#HIMSS14 and Workflow: Are We Making Progress Taking Business Processes Out Of Applications?

With a 37+ thousand tweets about healthcare workflow (well, a majority) and almost a half-million words on three blogs, I’ve been quizzed: What, exactly, are you trying to accomplish?


My answer is always the same: Change health IT. I say this without hubris (well, maybe a little) because I’m not the only one. Mine is increasingly becoming a group effort, and social media has been essential to creating a ragtag band of Workflowistas. I, we, are gradually seeing light bulbs gradually appearing over the heads of thousands of health IT professionals.

When did my light bulb go off? Well, as an pre-med Accountancy major, who went on to degrees in Industrial Engineering and Intelligent Systems, that light bulb been around for a long time. However, it went from dim to bright when I read the following (from @wvdaalst and van Hee’s Workflow Management: Models, Methods, and Systems):

1965-1975: decompose applications.

During this period, information systems comprised decomposed applications, each with its own databases and definitions. The applications ran directly on the operating system and had just a simple command line interface or custom-made graphical interface.

1975-1985: database management – “take data management out of the applications”.

This period is characterized by the rise of the database management system (DBMS). A database is a permanently available, integrated collection of data files, which can be used by many applications. The use of databases has the advantages that data managed by different applications can be combined, that data structures only need to be defined once, that the organisation of data can be handed over to a database management system, and that the same data item only needs to be stored once.

1985-1995: user-interface management - “take the user interface out of the applications”.

During this period, the user interface was extracted from the application program. Originally user interfaces were designed by the developers screen by screen, field by field. Not only did this take up a lot of time, but also each designer had her own style, which meant that every system had to operate in a different way.

1995-2005: workflow management - “take the business processes out of the applications”.

Now that data management and user interfacing have largely disappeared from applications themselves, it seems that much of the software is devoted to business processes (procedures) and the handling of cases. Therefore, it has become attractive to isolate this component and find a separate solution for it. Not only can this accelerate the development of information systems, but it also offers the added advantage that the business processes become easier to maintain. A workflow management system (WfMS) manages the workflows and organizes the routing of case data amongst the human resources and through application programs.”

I’ve given many presentations (increasingly online, as most everything is these days) about diffusion of workflow tech into healthcare. Above’s the slide I created to depict the have of change of application architecture. Right now, health IT is in the early stages of joining the rest of the world, partway between taking the user interfaces out of applications and taking workflow out of applications.

Last year I visited every one of the 1200+ HIMSS13 exhibitor websites. About 8% has showed technical and/or marketing signs of workflow tech adoption. I did the same for this year’s HIMSS14 in Orlando. About 16%-20% (depending on my inclusion/exclusion rules, sound familiar?) of exhibitor websites showed signs of workflow adoption.

So what?

Almost everything I’ve written on this and other blogs, and tweeted every day, about effective, efficient, flexible, satisfying, improvable workflow, requires process-aware tech, technology that represents, executes, reasons about, and systematically improves workflow.

And I just observed a more than doubling of process-aware tech between #HIMSS13 and #HIMSS14.

I’d say that’s progress!

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