14th, during both the Healthcare Billing Management Association Conference and the Consumer Health IT Summit]

What are typical limitations of EHR/Practice Management systems? And how does ClinicSpectrum eliminate them?

[To be published soon! Check back!]

What kinds of information about a patient’s eligibility verification are NOT available through software technology interfaces?

[To be published soon! Check back!]

What are some Do’s and Don’ts when calling to inquire about covered vs. un-covered procedures?

[To be published soon! Check back!]

Once you know a patient’s eligible benefits (high deductible, non-covered, max caps, etc.) what are appropriate action plans?

[To be published soon! Check back!]

What are typical percentages of denials due to eligibility issues? How much can these percentages be reduced through a more proactive approach?

[To be published soon! Check back!]

As deductibles go up, how can medical practice begin to manage their patients’ “viability” of paying their portions of the bill?

[To be published soon! Check back!]

What’s is best and most cost effective manner to follow up on balances through a “soft” collection method.

[To be published soon! Check back!]

Where do you see Eligibility/Benefit Verification going years from now? How will it fit into larger population health and care coordination landscape?

[To be published soon! Check back!]

I love animations of workflow (use to create them myself!). Any cool patient insurance workflow animations?

[To be published soon! Check back!]

That’s a wrap! I’d like to thank Vishal for sharing his passion for eligibility verification. Anyone who SPRINKLES EXPLANATIONS WITH ALL CAPS really cares. :)

Until next time… Vishal & Chuck!

Posted in EHR Workflow | 3 Comments

10 Questions For @PrimeDimensions: Real-Time, Event-Driven, Complex Event Processing In Government and Healthcare

A few years ago I flew all the way to Cape Town, South Africa to present a paper at the triennial World Congress on Medical and Health Informatics, commonly know as MedInfo. My topic was a “big picture” framework of how electronic health records can be supplemented with process-aware Business Process Management ideas and tech. A key link in that framework was Complex Event Processing. I am not an expert on Event-Driven Architectures. So I am so delighted to convince Michael Joseph of Prime Dimensions, who is expert, to answer my questions! He’s experienced in both government and healthcare real-time information processing systems. By the way, I’m tweeting out chunks of this interview during the NextGov Prime2014 conference. Both Michael (@PrimeDimensions) and I (@wareFLO)will be responding to replies and retweets — in real-time!

eda

Every hour or two I’ll update this blog post and tweet links to each added question for which there is a new answer. I’ll tweet on the #Prime2014 hashtag, so be sure to follow it during the Prime2014 conference, Monday, September 2014. Say hi to Michael for me if you bump into him at #Prime2014.

Thanks Michael! First of all. Enjoy the conference! Now, let’s dive into the real-time, event-driven weeds! Could you provide us a brief glossary of terms, so we won’t feel lost?

Sure, Chuck. The following is from one of my slide decks.

  • Real-time Data: Data streams processed and analyzed within seconds of data collection.
  • Business Process Management (BPM): Includes user-friendly business modeling and optimization tools, system integration tools, business activity monitoring tools, and rich workflow capabilities for end users.
  • Complex Event Processing (CEP): Advanced analytics on one or more streams of real-time data to quickly identify and respond to meaningful events.
  • Data in motion: Steaming data flowing within a system or from one system to another (ie: HL7, medical devices, real-time location services).
  • Data at rest: Data stored in a database or file.
  • Business Activity Monitoring: Real-time activity data converted to information and pushed to end-users through a visualization tool or dashboard.
  • Operational Business Intelligence (BI): Reporting of real-time data triggered by an end-user request.
  • Event-driven Architecture (EDA): A framework that orchestrates behavior around the production, detection, consumption of events as well as the responses they evoke.

Thanks, Michael, that was very helpful! If we count that as the first question in this interview, it get’s us to a nice round ten (plus one!). Here are the rest of the questions I have, base on past conversations with you. I know you’ve got a foot in both the government and healthcare spheres, so I’d appreciate it if you could address both areas, when practical.

