Patient Experience And Engagement, Workflow And Workflow Tech: What Is The Connection?

I’m not a touchy-feely person. At least I don’t think of myself that way. But I have feelings, anxieties, hopes, dreams, etc., of which can be hurt, assuaged, encouraged, etc. And I’m a patient too. A patient who experiences our healthcare system.

I’m also well-known for obsessively blogging and tweeting about workflow and workflow tech. Hence the tweet above.

So I asked myself: Patient Experience And Engagement, Workflow And Workflow Tech: What Is The Connection?

The following is somewhat technical, about patients as resources, in roles, and planning workflow systems around them. I know some take offense at calling a user, let alone a patient, a “resource”, especially to be “exploited,” but this is just systems engineering jargon. I actually think of it similar to a kind of distancing a medical student goes through the first time they confronting cutting through the flesh of a naked, dead, stranger in anatomy lab. We retreated into a conceptual universe of abstractions, about articulation and layers and orientation. We did this, I know we told ourselves, to better learn and better perform and better serve humans and humanity. No less, systems engineers seek to design systems that learn and perform and serve humans and humanity. The jargon is just shorthand to think and communicate more analytically. In this paragraph I am both defending viewing patients as resources, who fill roles, and have jobs to do, and confessing mixed feelings about doing so.

[6/3/14: I recently spotted these tweets from Health Data Palooza, also mentioning patients are resources.]

Now that I’ve prepared you for the gobbledy-gook…

From my comment on Translating Healthcare’s Rosetta Stone:

Thank you Mary Ann, for your “Thank you”!

Business process management ideas and software can accommodate both patient-centric and physician-centric emphases. The patient role is a “role”, just as the physician’s role is too. According to the Workflow Management Coalition’s “The Workflow Reference Model” a role is “a collection of participants based on a set of attributes, qualifications and/or skills.”

So, what are a patient’s (or customer’s or client’s or whatever is consistent with political, marketing, or ideological orientation) attributes, qualifications or skills? When a process-aware health information system is designed, encompassing patient activities, the patient’s role needs to be defined as part of that design. More abstractly, the patient is a resource, just as other users are resources, necessary to accomplish a business process (or clinical process, health process, or just “process”, again terminology varies according to agenda).

Just as physicians, nurses, technicians, transcriptionists, billers, and other staff have worklists in which workitems appear (placed there by a workflow engine executing a process definition, or placed there in an ad-hoc fashion by a human user), patients could and should have worklists of workitems too (perhaps appearing in smartphones). Of course, patients (and physicians and nurses and others too) may ignore these items, in which case these items can be programmed to automatically escalate. Some of these items also may be accomplished automatically or semi-automatically via home or mobile devices on, connected to, near, or ambiently present near, the patient.

Current structured-document, as opposed to structured-workflow, EHRs don’t have the necessary process-centered data models necessary to represent patient and provider roles and to automatically, semi-automatically, or manually (but with real-time activity monitoring and visibility plus subsequent opportunity for design-time improvement) execute, or “enact”, healthcare processes. This is a large part of the reason that I believe that health IT needs to move from debate about patient-centered versus physician-centered design (“Who is the real user?”) to a more encompassing view (including explicit and executable representations) of the processes within which users (including patients) are embedded.

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