Anyone who reads my EHR Workflow Management Systems blog, or follows me on Twitter at @EHRworkflow, knows I pay attention to BPM-in-healthcare developments. Business process management and related technologies are underused in healthcare relative to other industries and potential to improve healthcare’s inefficient, ineffective, and inflexible processes. So I was delighted several days ago to see a position paper about BPM and healthcare on BPM’s DeveloperWorks website. It’s a great excuse to follow up the blog post I wrote this spring about IBM Impact 2012 Global Conference (Hold Onto Your Hats: BPM in Healthcare is Taking Off!).
I grabbed the best bits (fair use, mind you, indented and italicized), added some of my own thoughts, and provided links to additional resources.
“Historically, healthcare excellence has been achieved through individual practitioners focusing on being best in their medical discipline. The industry has evolved into a series of independent providers and processes, focusing on intervention. Focusing within each discipline does not provide consideration for the overall patient experience. Today, the healthcare industry is marked by its poor design, high fragmentation, and stunning inefficiency. Care Process Management (CPM) uses best practices for business process management to improve clinical outcomes without changing care processes or displacing the role of health workers.”
- Poor design
- High fragmentation
- Stunning inefficiency
Strong words! But they are sentiments I hear frequently from healthcare IT folks too.
“Care Process Management” is essentially a rebranding of “Business Process Management” for healthcare. The basic motivation to rebrand BPM is that physicians don’t like to think of healthcare as a “business.”
I’ve written (and tweeted) a lot about business process management and healthcare. And I’ve thought about rebranding BPM. Several years ago I defined “clinical groupware” as a kind of brand extension of workflow management systems, business process management, and case management into healthcare.
Factors influencing brand extension success include:
- Similarity between extended-from brand to extended-to brand
- Reputation (strength) of the extended-from brand
- Risk of loss due to purchase of extended-to brand
- Innovativeness of potential customers for extended-to brand
By the way, natural language processing (NLP, another theme on this blog) faces the same dilemma. Clinical NLP vendors speak and write of both clinical language understanding and natural language processing in almost the same breath or sentence. Both BPM and NLP have stronger brands outside of healthcare than within healthcare. Both BPM and NLP have great promise in medicine (See my comments on IBM’s Watson). It will be interesting to watch this terminology evolve over the next several years.
“Care process management (CPM) is the application of business process automation and optimization techniques to clinical care processes in the healthcare environment. CPM uses best practices for BPM to improve clinical outcomes without changing care processes or displacing the role of health workers.”
“[B]est practices for BPM to improve clinical outcomes without changing care processes” is an interesting idea. I wrote about similar in my Automate Your EMR Cow Paths *and* Reengineer Them Too! blog post. The intuition behind this phraseology, which I share, is those information technologies that least disrupt existing clinical workflows will be most easily accepted and implemented. Many electronic health record and health information systems are criticized by users for unusable workflows and no means to improve them. One of business process management’s unique strengths is that its workflows are controlled by explicitly editable (by non-programmers) workflow plans, sometimes called workflow or process definitions.
Healthcare inefficiency and complexity
“[H]ealthcare ranked as the least efficient industry in the world, with more than $2.5 trillion wasted annually”
Holy. Cow. Would you look at healthcare way up there in the upper right! Healthcare is even more inefficient that education and government. By the way, in the lower left, the least inefficient (most efficient) are communication (which I totally get) and leisure/recreation/clothing (clothing I get, but it’d be interesting to go to the original report to find out what it means for leisure and recreation to be so efficient!).
“BPM is the means by which organizations improve their operations by leveraging internal expertise in new and scalable ways. This is achieved by directly engaging business people in the design, definition and creation of enterprise class process applications. BPM excels at providing comprehensive change management of business processes that results in continuous process improvement.”
“CPM is the strategic application of the BPM methodology to clinical care processes in the hospital/healthcare environment. The focus is on the patient and how care is delivered.”
“The traditional application of BPM to the hospital environment has been challenged because many healthcare practitioners do not see healthcare as a ‘business’ but as a ‘calling.’ Healthcare practitioners are not ’servicing customers’ but ‘caring for patients.’ However, CPM does not change what a provider does to care for a patient. It focuses on process improvements - on coordination and collaboration between care providers.”
Here I’ll have to quibble (hey, I am very enthusiastic about this paper, but this wouldn’t be a blog post by me, if I didn’t quibble). I don’t think the issue is that clinicians don’t like the word “business.” They may, or may not, but that’s not what’s keeping business process management technology from more rapidly diffusing into healthcare. In fact, in Top Ten Reasons EHR-BPM Tech Is Not (Yet) Widely Deployed in Healthcare, I list the restraining forces, and none of them are about the word “business” versus the word “clinical.”
By the way, I otherwise agree with the characterization of BPM/CPM as a technology for improving processes. It’s consistent with my favorite short definition of business process management as essentially being about “process optimization process.”
Core IT functionality
- “BPM engine – Care processes execute within a BPM engine. The engine implements the following functions that are critical to CPM:
- Notifies care providers when a patient is admitted, when a consult is requested and when the patient is discharged
- Creates and maintains an electronic version of the multi-disciplinary activity plan on behalf of the doctors and nurses
- Manages assignments, reassignments and coverage of care activities on behalf of care providers
- Can integrate with external systems to schedule medical procedures or equipment”
“BPM Engine” refers to what is often called a workflow engine or orchestration engine. I used to run a yearly three-hour tutorial about EHR workflow management systems. Here are the slides and notes for the workflow engine portion of that tutorial.
It’s worth reading about definitions of workflow systems, workflow management systems, and process definitions first:
- 2006 EHR WfMS Tutorial Slides 98-102: More Workflow Definitions (No Pun Intended) Applied to Patient Encounter
Then read about workflow engines:
- 2006 EHR WfMS Tutorial Slides 103-108: To Be, or Not to Be (the Workflow Engine) That is the Question
“Care process management offers a roadmap that will help the healthcare industry to transform delivery. Without changing what healthcare workers do best, it addresses the inherent inefficiencies of the care delivery process. Many aspects of care delivery can be improved using business process management to automate the coordination of care delivery and to enable providers to collaborate more effectively.”
While I may quibble about whether to call it care process management or business process management, I couldn’t agree more with the rest of the paper. I’m delighted to see BPM vendors beginning to make their best cases for use of BPM in healthcare. There’s remarkably alignment between disadvantages of current process-unaware EHRs and HIT systems and advantages of process-aware information systems: workflow management systems, BPM suites, and innovative case management systems.
If you’d like to read more about combining business process management and healthcare information technology, here are some of my past posts on the topic.
- EMRs and EHRs Need to Solve “The BPM Problem”: Why Not Use BPM to Help Do So?
- Well Understood, Consistently Executed, Adaptively Resilient, and Systematically Improvable EHR Workflow
- What’s So Special about EHR Workflow Management Systems?
- (EHR) Workflow Management: Models, Methods, and Systems
- Top Ten Reasons EHR-BPM Tech Is Not (Yet) Widely Deployed in Healthcare
If you’d like to join a conversation about these topics I hope you’ll follow me on Twitter. We’re a growing band of BPM and health IT researchers and professionals learning from each other. I’ll gladly introduce you around!
P.S. By the way, I know of tweeps who joined Twitter solely to listen to this specific conversation but ended up going quite native, so to speak!