Workflow In ONC’s 10-Year Vision to Achieve an Interoperable Health IT Infrastructure

I do what I always do, when a major health IT strategy white paper appears: count ‘workflow’s! :) In the case of Connecting Health and Care for the Nation: A 10-Year Vision to Achieve an Interoperable Health IT Infrastructure, just released by the ONC, workflow is mentioned in four passages.

And here they are.

“One size does not fit all. Interoperability requires technical and policy conformance amongnetworks, technical systems and their components. It also requires behavior and culturechange on the part of users. We will strive for baseline interoperability across health IT infrastructure, while allowing innovators and technologists to vary the user experience (the feel and function of tools) in order to best meet the user’s needs based on the scenario athand, technology available, workflow design, personal preferences, and other factors….

We will work with stakeholders to refine standards, policies, and services to automate the continuous quality improvement process and deliver targeted clinical decision support that fits into a clinician’s workflow to close care gaps and improve the quality and efficiency of care….

We will encourage the development and use of policy and technology and workflow practices to advance patients’ rights to access, amend, and make informed choices about the disclosure of their electronic health information….

We will work to improve standards, technology, and workflow that enable the electronic collection and management of consent as well as the electronic exchange of related information within existing legal requirements (including notice of redisclosure restrictions).”

Accomplishing these aims will require workflow technology. My most relevant blog posts are:

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Attending Upcoming Future of Wearable Technology In Healthcare Conference

http://ehr.bz/watch

A.S. (opposite of P.S.!)

I’m bringing my buddy Mr. RIMP. He’s a wearable robot controlled by Google Glass! Kids love him. And he even has a Twitter account!

July 25-26, in Indianapolis, The International Society of Wearable Technology in Healthcare is putting on what promises to be tremendous conference on wearables in medicine. Predictably, Google Glass is well represented, with at least eleven presentations out of a nineteen (some of which are TBA, so could be Glass as well).

watch-program3

I’ll be there, to add to my over 2000 #GoogleGlass tweets, a many blog posts and trade journal articles. This is a place to for me highlight speaker Twitter accounts and tweets. Below are just those I could find.

I also created the Twitter list Wearable Tech Conference.

  • @ZGJR Rafael Grossmann, MD, FACS Surgeon, Eastern Maine Medical Center in Bangor, Maine United States
  • John Scott, Founder and CEO, ContextSurgery by Context Aware Computing Corporation http://www.contextsurgery.com (not Twitter account, but interesting website)
  • @PaulSzotekMD Paul Szotek, MD Assistant Professor of Clinical Surgery Trauma&Acute Care Surgery / Abdominal Wall Reconstruction Indiana University Health, Indianapolis United States
  • @TGrantcharovMD Teodor Grantcharov MD PhD FACS Associate Professor of Surgery University of Toronto. Scientist Keenan Research Centre of the Li Ka Shing Knowledge Institute Canada
  • @ChrisVukin Christopher Vukin Team Evermed/Medright “How to use wearables with your EMR workflow”
  • @MarliesSchijven Marlies Schijven MD PhD MHSc Associate Professor of Surgery Academic Medical Center Amsterdam, The Netherlands
  • @NoorFSiddiqui Remedy - or how to save lives with Google Glass
  • @DrMartineau On Glass and challenges in hand surgery
  • @drtom_kareo Kareo CMIO, passionate about helping small medical practices successfully leverage technology
  • @kylesamani of @pristineIO How to obtain success with google glass
  • @Geek_Nurse of @SocialHealthIs Development & design of wearable devices for the ecosystem

I’m glad to see Rafael Grossmann, MD kick off the conference with the appropriately titled “In the Beginning…” By the way, @ZGJR was featured on Drudgereport! :)

And Kyle Samani of PristineIO, see my 10 Questions for Glass in Healthcare Pioneer Kyle Samani of Pristine.io.

