How Easy Is It To Integrate Availity APIs Into Your Payer-Provider Workflow? Very!

[I am writing this blog post in preparation and support for the upcoming #AskAvaility tweetchat Optimizing Payer and Provider Communications hosted by @shimcode and @HIT_MMartin(@Availity), at 1PM EST, Friday, September 30!]

The following (non-HIPAA sensitive) structured data was pulled across the Availity API (@AvailityAPI) into this blog post via execution of PHP in real-time when you viewed this post in your Web browser. (API stands for Application Programming Interface.)

Member Info (JSON string)nn

Member Info (JSON object)

object(stdClass)#367 (6) {
["firstName"]=>
string(4) “ZENA”
["lastName"]=>
string(6) “MARDIN”
["memberId"]=>
string(4) “H123″
["gender"]=>
string(6) “Female”
["genderCode"]=>
string(1) “F”
["birthDate"]=>
string(28) “1942-09-15T04:00:00.000+0000″
}

Member Info

ZENA
MARDIN
Female
1942-09-15T04:00:00.000+0000
BCBSF
1234567893

Back when I was a CMIO/programmer, we integrated a lot of third-party services with our EHR. In fact, we were constantly contacted by vendors and customers to integrate with this or that partner. We asked two questions of ourselves. Does it serve a need? How easy is it to add to our IT workflows? Clinicians and business people answered the first question. Programmers answered the second.

What’s the best way to see how easy it is to integrate a third-party into your health IT workflows? By taking a quick whack at it. See how far you can get with only a minimum amount of effort. In other words, the proof is in the (eating of the) pudding. It’s the only certain way to tell for sure whether the pudding is tasty, or the integration is (potentially) easy.

proof-is-in-the-pudding400

Sometimes, over a long weekend, a programmer (sometimes, me) sat down with an SDK (Software Development Kit) just to take a wee keek (as the Scottish say), and showed up Monday morning with a working prototype! This put a very different spin on the first question. Instead of a manager saying, sorry, we already have too many other priorities, they said, how soon can you finish this so we can sell it…

So, this morning I logged into the Availity - Developer Center for Health Care APIs to take a whack at it. I wanted to see how easy and fast it is to pull structured data into this blog post, using PHP (in which WordPress is written). It didn’t take very long at all! At the beginning of this post you saw a subscriber JSON string, a PHP JSON object, and name, gender, birth date, payer, and requesting physician NPI.

By the way, here is some entertaining context! (At least to me…) I attended the AHIP Institute this spring and I did what I (almost) always do. I search every website of every exhibitor for evidence they use workflow technology (workflow/process/orchestration engines, editors, mentions of Business Process Management, and so on). I tweeted I was doing so and then I tweeted what I found.

In the mean time Availity is waving its Twitter hand and tweeting: us, us, us! If you are interested in healthcare workflow, you have just got to come talk to use about our API platform and how it’s used to improve payer/provider workflow. The following is from my post AHIP Institute blog post, AHIP Institute Trip Report: Business Process Management & Workflow Engines.

Availity

The following conversation was interesting because Availity wasn’t actually on my initial list. However, they saw me tweeting about AHIP vendors and workflow and basically demanded I come to their booth. I’m glad I did. As Mark Martin explained, they provide the APIs (and a portal) that can be consumed by workflow tech. In fact, if you think about it, even if you have the best workflow engine in the world, you still need data to achieve whatever strategic goal you set. Availity goes beyond currently, typically available standard APIs to empower necessary administrative workflow between healthcare organizations. I love it. Thank you for your enthusiasm, seeing my #AHIPinstitute tweets, and reaching out about this important topic.

When it comes to healthcare APIs, the proof is in the (eating of the) pudding!

Yum!

Thanks Availity!


@wareFLO On Periscope!

firetalk-button2

Posted in social-media | 2 Comments

Communication Ethics in Healthcare and Health IT

WHAT TO SAY WHEN THE WRONG THING WAS SAID

Today’s #HCLDR (Healthcare Leadership) tweetchat topic, What to Say When the Wrong Thing Was Said, hosted by @researchmatters, reminds me of a paper I wrote and presented over two decades ago (in Hong Kong!): Communication Ethics and Human-Computer Cognitive Systems. I discuss communication ethics and its relevance to designing intimate human-technology interfaces. My paper is mostly about humans using and communicating with intelligent tools, from intelligent prostheses to smart robots. In this post I retrieve some of those ideas and apply them to ethical human-to-human communication.