  1. Could you provide us a brief glossary of terms before we dive into the Real-Time weeds?
  2. What are the advantages in adopting a real-time data capability?
  3. What are the advantages in adopting a real-time data capability in healthcare?
  4. Is there an industry-wide, accepted definition of “real-time?”
  5. What are typical sources of real-time data?
  6. What type of analytics can be generated with real-time data?
  7. How does this real-time capability influence or drive the future-state solution architecture?
  8. What are advantages of an Event-Driven Architecture?
  9. What technologies are required to deploy a real-time capability?
  10. What is the relationship between business process management (BPM) and Complex-Event Processing (CEP)?
  11. You’ve got a great marketecture of how an Event-Driven Architecture could fit into a hospital IT architecture. May I share it?

2. What are the advantages in adopting a real-time data capability?

Government agencies continuously generate and collect valuable real-time data associated with specific transactions, but they generally have limited ability to effectively analyze, process and present this data for actionable intelligence and real-time decision support.

Real-time data allows information to be disseminated in a timely manner, when and where it is needed. Most organizations have been focusing efforts on leveraging technology to become a data-driven enterprise; the next evolution is to also consider how to become an event-enabled enterprise. Real-time capability and related process automation assist in accessing data to build event-driven applications enriched with other relevant information and bringing them together in a scalable, vendor agnostic platform.

The expectation and pressure to deliver measurable results and meaningful change has never been more pronounced, as government executives face enormous challenges and risks as they navigate the complexity of our digital, data-driven world. These circumstances necessitate next-generation technologies designed to extract value from very large volumes of disparate, multi-structured data by enabling high-velocity capture, discovery, and analysis.

3. What are the advantages in adopting a real-time data capability in healthcare?

For the healthcare industry, a real-time capability is required to exceed future standards of care, provider experience and patient engagement expectations and to accommodate the massive transformation currently occurring in the healthcare industry — a transformation focused on opening up health data to facilitate exchange with providers, payers, and patients. For this reason, healthcare providers should be seeking to deploy an Enterprise-wide real-time processing capability that provides improved clinical insights, operational effectiveness and situational awareness associated with key indicators and events.

4. Is there an industry-wide, accepted definition of “real-time?”

Not exactly. The real-time platform should be designed based on requirements for providing minimally acceptable timeliness of information based on feasibility and clinical necessity. In collecting, processing and analyzing real-time data, there is inherent latency depending on data rates, volume, aggregation method, processing power, embedded analytics and throughput. In general, real-time data is defined as data streams that are processed and analyzed from milliseconds to approximately 30 seconds of collection. This is done either through a machine-to-machine or machine-to-human interface. Sensors and medical devices generate real-time data that are captured by other systems for continuous monitoring. Depending on the scenario, anomalies may be resolved by automated responses or alerts for human intervention.

5. What are typical sources of real-time data?

Sources of real-time data include data-in-motion, such as instant messages, flow sheets, device and sensor data, business process and workflow data, and real-time location services (RTLS). The goal of the real-time capability is not only to capture and integrate these sources, but also to transform and collect latent, transactional data as it becomes available in various source systems, such as financial, human resources, operations, and supply chain management. The challenge is efficiently integrating these disparate data sources across a fragmented information infrastructure, with multiple data silos, data marts and operational data stores. The real-time platform will provide specialized data services to extract data-at-rest that represents the most current records and maintains “a single version of the truth.”

6. What type of analytics can be generated with real-time data?

The real-time processing provides better visibility into all dimensions of healthcare delivery with real-time information. Disparate clinical and operational applications create the need to aggregate patient data in a new IT environment for real-time collection, processing and analysis. Analytic engines process vast amounts of data to identify and correlate the most important factors influencing patient care to develop an optimal treatment plan. In addition to real-time response and alerting, the platform enables the emergence of a new class of analytic applications, dashboards and visualizations for predictive modeling, clustering analysis, decision trees, root-cause analysis and optimization.

By supporting both on-demand and continuous analytics, the real-time platform extends and improves operational business intelligence and business activity monitoring through integration with Enterprise reporting and dashboard tools. On-demand real-time analytics are generated and delivered based on a user query; the data are pulled in real-time. Continuous real-time analytics notifies users with continuous updates in real-time; the data are pushed through on a regular basis. Algorithms include statistical analysis, predictive modeling, root-cause analysis, optimization, data mining, decision trees, clustering and natural language processing.

7. How does this real-time capability influence or drive the future-state solution architecture?

Event-driven architecture (EDA) integrates relational, non-relational and stream data structures to create a unified analytics environment. EDA describes an architecture where layers are partitioned and decoupled from each other to allow better or easier composition, asynchronous performance characteristics, loose coupling of APIs and dependencies and easier profiling and monitoring. Its goal is a highly reliable design that allows different parts of the system to fail independently and still allow eventual consistency.

