I was going to write a blog post for the upcoming AHIP Institute (June 3-5 in Nashville) titled “10 Reasons Why Health Plans Need to Double Down on Modern Business Process Management!” (and I still might!). But then this week’s #HITsm (Health IT Social Media) tweet chat topics were posted. I’d been thinking of writing a workflow version of the recent 95 Theses for a New Health Ecosystem, so I did, tho scaled down due lack of time (certainly not lack of ideas or ambition).
By the way, AHIP stands for America’s Health Insurance Plans. As I usually do before a conference with a substantial health IT component, I search every exhibitor website for evidence of workflow technology. The good news is that health payer IT is a hotbed for the kind of customizable workflow, process-aware BPM (Business Process Management) style tech I advocate. As healthcare increasingly integrates clinical and financial IT system, a task for which BPM is ideal, health payer IT is a major route for diffusion of workflow tech into health IT and healthcare.
1. Thou shalt not be enslaved and oppressed by your Health IT workflows.
Users of health IT, from clinical staff to patients to health plan employees, need to own their workflow. What could I possibly mean by “own workflow”? How can we make it possible that patients, physicians, the intended beneficiaries and users of these IT systems, should own their own workflows?
Use workflow technology. Draw workflows in workflow editors. The results are both executable by workflow engines and understandable by non-programmers. Some of these systems look like traditional workflow diagrams, such as produced by Visio. If you don’t think non-programming users of these systems can understand workflow diagrams (many can, in my experience), then there are systems that present simplified, but still usefully editable, workflow.
What if patients, physicians, and other health IT users don’t want to click or touch anything during design? BPM (Business Process Management) systems can be changed, even implemented, a magnitude faster than traditional health IT system. Analysts (business and clinical) can quickly iterate through a series of workflow designs, until converging on workflow satisfactory to patients, physicians, and staff. In either case, super-users creating super workflows, or healthcare organization analysts doing the same in close coordination with users — break the workflow monopoly that has been imposed on us by workflow-oblivious legacy health IT.
2. Thou shalt not force fit clinical and financial workflow into workflows dictated by workflow-oblivious health IT systems.
Most current health IT systems have relatively frozen workflows. They have no means to use workflow execution context (”enactment” in BPM parlance) to intelligently decide at run-time what and how to paint content on each screen and which screens to present in which order based on user who-what-why-when-where-how context.
Structured-workflow-based IT systems, AKA modern Business Process Management work/flow platforms have exactly this means. Combining this means with usability engineering and appropriate governance promises more systematically improvable health IT workflow and usability.
3. Thou shalt not confuse healthcare workflow with workflow technology.
You wouldn’t confuse your baseball card collection with the Microsoft Access database management system you use to manage it. Or your patients with your EHR. Or your health plan members with your membership management system. But people, especially in healthcare, confuse workflows with workflow management systems all the time.
Workflow is what actually happens when work is done. It is a series of steps, or tasks, that consume resources (money, time, effort, attention), and achieve one or more goals. Virtually all purposeful activity involves workflow.
Workflow technology, on the other hand, has some sort of model of workflow. This is model is executed or consulted, in conjunction with human users, when they do their jobs. These executable process models are at the heart of what distinguishes healthcare workflow technology from generic healthcare information technology. All information systems “affect” workflow (that is, influences workflow, for good or ill). But healthcare workflow technology “effects” workflows (that is, drives, makes it so, in the Captain Picard, Star Trek sense).
4. Thou shalt replace “Data Silo” with “Workflow Silo in your vocabulary.
Metaphors are not just flowery language used by poets. The metaphors and analogies we use, user-friendly (treating computers as people), data silo (farming, nuclear war), and data liquidity (flowing water), powerfully influence how we think. That is the point of Metaphors We Live By, an influential book in cognitive science.
I propose we stop talking about ‘data silos’; start talking about ‘workflow silos”. Data and workflow are related concepts, but very different ways of looking at healthcare. In fact, almost everywhere you see ‘data’ (especially in a headline), just replace it with ‘workflow.’ You’ll be pleasantly surprised by the innovative ideas that just seem to begin to, well, flow
5. Thou shalt use workflow technology to create true workflow interoperability.
“WFM/BPM systems are often the “spider in the web” connecting different technologies. For example, the BPM system invokes applications to execute particular tasks, stores process-related information in a database, and integrates different legacy and web-based systems….