Communication Ethics

“Communication ethics, traditionally, involves the nature of the speaker (such as their character, good or bad), the quality of their arguments (for example, logical versus emotional appeals), and the manner in which presentation contributes to long term goals (of the individual, the community, society, religious deities, etc.) (Anderson, 1991 [in Conversations on Communication Ethics]). These dimensions interact in complex ways”

conv-comm-ethics-300

“Consider Habermas’s (1984) ideal speech…. Communication acts within and among cognitive systems should be comprehensible (a criteria violated by intimidating technical jargon), true (violated by sincerely offered misinformation), justified (for example, not lacking proper authority or fearing repercussion), and sincere (speakers must believe their own statements). These principles can conflict, as when an utterance about a technical subject is simplified to the point of containing a degree of untruth in order to be made comprehensible to a lay person. Thus, they exist in a kind of equilibrium with each other, with circumstances attenuating the degree to which each principle is satisfied.”

Medical Ethics

“Four principles—observed during ethically convicted decision making—have been influential during the last decade in theorizing about medical ethics (Beauchamp & Childress, 1994): beneficence (provide benefits while weighing the risks), non-maleficence (avoid unnecessary harm), self-autonomy (respect the client’s wishes), and justice (such as fairly distribution benefits and burdens, respect individual rights, and adherence to morally acceptable laws). People from different cultures and religions will usually agree that these principles are to be generally respected, although different people (from different cultures or ethical traditions) will often attach different relative importance to them.”

Pragmatic Interoperability

In another series of posts (five parts! 10,000 words!) I wrote about the concept Pragmatic Interoperability. Key to pragmatic interoperability is understanding goals and actions in context, and then communicating in a cooperative fashion. Healthcare professionals are ethically required to cooperate with patients. Implicature part of the linguistic science of cooperative communication.

“We’ll start with implicature’s core principle and its four maxims.

The principle is:

“Be cooperative.”

The maxims are:

  • Be truthful/don’t say what you lack evidence for
  • Don’t say more or less than what is required
  • Be relevant
  • Avoid obscurity & ambiguity, be brief and orderly”

I think most, or all, of the above ideas are relevant to figuring out that to say next, when the wrong thing was said. I will be looking for examples during the Healthcare Leadership tweetchat.

Healthcare Leadership Tweetchat Topics

T1 Beyond classical adverse events like wrong-site surgery or incorrect medication dose, adverse communication events can also occur in healthcare. What types of troubling or harmful communication issues have you experienced that affected your care?

T2 Perceptions vary. Patients may perceive something as a problem, whereas the healthcare team just sees business as usual. How can patients help clinicians understand that perceived problems are as important as actual problems?

T3 What steps can help (quickly) establish rapport between health care practitioners and patients so that if communication goes off-track, each is better equipped to address the problem or perceived problem?

T4 If nurses or other care team members observe poor communication between a physician and patient, what is their obligation–how should they attempt to address the situation?

Posted in natural-language-processing | Leave a comment

Health 2.0 Fall Conference Sponsors Using Business Process Management and Workflow Engines

I searched every website of every Health 2.0 Fall Conference sponsor, 87 in all. I found three companies that emphasize Business Process Management (BPM) and/or workflow engine technology. As I am always trying to encourage more use of workflow tech in healthcare and health IT, I am writing this post to highlight these progressive Health 2.0 sponsors.

The three progressive bringers of workflow technology to healthcare and health IT are…

From the Kainos Evolve website:

(about use of Alfresco Business Process Management software: very complimentary!)

“When we set out to design our Mobile-Enabled Healthcare Platform one of the biggest decisions we made was to use Alfresco for our Business Process Management (BPM) and Electronic Content Management (ECM) services. This decision had a major impact on our product, and we’re convinced we made the right choice, so I wanted to walk you through how we made it.”

evolve2

“Workflow processes are a fundamental part of our platform. We have a number of core principles that we use to help guide us when we build product. Firstly, everything we build must be driven by the user need and all our applications must be mobile first, interoperable and extensible. eForms and Workflow is one way we make our platform extensible. We want our customers to use our tools to quickly build forms and model entire care pathways. We want them to do this independently without having to wait on features to be added to a product roadmap. But in a modern healthcare environment, traditional BPM is not enough. We need tools that are simple and easy to use, yet flexible.

customerdefined

Clinician’s behavior can not always be mapped using rigid processes. We need modern tools enabling ad-hoc tasks to be generated, dynamic processes to be modelled, simple collaboration between care providers and care recipients and analytics to measure and report on outcomes.”

evolve1

ECM and BPM are traditionally two very distinct things. When we embarked on this journey we had a very clear vision to select the best tools for the job. This meant we wanted the best ECM product and the best BPM product from the best vendor in each space. We performed two separate and distinct evaluation exercises and I fully expected to be working with two products from different vendors. But midway through our journey it became clear that Alfresco offered something unique that didn’t exist anywhere else on the market. Yes, they have two separate products – Alfresco One for ECM and Alfresco Activiti for BPM, but in combination what they have created is something greater than the sum of its parts and so unique that I don’t really recognise it as either ECM or BPM. In fact, these terms describe something that I don’t really relate with. When I see the words ECM and (especially) BPM I think complex, heavy-weight, closed. Stale. Alfresco have created something different – something simple, something light-weight, something open. Something fresh. I don’t know what the term is to describe this. It’s not ECM and its not BPM, but its definitely the future.

