My Excellent Google Glass, BPM, Healthcare Adventure: Appian World 2014 Trip Report

Anyone who follows me on Twitter, or reads more than one of my blog posts, knows I’m the self-styled King Of All Workflow In Healthcare. It’s good-natured ironic puffery dedicated to a good cause. Healthcare has a workflow problem: why not use workflow technology (AKA Business Process Management, or BPM) to solve it, or at least better manage it? I’m based in Washington DC. Nearby is Reston, Virginia, where Appian is based. Appian is, according to Gartner, a respected research and advisory firm, the reigning BPM champ. (See next tweeted slide.)

Even though I’m not an Appian employee, I’ve been to all the yearly Appian Worlds. (Here’s a previous trip report.) Why? Well, if you where fascinated by BPM’s potential in healthcare, wouldn’t you go? This post is a place to collect my favorite tweets, videos, and musing re my experience at this year’s Appian World. I’ll also refer to some previous tweets and material when I think it can provide some healthcare care context and meaning to ideas at what is not a healthcare IT conference.

What was different this year was this: I was one of the speakers, on a panel about BPM and mobility. I was there representing Google Glass. In a previous post I described how I approached Appian about building a proof-of-concept integration between Glass and Appian’s BPM platform. I spoke about how I got Glass, what’s it like to walking around with Glass on, and the hospital (or hotel) environmental services task management app we created.

You can even see and listen to my presentation, albeit from my point-of-view, recorded using Glass.

The hospital/hotel housekeeping task management Glass app I mentioned earlier does three things. A picture of a floor’s QR code retrieves a list of uncleaned rooms. A room’s QR retrieves cleaning history, plus options to request it be recleaned or adding a comment to an activity stream (similar to Twitter or Facebook) shared by housing keeping staff. And, illustrated below, the picture of an employee retrieves name, employment history and list of open tasks (available by tapping on the Glass card below).

Many thanks to Malcolm Ross, VP of Product Marketing at Appian, for enthusiastically facilitating this proof-of-concept integration between Google Glass and the Appian BPM software suite. Below, he traces the rise of business computing and work platforms all the way from ENIAC in 1947.

I participated in a couple interviews. This one with the Washington Post…

And this one with TV channel WUSA9 …

…with Mike Hydeck ….

…and also with Jessica Doyle, who donned Glass to turn the tables on me!

On the way out, TV reporter Nikki Burdine trying on my bright blue Glass, boy does it pop!

The rest of this blog post turns a bit more serious, serious about the serious benefits business process management offers for better management of complex healthcare workflows.

While there were no healthcare-specific presentations at this year’s Appian World, there have been at previous Appian Worlds, as I’ve discussed in previous blog posts. Nonetheless I’m intrigued to see healthcare examples on some of the most interesting slides, such as this one about Appian’s SAIL tech. SAIL stands for Self-Assembling Interface Layer. SAIL is what make is possible to generate workflow apps that will execute across multiple mobile platforms and form factors.

During Appian World 2014, Appian’s website moved into the first position on the first page returned by Google for “healthcare” cross-indexed with “BPM.” I’ve a half a million words on a half a dozen websites about healthcare business process management. I’ve over 42K tweets on the subject. I’ve been posting content about Appian and Appian World… I wonder if there is a connection…

The most relevant healthcare BPM activity and conversations occurred around Appian World exhibitor booths. Besides the Glass BPM hospital housekeeping app demoed (100 times?) at the Appian booth, Incessant Technologies showed off its own use of Appian BPM to implement clinical pathways. In the following five-minute Glass interview Vijay Poondy and Seemant Ahuja of Incessant Technologies explain how and why they’ve used Appian to implement clinical pathways on a business process management platform.

BPM, Business Process Management, has so much potential in healthcare, but it’s been slow to diffuse into healthcare. One of my most popular blog posts is the Top Ten Reasons EHR-BPM Tech Is Not (Yet) Widely Deployed in Healthcare. Fortunately I am convinced this is changing, right now, in a big way. For example, every year I search every website of every exhibitor at the HIMSS conference. That’s over 1300 exhibitors. In 2013 about eight percent had workflow-related technical and marketing material. In 2014 this rose to over sixteen percent. In other words, representation of workflow-related ideas and technologies more than doubled between HIMSS13 and HIMSS14. I think we’re looking at between 50 and 100 percent increase at HIMSS15 in Chicago.

An industrial engineer who went to medical school, I’ve advocated workflow technologies in healthcare for over two decades. Sometimes I was frustrated, because I felt progress was unreasonably slow. But I never doubted that traditional health IT would eventually hit a wall. And it has. Reasons and consequences are varied and complicated. But here I’d like to focus on several windows of opportunity that appear to be opening up.

First, several weeks ago I attended the Healthcare Business Intelligence Forum here in DC. Just as I did at Appian World, I videoed and blogged and tweeted furiously (my Day One and Day Two posts). The following tweeted slide was by far my most popular.

ACO stands for Accountable Care Organization. The Federal Government has spent over twenty billion dollars on subsidizing Electronic Health Records. Now that a majority of physicians and hospitals have EHRs, the challenge is to use them to create ACOs. However, EHRs, alone, will be insufficient. We have to get the data back out of EHRs (that’s the “data warehouse”) in a form we can mine and learn from and use to drive clinical and administrative workflows and processes. That’s the “care coordination platform.” Use of workflow tech, AKA BPM platforms, to implement care coordination systems!

Take a look at the following diagram, from a recently released, high profile report, about the failure of traditional health IT to improve care and reduce cost. The JASON report advocates a decomposition of functionality in order to promote more interoperable health IT systems.

Health IT is complicated, partly due to being a generation behind other industries in adoption of workflow technologies, and partly due to healthcare, itself, being so complicated. We can’t easily do anything about healthcare’s intrinsic complexities, but we can advocate for use of modern workflow technology to better manage modern healthcare’s complex workflows and processes. There are numerous places in the JASON architecture where workflow tech would be the ideal glue between modules as well as workflow-oriented user interfaces to those modules.

One more slide! When I say health IT is behind the times, is hitting a wall, and is literally decades behind other industries in adoption of workflow tech, I mean it.

This slide depicts generations of application architectures. Most healthcare information systems have yet to take the workflow out of applications, out into workflow platforms and services that can better manage and improve it. Let’s solve this problem. Let’s fix HIT. Let’s move current health IT failed “solutions” off workflow-oblivious platforms and to modern process-aware information systems, such as Appian BPM.


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