— Charles Webster MD (@wareFLO) April 29, 2015
…Different components may fail resulting in loss of data and parts of the systems that are out of sync. Ideally, the so-called ACID properties (Atomicity, Consistency, Isolation, and Durability) are ensured by the WFM/BPM system; atomicity: an activity is either successfully completed in full (commit) or restarted from the very beginning (rollback), consistency: the result of an activity leads to a consistent state, isolation: if several tasks are carried out simultaneously, the result is the same as if they had been carried out entirely separately, and durability: once a task is successfully completed, the result must be saved persistently to ensure that work cannot be lost. In the second half of the nineties many database researchers worked on the so-called workflow transactions, that is, long-running transactions ensuring the ACID properties at a business process level [40, 109–113]. Business processes need to be executed in a partly uncontrollable environment where people and organizations may deviate and software components and communication infrastructures may malfunction. Therefore, the BPM system needs to be able to deal with failures and missing data. Research on workflow transactions [40, 109–113] aims to gracefully handle exceptions and maintain system integrity at all times.”
6. Thou shalt build your next great health workflow app on a true work/flow platform.
If you can’t find any health IT applications that fit your needs and workflows, and you don’t want to create such health IT applications from scratch (meaning hiring programmers to write code) consider a “low code” approach.
- Design your app on a modern platform.
- Draw workflows in a editor without coding.
- Design forms with point-and clicks.
- Use the completed application over the Web.
7. Thou shalt use intelligent workflow to create engaging patient experience.
The intelligent workflows behind engaging patient experience… what do I mean by that? Well, I mean something similar to “the systems behind the smiles”, i.e. the “robust systems and processes” employees need to simply assume exist, so their minds are free to extend fantastic service. Healthcare needs both, great people and great workflow. I tend to focus on the workflow tech necessary to deliver great workflow, but first I must acknowledge healthcare’s great people.
— Charles Webster MD (@wareFLO) April 29, 2015
We’re moving from Systems For Transactions to Systems for Engagement. Systems For Engagement focus on delivering adaptive user experience. They’re idea for fast-paced change. And they support new work patterns, such as embracing mobile and social.
Workflow tech continues to diffuse into healthcare and health IT, especially with its maturing hooks into social, mobile, analytics, cloud, and even Internet of Things and wearable technology. As a result, health IT, and even EHRs, are becoming more effective, efficient, flexible, and relevant to the patients who encounter it when they have to, and the providers who use it daily.
8. Thou shalt use modern Business Process Management for Population Health Management.
The best technology on which, from which, to create care coordination platforms is workflow technology, AKA business process management and adaptive/dynamic case management software. In fact, when I drill down on most sophisticated, scalable population health management and care coordination solutions, I usually find a combination of a couple things. Either the health IT organization or vendor is, in essence, reinventing the workflow tech wheel, or they embed or build on third-party BPM technology.
— Charles Webster MD (@wareFLO) May 12, 2014
Seven advantages of BPM-based care coordination technology. It…
- More granularly distinguishes workflow steps
- Captures more meaningful time-stamped task data
- More actively influences point-of-care workflow
- Helps model and understand workflow
- Better coordinates patient care task handoffs
- Monitors patient care task execution in real-time
- Systematically improves workflow effectiveness & efficiency
9. Thou shalt carry the message of usable, agile, interoperable, and transparent workflow far and wide!
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.
— Charles Webster MD (@wareFLO) June 15, 2014
9.5/10. Thou shalt not feel constrained by cute blog post titles as to content in your blog post.
My blog post title has been riff on the recent 95 Theses for a New Health Ecosystem (scaled down due lack of time, certainly not lack of ideas or ambition). Health IT reminds me of that old poem line, “Water, water, everywhere, Nor any drop to drink”, except in this case it’s “Data, data, everywhere Nor any workflow to connect, to accomplish, to measure, to track, to harness”.
Data mentioned 20 times, workflow zero times > 95 Theses for a New Health Ecosystem https://t.co/DeBlhCpGwm need health workflow reformation
— Charles Webster MD (@wareFLO) May 4, 2015
Let’s change this!
Fellow workflowists, viva la workflow!