EDA enables discovery, or exploratory, analytics, which rely on low-latency continuous batch processing techniques and high frequency querying on large, dynamic datasets. This type of architecture requires a different class of tools and system interfaces to promote a looser coupling of applications to streamline data access, integration, exploration, and analysis. It is also designed to deploy real-time Web applications using NoSQL databases, RESTful interfaces and advanced platforms that maximize throughput and efficiency by providing evented, asynchronous I/O and guaranteed, non-blocking libraries, thereby sharing code between the browser and server, effectively eliminating the Web server layer.

8. What are advantages of an Event-Driven Architecture?

  • Promotes operational effectiveness, process automation and analytic excellence
  • Enables advanced analytics and clinical informatics through an interoperable and scalable infrastructure
  • Streamlines technology insertion based on agile development methodology for rapid deployments
  • Controls IT operational costs by eliminating redundancies and aligning capabilities
  • Supports strategic planning, organizational alignment, and continuous process improvement
  • Provides a practical framework for defining and realizing the evolving future state
  • Integrates multi-structured and stream data using advanced technologies that provide high velocity data capture, discovery and analysis
  • Establishes a virtualized data environment and extensible service-oriented architecture that supports both Restful and SOAP APIs, allowing multiple data structures and formats (JSON, XML, etc.)
  • Provides an application development platform with domain-specific enclaves for evolving from “systems of record” to “systems of engagement”

9. What technologies are required to deploy a real-time capability?

A real-time platform ingests and processes data streams from clinical and operational systems, performs complex event processing (CEP), pattern matching and anomaly detection, applies on-demand and continuous analytics and triggers notifications and alerts based on an embedded rules engine. The platform also aggregates at-rest retrospective data from other source systems with real-time data streams for enhancing the context of information presented through operational business intelligence. With an in-memory cache, the platform has the ability to retain and persist data as long as it remains relevant to the real-time event. Detecting and reacting to events in real-time allows wide variety of business processes to be automated and optimized, improving a patient’s entire care team to improve communication and collaboration.

CEP provides an organization with the ability to detect, manage and predict events, situations, conditions, opportunities and threats in complex, heterogeneous networks. The in-memory cache provides the capability to run multiple, complex filters that compare events to other events in the same stream, or in another stream, or compare events to a computed metric. Moreover, in conjunction with the CEP rules engines, multiple algorithms can be deployed simultaneously and include the following rule types: (1) message syntax and semantic rules, (2) routing and decision rules, and (3) aggregation and transformation rules. Sophisticated rules engines can invoke in-memory analytics. To optimize performance, the platform can apply data compression and message parsing directly on the incoming streams, depending on the data rate, content and structure. Detection-oriented Complex Event Processing focuses on detecting combinations or patterns of events. Aggregation-oriented Complex Event Processing focuses on executing embedded algorithms as a response to data streams entering the system.

10. What is the relationship between Business Process Management (BPM) and Complex Event Processing (CEP)?

An ideal real-time platform integrates Business Process Management and Complex Event Processing. Together, these components create an agile, high performance, scalable platform that can deliver fast insights through real-time queries, notifications, alerts and advanced analytics. With BPM, the platform is able to detect discrete events and trigger a workflow that completes a specific process through a series of transactions. CEP extends this capability by correlating multiple events through a common interface that invokes an embedded rules engine. Event filtering evaluates a specified logical condition based on event attributes, and, if the condition is true, publishes the event to the destination stream as a notification or alert. Moreover, integrating BPM tools, and other line-of-business (LOB) applications, improves operational business intelligence and business activity monitoring (BAM), the use of technology to proactively define and analyze the most critical opportunities and risks in an enterprise. By deploying a BPM capability based on CEP technology, providers will be able to process high volumes of underlying technical events to derive higher level business and clinical decision support, extending the functionality of BPM tools and providing insights to a wider audience of users.

11. You’ve got a great marketecture of how an Event-Driven Architecture could fit into a hospital IT architecture. May I share it?

[Michael, you've got an incredibly detailed "marketecture" of how an Event-Driven Architecture integrates into a hospital venue. May I share it? Also, your detailed answers to my in-the-weeds question really started a bunch of wheels spinning in my head. Do you mind if I followup at a future date with ten more questions, even more healthcare focused?]

