Give BPM A Chance: Medical Informatics Should Add Business Process Management To Its Toolkit

The American Medical Informatics Association (AMIA) conference occurs this week in San Francisco. I’ve attended and occasionally spoken at this annual gathering of several thousand thought leaders. Ever since SCAMC (out of which the conference evolved) I’ve watched ideas go from gown (academia) to town (industry) over-and-over again.

There is a remarkable exception to this pattern, though. The health IT industry is considerably further along in adopting workflow technology than medical informatics professional are at studying it. And workflow technology, variously referred to as process-aware information systems (PAISs), Business Process Management (BPM), and Workflow Management Systems (WfMSs) is considerably further along outside of healthcare than in health IT. WfMSs have literally been around for decades, but have been little used or discussed in health IT.

Recently, however, BPM and WfMS technology has begun to more rapidly diffuse into health IT. I know this because every year for the past five years I search every website of every exhibitor at the annual HIMSS conference (for example). I search for such phrases as “BPM”, “workflow management”, “process orchestration”, and “workflow engine” (an important software component of these systems, whatever they are called). Five years ago, starting with HIMSS11, there was very little evidence of workflow technology. But then the number of exhibitor websites with interesting workflow and workflow tech storied essentially doubled every year, all the way from two percent to over a third. At this year’s HIMSS15 in Chicago, five percent of exhibitor websites (~75) mentioned “workflow engine” someplace (technical documentation, user forums, sometimes even marketing or on their home page!).

There is something else I do every year. I search the entire AMIA proceedings (over 2000 pages and 100M pdf!) for the same sorts of content (Workflow-Related #AMIA2014 Papers and Posters). I find more-and-more “workflow”s (509 hits this year, not counting hyphenated “work-flow”s due to line breaks and the unfortunate “work flows”). But still very little, if any, evidence of workflow technology. There were only two instances of “Business Process Management” this year. Both were in the titles of references. One was to my 2012 EHR Business Process Management: From Process Mining to Process Improvement to Process Usability. The other was right next to me, to a 2010 workshop about BPM in healthcare. This workshop was, notably, held abroad. Historically, most BPM academic research has not occurred in the US, possibly explaining some of it’s relative lack of penetration into medical informatics research.

Every year during the AMIA conference, I engage tweeps monitoring and tweeting on the conference Twitter hashtag, this year #AMIA2015. Last year I precipitated some interesting debates about whether medical informatics has sufficiently paid attention or workflow technology. I’ve lots of tutorial content on my website (for example, my Workflow Interoperability in Healthcare series), and I offered up this links (another example, BPM-based Population Health Management & Care Coordination: Workflow, Usability, Safety & Interoperability Perspectives). I think I did get a couple dozen #AMIA2015 tweeps to follow me and to continue the conversation after the conference. Thank you! (You know who you are.)

In this post I’d like to point you to two recent articles. One is a traditional (to medical informatics academic eyes) research paper measuring the effects of workflow technology on organizational performance. Several of the surveyed organizations are in healthcare. The other article is about a particular BPM product. I chose it because as much as I love research, it will be actual for-sale products and services that will bring true modern process-aware workflow technology to healthcare customers, employees, and independent providers.

This is the research paper, The Effectiveness of Workflow Management Systems: Predictions and Lessons Learned, is the first longitudinal study of the effective of workflow technology and organizational performance. To follow (and follow-up) so many real-world organizations over so many years must have taken an extraordinary amount of work.


“Workflow management systems are widely used and reputable to improve organizational performance. The extent of this effect in practice, however, is not investigated in a quantitative, systematic manner. In this paper, the preliminary results are reported from a longitudinal, multi-case study into the effectiveness of workflow management technology. Business process improvement is measured in terms of lead time, service time, wait time, and resource utilization. Significant improvement of these parameters is predicted for almost all of the 16 investigated business processes from the six Dutch organizations participating in this study. In addition, this paper includes lessons learned with respect to the simulation of administrative business processes, data gathering for performance measurement, the nature of administrative business processes, and workflow management implementation projects.”

The second paper recently appeared in an IT trade publication, notably Integration Developer News (notable due to the importance of “integration” to interoperability). I highlight this article for three reasons.

  • I am familiar with the Appian BPM platform. They are headquartered in the Washington DC areas, where I currently live.
  • Appian consistently ranks extremely high in both modernity of its technology and ability to execute.
  • What this article discusses is squarely situated among many current medical informatics topics (or, in several cases, should be). The following are the articles tags: agile, Appian, apps, BPM, CEP, data, deploy, devices, integration, mobile, OSGi, platform, SOAP, REST

The title of this second paper is, Appian Modernizes BPM; New Platform Creates ‘Agile Apps’ That Share Any Data, Run on Any Device.

Here are key quotes:

“app platform combines BPM’s power to build apps ‘drawing a picture’ with easier ways for apps to share data and run on multiple devices – often with little or no coding”

“flexible any-to-any environment for apps, data, devices and users”

  • “Faster, visual ways to build apps
  • The ability for apps to retrieve and share data from hundreds of outside sources.
  • Apps the capability to deploy without complex coding on any device, including PCs, laptops, phones, tablets and even wearables and IoT devices.”

“Breaks Silos, Eases Integration … any app should be able to get any data and run anywhere”

“In the old [custom app] vertical model, every app has its own data source and its own interface,” … Today, with so many more data sources and device interfaces, a new ‘horizontal’ model for how apps work is necessary” (play attention SMART on FHIR folks)

“every time you plugged in new data or new users, all those assets became available to the entire universe of users”

“Library of system-specific connectors to established enterprise apps, including SAP, Oracle Siebel, Microsoft Dynamics, Microsoft SharePoint, and Content Management Interoperability Services (CMIS).”

‘Pre-built library of integration options for SOAP and REST web services. These include the ability to model and build complex orchestrations.”

“Complex event processing (CEP) to let users combine and correlate events from multiple systems. CEP will also recognize patterns, as well as define process-based responses and notifications.”

“Data parsing and transformation via data extraction and manipulation tools. These parse and transform content between systems in automated processes.”

“A secure data store to make it easier to govern data integration, to ensure data is only shared where there are permissions.”

OSGi framework-compliant plug-ins and capabilities for custom extensibility.”

“Appian is also enlisting support of many third-party partners for its new app platform. Just last month, the company launched its Appian App Market, a collection of ready-built business apps and components for the Appian platform.”

I don’t know about you, but wearing my medical informatics hat — I designed the first undergraduate program in medical informatics in the early 90s — all the above, all, is extremely on-point regarding today’s medical informatics and health IT challenges. If you read the research paper and trade journal article together, you see two things. First, using workflow technology (AKA BPM) is nontrivial but worth it. Second, from a (potentially) health IT and medical informatics perspective, you see specific software capabilities of a leading BPM platform.

If you are attending this week’s AMIA conference in San Francisco, or simply monitoring the #AMIA2015 hashtag, I hope you’ll, to paraphrase a Beatle, “Give modern BPM a chance.”

@wareFLO On Periscope!


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