Here are some of my own articles about Google Glass in healthcare:

The first describes my project interfacing Google Glass with a state-of-the-art business process management system to manage hospital housekeeping tasks.


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Business Process Management In the PCAST Systems Engineering in Health Care Report

I’m delighted to see Business Process Management (BPM) cited in the recent PCAST Systems Engineering in Health Care report Better Healthcare and Lower Costs: Accelerating Improvement Through Systems Engineering.

pcast

Systems Engineering used to be called Industrial Engineering. I have a graduate degree in IE. My old department at the University of Illinois is now called the Department of Industrial and Enterprise Systems Engineering.

In this report they write

“Successful and sustainable improvement must involve reconfiguring the workflow and overall environment in which these professionals practice, which can help to reduce the burden of work while improving the performance of the system.”

“Reconfiguring workflow”, that’s what I blog and tweet about constantly. Sometimes I wonder what people think. Chuck, workflow, workflow, workflow, blah, blah, blah… :)

Anyway, this post is just a squib to pull out several quotes about BPM, Human Factors (part of IE) and Systems Engineering (above).

Business Process Management: cross-functional, iterative approach to optimize processes and knowledge transfers as changes occur in the system. Most common tools are software packages (vendors include IBM, Oracle) implemented to manage workflows, documents, and processes.”

Human Factors: study of the cognitive and environmental influences on human performance.”

I continue to work for, and increasingly see, awareness and diffusion and adoption of workflow technology in healthcare. The PCAST Systems Engineering in Health Care Report report is just one (particularly salient) datapoint in amidst a cloud of signs and signals that healthcare is finally beginning to take workflow seriously.

Yeah!

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I’m Speaking On BPM, Case Management and US Healthcare at BPM & Case Management Global Summit

bpm-summit

On June 16th I’m presenting BPM and Case Management: US Healthcare Wants You, But May Not Know It, Yet at the BPM & Case Management Global Summit (archive) here in DC. I hope to meet you and talk shop! I’ll be tweeting about my presentation and the conference, so I hope we can “tweet shop” too!

us-healthcare-bpm


P.S. An offering to the search engine gods…

BPM and Case Management: US Healthcare Wants You, But May Not Know It, Yet

Charles Webster, MD, President, EHR Workflow, Inc.

Healthcare processes are mess, no matter whether structured and repeatable or unstructured and one-of-a-kind problem solving and interaction among knowledge workers. One third of an almost three trillion dollar economy is estimated to be wasted due to inadequately managed clinical and administrative workflow and processes. How is traditional health IT failing to solve these problems? How can business process management and case management (BPM/CM) help? What are ten obstacles slowing diffusion of process-aware information system into healthcare? How can we eliminate, reduce, and circumvent these enemies of healthcare workflow progress? These and other questions will be answered, to help you, a BPM/CM vendor, gain audiences with, and prove your worth to, health IT professionals, managers, and decision-makers.

A Google Glass Explorer with degrees in Accountancy, Industrial Engineering, Artificial Intelligence, and Medicine, Dr. Webster designed the first undergraduate degree program in medical informatics and partnered with three healthcare organizations to win the first three consecutive HIMSS Davies Awards for Ambulatory Excellence, the top award in the health IT industry for electronic health records.

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Business Process Management’s Royal Road to Healthcare Runs Through Care Coordination

I see convergence between care coordination platforms and business process management tech used to implement them. The following slide crystalized this for me.

An Accountable Care Organization, or ACO, is a virtual enterprise of primary care physicians, specialists, and hospitals that coordinate care for a population of patients and are “accountable” for both cost and outcomes. There’s much discussion of what kind of IT infrastructure is needed to create successful ACOs. The above tweeted slide is an example. That it was retweeted at least thirteen times indicates some agreement, or at least interest, in the health IT Twittersphere I inhabit online.