Please do! I look forward to it!

Cheers

Michael



P.S. [Chuck writing] You can see that Michael is fount of detailed knowledge about real-time analytics. Michael comes from a business intelligence and analytics background. I, of course, come from a healthcare workflow tech background. It’s fascinating to see how event-driven architectures are so at the intersection between clinical business intelligence and clinical business process management. And I’d like to thank Michael for having a conversation about that intersection. By the way, as I mentioned at the outset, I’m tweeting out chunks of this interview during the NextGov #Prime2014 conference. And both Michael and I will be responding to replies and retweets — in real-time!

Posted in clinical-intelligence | Leave a comment

Box Brings Cloud-Based, Intelligent, Open Workflow Engine to Healthcare

As King of All Workflow In Healthcare, I pay close attention to our increasingly porous borders with adjacent kingdoms. So-called SMAC technologies (social, mobile, analytics and cloud) are diffusing into healthcare. Along with them, process-aware technologies (workflow engines, business process management, adaptive case management) are arriving too. Therefore I’m particularly interested into Box, a popular online file sharing company, announcing at BoxWorks 2014 (ending today) both a workflow engine and secure healthcare initiatives.

Here’re some quotes and links:

“At BoxWorks 2014, Box detailed a new workflow management tool set to arrive next year as well as a new service that is essentially a custom-built Box platform for the retail, health care and media industries.”

“The service is essentially a customized version of the core Box platform that is tailored to meet the needs of a particular field. For example, Box for Industries for healthcare comes allows users to access content on their mobile devices that adheres to HIPAA standards and will help doctors collaborate with one another on research.”

http://gigaom.com/2014/09/03/box-announces-new-industry-specific-service-as-well-as-a-workflow-management-tool/

“Box is initially launching in Retail, Healthcare, and Media & Entertainment, three industries where we’ve worked with launch customers and partners to co-design solutions for each market. We’re thrilled to be working with incredible brands like … Stanford Health Care, MD Anderson Center, and St Joseph Health for Healthcare”

http://blog.box.com/2014/09/boxs-next-act-box-for-industries/

“By combining our core content and collaboration capabilities with new automation and metadata features, we’re able to drive workflows built around your most important content and data….

  • Rules-based: Admins can drive specific tasks and actions based on a set of rules that touch actions, events and objects in Box. These rules are fundamental building blocks to building better business processes.
  • Intelligent: Because process is about the content, not just filenames and folders, you’ll be able to use Box’s machine learning algorithms to intelligently classify and recommend related documents with little to no manual intervention.
  • Open: Get direct access to content, collaboration, and metadata events through the Box V2 API. Enterprise developers, architects, systems integrators and ecosystem partners can build custom processes and products on top of the Box Platform.”

http://blog.box.com/2014/09/introducing-box-workflow/

In fact, I don’t believe that Box announcing its workflow engine and foray into vertical industries, including healthcare, is a coincidence. The thing that most distinguishes vertical industries, especially healthcare, are their workflows! Thus, it is this customizable, rules-based, intelligent and open workflow automation that makes it possible to move from an horizontal application (file sharing) to a vertical application such as automating healthcare workflow.

I’ve frequently written about relevance to healthcare of Workflow-As-A-Service and cloud-based workflow engines and Business Process Management. If the folks who know clouds and workflow tech can assuage healthcare’s HIPAA-crats, this approach is going to (eventually) take off like gangbuster. I am certain routing for it to do so. Health IT and EHRs are notoriously workflow-oblivous. The faster we can move to truly process-aware platform foundations, the faster we’ll begin to master the usability, interoperability, and patient safety issues bedeviling health IT.

Here are today’s healthcare-specific presentations at BoxWorks 2014 in San Francisco.