From the Axway website:

Axway ProcessManager Key Capabilities

Use the BPMN-based graphical modeling environment to design processes and specify attributes

ProcessManager’s graphical modeling environment is based on the Business Process Management Notation (BPMN) 1.1 standard, which allows business analysts to represent business process logic and patterns by drawing a diagram.

Business analysts can then specify the attributes for the process objects, such as:

  • Relevant communication service (e.g., OFTP 2) for an incoming order
  • Back-end integration service for processing the order in the ERP system
  • Transformation service for converting the file (e.g., EDIFACT or XML)
  • Routing mechanism

The modeled process can then be tested and refined before it is put into production.”

And from BPM Visibility Paves the Road to Operational Excellence:

Business Process Management Systems (BPMSs) are extremely powerful, as they allow process automation and offer visibility on how an organization performs in its overall value creation network.

In fact, BPMSs can also provide visibility without automating anything, simply by consolidating flows of events. For instance, probes can be used to fetch information from legacy applications and generate events, which are consolidated by a BPMS providing visibility on parts of process instances about which one has very little information. Another important usage of non-automated processes is the control of events coming from business partners, ensuring that every collaboration’s participant provides the appropriate information at the right time (and in the right format) as defined per the service level agreement.

BPMSs make many aspects visible, most notably these two: the proper state of process instances and the different variables associated with each step, such as its cost or completion time. Hence, BPMSs can help predict the future state of an organization based on its current situation. For instance, BPMSs can help identify a potential bottleneck before it arises, and can easily correct it through something called “dynamic resource re-affectation.” BPMSs can also provide real-time visibility on specific customer cases and answer important questions (e.g., “Where is my order?”), ease human work and interactions, and identify who is responsible for what and who did what. A BPMS is simultaneously the rearview mirror allowing you to understand what happened, the windshield through which you view what is about to happen, and the steering wheel empowering you to modify and adapt your course of action.”

From a review of CareCloud:

“CareCloud has an innovative workflow engine and systems architecture”

“automatic notifications when anything takes place in your medical practice with a live feed. In real time you will know when charges are posted, when a patient checks in, or if an appointment gets rescheduled”

From the CareCloud website:

Accounts Receivable Best Practices: Automated Workflow Engine

By way of context, every year for the past 6 years I have searched every single HIMSS conference exhibitor website (1400+!) for “workflow engine” or “Business Process Management” (15% in 2016!). Health IT is gradually, but ever more quickly, moving from a purely data-centric orientation to a more balanced emphasis on both data and workflow. The primary area in which this trend manifests itself is in software architecture. The best known specific terms-of-art associated with workflow technology are workflow engine, workflow management, business process management, process orchestration, and process-aware (academia), to name a few. As workflow engines and BPM become better known in healthcare and health IT, the increasing presence of these phrases on health IT conference websites is but one harbinger of a much needed transition from data-only, to data-and-workflow, emphases.

Note, workflow tech diffusion into health IT is still a bit under the radar, so to speak. Other Health 2.0 sponsors likely leverage proprietary or third-party workflow engine and process-aware technology. It just isn’t on their website! This will also change, as the sterling qualities of workflow tech — automaticity, transparent, flexibility, and improvability — increasingly become valuable competitive marketing collateral.


@wareFLO On Periscope!

firetalk-button2

Posted in healthcare-BPM | Leave a comment

Blockchain, Pragmatic Interoperability, and the Workflow-ization of Health IT

What three health IT trends are top-of-mind for me right now?

  • The “workflow-ization” of health IT
  • Pragmatic interoperability in healthcare
  • Blockchain

These health IT trends are all top-of-mind for me because they are coming together and interacting. Individually, they are notable. Together, they may be transformational, to use a tired and over-used word. But in this case it is completely true and appropriate.

By “workflow-ization” of heath IT I refer to the diffusion of workflow technology into healthcare. 15 percent of HIMSS16 conference exhibitors refer to “workflow engine” or “business process management” someplace on their websites. Five years ago virtually zero exhibitors used these workflow industry terms of art. Health information systems are increasingly proactive, transparent, flexible, and improvable, when it comes to workflow, and therefore when it comes to data too, since workflow drives the creation, transformation, and use of data.

