Ebola, APIs & Workflow: We Need A More Process-Aware Health IT Ecosystem

Reviews are in!

I was all set to write a blog post about today’s #HITsm API (Application Programming Interface) questions. (See below if link is out of date.) I’ve “consumed” APIs (written code to call them). I’m even creating a crude API for a little Internet-Of-Things project I call @MrRIMP.

  • Topic 1: Modified from @KBDeSalvo: What will the #healthIT ecosystem be like in 2024? What role can APIs play?
  • Topic 2: Pay now or pay later: How much consistency should EHR APIs have? via @GrahameGrieve #HITsm
  • Topic 3: Via @UsabilityPeople: What is needed for APIs to be more “usable?”
  • Topic 4: Modified from @Greg_meyer93: Are APIs the solution? Are they simply ‘enablers?’
  • Topic 5: Raised by @VinceKuraitis: Public API. Describe & discuss the benefits.

But then….

…blamed on EHR workflow…

Well, IT hit the fan this morning (at least on Twitter). The failure to immediately quarantine an Ebola patient upon presentation to a Texas emergency department is being blamed on EHR workflow.

Now, whether or not it’s the EHR fault, I don’t know. I’m looking forward to some sort of forensic workflow post mortem…. But lots of people cc’d me on tweeted links to the story, because, presumably, I tweet a lot about EHR and health IT workflow and workflow tech. Since workflow can be between people, between people and machines, or between machines, workflow problems aren’t automatically EHR problems. But discussion will be fascinating to watch play out.

No, what I really want to do here so pivot from Ebolagate to how a more process-aware health IT system could better respond to similar public health emerging emergencies. Back in 2008 I gave the following presentation at the HIMSS conference in Florida. You can watch it here for 18 bucks. My presentation was, essentially, about APIs and workflow between public health entities and EHRs.

This is a framework I developed to compare connecting an EHR to a public health IT system:

  • Project Management
  • Standard Data Format
  • Simplicity of Dataflow
  • Maturity of Transport Infrastructure
  • System Stage (such as Production vs Testing)
  • Data Format

I think it’s still a pretty good way to compare health IT interface and integration projects. Perhaps at some future date I’ll update the rest of my slides to reflect today’s concerns and technologies.

But for now I want to get this blog post up before today’s #HITsm chat on APIs (Application Programming Interfaces).

The basic problem confronted by public health professionals and users of EHRs in emergency departments boils down to the degree to which the systems they use are “process-aware.” Process-aware systems have some sort model of work or workflow that is executable or at least mechanically consultable. Why do I say this? Because we, as a nation, need to be able to automatically, or at least semi-automatically push candidate workflows from public health organizations down to EHRs at the point-of-care. And to do so in a way that supports, but does not disrupt, evolutions in workflow necessary to, say, flag someone who just came back from Liberia. The only way to do this is to actually model workflow. And to transmit these models of workflow via APIs.

P.S. I’ve got over 50,000 tweets about healthcare workflow (including cat videos) at @wareFLO, and about a third of million words across this several blogs.

Please interact with me on Twitter at @wareFLO, leave comments on any of my blogs, and contact me to help accelerate change. While I believe it is only a matter of time before current workflow-oblivious health IT system are replaced by truly process-aware health IT systems, we may be in a race. A race to implement these systems, at the front lines of healthcare, before the next, more virulent Ebola-like threat looms.


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