11:45 PTZ

Box for Healthcare and Life Sciences
Speaker: Missy Krasner, Head of Healthcare and Life Sciences
Bill Russell, St Joseph Health System
Monica Gupta, Stanford Health Care
Jeff Frey, MDAnderson
Derek Powell, Edwards Lifesciences
Room: 130-31
Level: Intermediate
Audience: IT, CIO/Business
The consumerization of IT backed by the evolution of the cloud is shaking up the healthcare and life sciences industry. This session will cover how healthcare providers and pharma companies are transforming the way they communicate and collaborate with internal and third parties, as well as how they are addressing HIPAA compliancy and data security.

http://www.boxworks2014.com

1:30 PTZ

The Innovation Curve in Healthcare: New Technologies and Policy Implications
Speaker: Missy Krasner, Box Managing Director Healthcare and Life Sciences
Aneesh Chopra, Co-Founder Hunch Analytics Formerly at U.S. White House
Darren Dworkin, Cedars-Sinai Health System
Don Jones, Scripps Translational Science Institute, formerly at Qualcomm Life
Dr. David Langer, Lenox Hill Hospital, North Shore LIJ/ Hofstra School of Medicine
Room: 134
Level: Intermediate
With sweeping changes to healthcare delivery, policy and insurance in the United States, innovative health IT technologies are emerging to help providers and patients improve communication and coordination of care. We’ll answer questions like, where are we on the innovation curve regarding mass adoption by consumers? What is the next big thing in healthcare? Topics will range from new ways to procure insurance online, to consumer-mediated data sharing to remote monitoring and wearables.

http://www.boxworks2014.com

By the way, re wearables, check out my free webinar on 9/16:
Wearable Workflow Needs Health Systems Engineering.

2:30 PTZ

Box Workflow: Doing More with Content in Box
Speaker: Annie Pearl, Box Sr. Product Manager, Governance
Justin Slaten, Netflix
Room: 130-31
Level: Advanced
Audience: CIO/VIP IT/Admin
Since we launched Policies and Automations earlier this year, we’ve made some awesome updates and added new capabilities. Bring your laptop and your Box account to this workshop. Get the inside scoop on the new process superpowers we’re unveiling through the rules engine in the Box platform.

http://www.boxworks2014.com


Posted in healthcare-BPM | Leave a comment

Health Systems Engineers Are, In Essence, Industrial Engineers By Another Name

I’m working on slides for my keynote at the Society for Health Systems February Healthcare Systems Process Improvement Conference in Orlando. (February, Orlando, that sounds nice!). The title of my talk is Wearable Workflow Needs Health Systems Engineering. I have a Masters of Science in Industrial Engineering from the University of Illinois. That department is now named the Department of Industrial and Enterprise Systems Engineering. So I thought I’d better look up Systems Engineering, just to make sure it’s what I think it is.

shs-ad-webinar

There it is, under the Wikipedia entry for Industrial Engineering, “health systems engineers are, in essence, industrial engineers by another name.” I’m good to go! I can use the same outline I’ve used over the years (designing a medical informatics curriculum and an EHR workflow system).

  • Work Study and Human Factors: Tools to improve efficiency in production systems, motion and time Study, job evaluation, human factors (including aviation human factors) and ergonomics (usability).
  • Industrial Engineering Tools: Production and inventory management, scheduling, facilities location and layout, material handling, production chain management, engineering economics.
  • Operations Research and Decision Theory: Statistics, optimization of production systems, probability theory, queuing theory, game theory, graph theory, decision analysis, and simulation.
  • Quality management: Basic tools of determining quality problems in production systems.
  • Automation: Impact of computers on design, implementation and management of production systems; for example, workflow-oriented groupware systems.
  • Project Management: Project planning networks and identifying critical paths.
    Systems Design: Planning, installing and managing of production systems.

Then I realized I didn’t have a blog post on this topic, even though I’ve often thought about writing one. So, here it is!

Cheers

Chuck

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Healthcare Services Platform Consortium Business Process Management Marketecture

Five years ago, when I set up this blog, I set myself the task of tracking diffusion of Business Process Management and related process-aware technologies into healthcare. I also aimed to educate and market the same, to accelerate transformation of workflow-oblivious health IT into true process-aware health IT. I’ve written and tweeted about IBM (IBM: Using BPM Tools and Methodology in Healthcare) and Siemens (Complex Event Processing, Business Intelligence, and Business Process Management From Siemens Healthcare) leveraging BPM. See also my five-part series on the much trafficked health IT blog EMR and HIPAA: BPM-based Population Health Management & Care Coordination: Workflow, Usability, Safety & Interoperability Perspectives.

So I’m delighted to see milestone, of a sort, achieved… a major health IT consortia is tackling in interoperability, and leveraging workflow technology, AKA Business Process Management (BPM) at the core of its “marketecture”.