“Pragmatic Interoperability” is a phrase I introduced to health IT in 2014, though it existed outside health IT before then. Pragmatic interoperability is the third leg of the healthcare interoperability stool. Syntactic and semantic interoperability are the other two legs. All of these words, syntax, semantics, and pragmatics come from linguistics. Syntax is about the structure of health data. Semantics is about health data’s meaning. Pragmatics is about health data’s use to achieve goals, and to assign, monitor, and accomplish healthcare tasks. When healthcare workflows cross organizational boundaries, this is pragmatic interoperability. When a message is sent from one healthcare entity to another, does the actual effect of the message match the intended effect of the message? If so, pragmatic interoperability is achieved.

Blockchain addresses one of the most important aspects of pragmatic interoperability: trust. Healthcare needs more than just trusted data; it needs trusted workflows. Back in 2015, in a five-part series titled Task and Workflow Interoperability in Healthcare, I argued that workflow interoperability requires workflow transparency between collaborating healthcare organizations. Also see my 10,000 word, five-part series on Pragmatic Interoperability, the linguistic theory behind Task Workflow Interoperability. By combining blockchain and business process management (BPM) technologies, healthcare can achieve exactly this.

To understand how blockchain and BPM can come together to achieve pragmatic interoperability, you have to understand trust. Trust is a hypothesis about future behavior used to guide practical conduct. I trust you, if I believe you will, though action or inaction, contribute to my well-being and refrain from inflicting damage on me. My hypothesis is supported by rationality (it is in your best interest to not harm me), routine (you’ve always delivered in the past), and reflexivity (I trust you because you trust me). Further more, if your goals, resources, intentions, plans, workflows, and activities are transparent to me, I am more likely to trust you. Pragmatic interoperability can be achieved through workflow transparency.

Untrustworthiness does not require nefarious intent. Simple ineptitude can make you, or your organization, an untrustworthy partner. Does that sound harsh? Please read Atul Gawande’s For the First Time in Human History, Ineptitude is a Bigger Problem than Ignorance.

Is workflow transparency possible? Yes. To support my claim, I draw your attention to an important paper, presented at BPM 2016, in Rio de Janeiro, Brazil, Untrusted Business Process Monitoring and Execution Using Blockchain. The use case is supply chain workflows among five organizations and individuals. As I read it, I imagined a similar paper, with a healthcare focus, titled Untrusted Clinical Workflow Monitoring and Execution Using Blockchain.

If I can see your workflows, I am more likely to trust you. In the paper I just referenced, workflow models, and their execution status, are shared across multiple interacting suppliers and consumers in a distributed manner. Instead of a single central meditator directing workflows among subordinate partners (orchestration), blockchain shares workflows as smart contracts among co-equal partners (choreography). Blockchain keeps everyone apprised as to which steps in which workflows achieve what status. There’s even a cool YouTube video demonstrating, step-by-step, workflow execution and changing workflow state.

(The following paragraph is for programmers! Feel free to skip, or not!)

The aforementioned paper is a good introduction to not only blockchain, but also a number of important BPM concepts, such as orchestration (workflow requiring a central conductor) vs. choreography (true peer-to-peer workflow). The researchers translate BPMN (Business Process Model and Notation) models of workflow into a programming language executed on blockchain nodes (Ethereum Solidity). GoLang and Node.js are also involved, so geek out! The research software is a one-of, but future similar platforms will be wrapped in APIs (Application Programming Interfaces) and access workflow, task, and patient data in other health IT systems through FHIR (Fast Healthcare Interoperability Resources) and non-FHIR APIs (see Blockchain as a Platform) Note: trusted choreography among healthcare organizations, to create virtual healthcare enterprises, is especially relevant to workflows between healthcare competitors (trust, but verify!). Finally, you don’t get something (automated trust/trustless consensus) for nothing. A blockchain implementation of BPM-driven workflow across organizations is slower and more expensive than a similar setup without blockchain. However, I believe both can be managed and made small enough to be tolerable.

I’ve been in medical informatics and health IT for over three decades. As an industrial engineer who went to medical school, I’ve long been frustrated by what I regard as insufficient emphasis on not just healthcare workflow, but workflow technology, in health IT. But I’ve never been as excited about the possibilities for creating trustworthy process-aware cross-organizational health information systems. These systems will greatly surpass current EHR and health IT systems in terms of clinical outcomes, efficient use of resources, and patient and user satisfaction.

Viva la workflow-ization of trustworthy healthcare interoperability!


@wareFLO On Periscope!

firetalk-button2

Posted in healthcare-BPM | Leave a comment

Care Innovations on Workflow Management and Telehealth

Telehealth and telemedicine have many implications and great potential for healthcare workflow management. In preparation for today’s #HITsm tweetchat, Remote Patient Monitoring: Opportunities & Challenges, hosted by Marcus Grindstaff (@magrinds), COO of Care Innovations, I looked back over that past four years and picked the juiciest tweets from @CareInnovations to highlight here. Enjoy!

Links tweeted:

The tweets themselves!

Posted in social-media | Leave a comment