“Healthcare Services Platform Consortium, a group of providers, IT vendors, system integrators and venture-led firms dedicated to solving the industry-wide interoperability problem.”

This trend, to use workflow tech to solve interoperability problems is at the heart of my well-reviewed and tweeted From Syntactic & Semantic To Pragmatic Interoperability In Healthcare.

Read HSPC Incorporates, Gears Up to Tackle Interoperability Problem and then take a tour of slides from their slide deck I tweeted immediately because I was so impressed and excited. Take a look at the marketecture layers in the above slide: workflow, process, business model…. Then, there’s the title: Seamless Service Orientation with BPM and SOA. SOA stands for Service-Oriented Architecture. Those are the building blocks. But what puts the building block together? What is the usability cement combining the bricks into seamless whole? Business Process Management!

So, what is Business Process Management? I’ve written about this topic many, many times. Probably the best single overview of BPM from the point of view of its relevance to solving healthcare and health IT’s many workflow problems (usability, interoperability, and safety, to mention the top three), is my EMRs and EHRs Need to Solve “The BPM Problem”: Why Not Use BPM to Help Do So?

Now closely examine the next slide. “Workflow SDK… Intercepts actions and events on the OS level… Monitors state of every application… Delivers a seamless in the workflow integration.” What we’re essentially talking about here, is, a retrofitting of workflow-oblivious health IT legacy applications with the more modern process-aware BPM technology. The reason actions and events are intercepted at the operation system level, is there’s a natural decomposition of here, between app and OS. The apps may be monolithic. The OS may be monolithic. But there’s a place, between app and OS, where communications between apps and OS can be captured. Language translation systems often use this same technique. An app sends “Hello” to an OS managed dialogue box. The “hello” is trapped between app and OS (which manages dialogue boxes) and substitutes “Hola”. It will be very interesting to see is this approach will work.

Now the following slide is the key, the key to combining two healthcare subdomains crying out to be reunited. On one hand we have the process improvement folks (quality improvement, Lean, 6 Sigma, etc.). On the other hand, processes are so mediated by software that they are essentially DICTATED by software. This is why doctors hate EHRs! The doctor’s workflow is different from the EHR’s workflow. But, unfortunately for the doc, it’s actually painfully EASIER to change the doctor’s workflow to fit frozen health IT workflow, than to change health IT workflow to fit the poor doc’s workflow. So many of our problems today, in the health IT industry, boil down to this unfortunate fact.

What is to be done? CHANGE THE FACTS. That is, change what economists call the Production Function, and the rest of us engineers, scientists, analysts, and programmers call “technology.” And, if we change workflow-oblivous health IT technology into process-aware health IT technology, we can achieve a virtuous cycle. The processes that process improvement folks are trying to improve are locked up in software. But that software is directed by representations of workflow that can be improved by users editing process definitions and, increasingly, automatically through machine learning (Think Google Now for Health IT).

Compare the previous slide, from the HSPC slide deck, with the virtuous cycle rounding from workflow and process design, though execution and monitoring, then through simulation and optimization, and finally back through design and implementation of improved workflows and processes, with the following slide from one of my webinars several years ago. In this webinar the topic was the advantage of adding BPM technology to an ECM (Enterprise Content Management) system: Enterprise Content Management & Business Process Management: A Healthcare Game Changer.

slide30

THEN compare both slides to this classic depiction of the BPM life cycle from its Wikipedia entry.

200px-business_process_management_life-cycle_svg

All three of the previous diagrams, from the HSPC slide deck, my own slide about BPM and ECM, and the BPM Wikipedia entry, emphasize the virtuous cycle of process improvement that current workflow-oblivious health IT makes very difficult. In fact, one definition of BPM is, the “process improvement process” (done on steroids, with the right software.

By the way, one of these days I’ll put the aforementioned webinar online, including recorded narration, on YouTube. In the mean time, check out my BPM & Case Management: Healthcare Needs You! YouTube video.

To sum up this post: Hold Onto Your Hats: BPM in Healthcare is Taking Off!

And I could not be more delighted or excited!

P.S. I’m very interested in which BPM platform they will go with…. I suspect it will be one which one of the consortium partners already uses…. which means it might be… or … :) …. Whoever’s BPM stack is adopted, that is an enormously strategically powerful position in which to arrive!

Posted in healthcare-BPM | Leave a comment