As an experiment I cross-indexed “care coordination” and “workflow engine” with BPM or “Business Process Management” or “Workflow Management System.” I found lots more links than I tweeted and embedded below. I arbitrarily stopped at ten or eleven. But even just those are pretty interesting. For example, I found an expected mix of academic presentations and papers, but I knew I’d find that. Researchers have zeroed in to what they called process-aware information systems (in healthcare) for over a decade. More interesting was all the vendor-related content. I’ll alternate between the two categories below.

First of all, there’s this slide from a non-academic source. It simply mentions a workflow engine being used to manage alerts and messages to providers. Workflow engines are the essential component of what used to be called workflow management systems, but now are called business process management systems or suites. Later links will explicitly invoke need to BPM tech in building care coordination platforms.

The following slide is from an academic presentation. The layers proceed in abstraction from medical guidelines based on medical experts and research, down through medical pathways based on cooperating care team members to treatment plans and processes. I really like the definition of care pathways: “Aim to model a timed process of patient-focused care, by specifying key events, clinical exams and assessments to produce the best prescribed outcomes, within the limits of the resources available, for an appropriate episode of care.”

What we need are models, executable models, at a variety of levels of abstraction, but consistent with each other, of both what we need to do and how much it will cost. And our healthcare information systems need to represent, reason about, and systematically improve these models. What was the above presentation called? “Personalized Care Pathways using Business Process Management & Artificial Intelligence.”

I am also reminded of a recent webinar given by Siemens Health IT discussing “contextualized” and “re-contextualized” process models. Above is a slide from that presentation. Adapt a process model to the patient and setting, tell a Business Process Management system to execute it. If the patient and setting changes in important ways, re-adapt the process model and continue with execution by the BPM system.

“Workflow engine closed-loop task execution escalation rerouting reprioritization” … exactly what I wrote about in my 2010 MedInfo paper, “Clinical Intelligence, Complex Event Processing and Process Mining in Process-Aware EMR / EHR BPM Systems.”

The above tweet links to a chapter in a book of research papers. The cool thing is I can actually embed the page from that chapter in that book from which I quoted. So, here it is.

This “invisible layer” between user interfaces and health information systems? This is the workflow technology that makes care coordination possible, that is, both flexible (by tweaking executable process models) and scalable (through their execution). I’ve written about the need for this layer of workflow interoperability and usability in my blog post, “From Syntactic & Semantic To Pragmatic Interoperability In Healthcare.”

The phrase “teamwork, collaboration, coordination” occurs in the abstract from this paper, which asserts Business Process Management software will be necessary to achieve those three necessary elements of care coordination. Elsewhere I’ve written about the science and technology of coordination, another name for BPM and related technologies.

Above, the authors explicitly define Care Process Management as using Business Process Management to manage clinical processes. Vendors often rebrand BPM because sometimes they feel the word “Business” has negative connotations to clinicians. You’ll also sometimes see Healthcare Process Management for the same reason. However, if you poke around in the footnotes, you’ll usually see some sort of reference to BPM. Even if “Business” is suspect, the allure of “[Something] Process Management” is irresistible. Interestingly, I’ve seen vendor phraseology evolve away and then back to the B in BPM. BPM has a several decade-old track record, going back to workflow management systems. It’s a track record vendors can point to harness some of that credibility.

The next few tweeted quotes, paraphrases, and links, just round out my sample of results returned by Google. Feel free to jump to my conclusion.

The above tweet is actually to a published research paper. I include it here because it evinces another interesting trend I’m observing. Folks who sell real-time location tech, to track people and equipment, are developing their systems into complete workflow solutions. I see the same thing happening with nurse call systems. When you are a necessary piece of the workflow, the next value-added strategic step is to begin to manage more-and-more of end-to-end workflow. We’ll see these and similar vendors (such as in Enterprise Content Management) both develop proprietary workflow solutions and embed or talk to third-party business process management suite vendors.

I’ve been tracking diffusion of workflow tech into healthcare for over two decades. I find it absolutely fascinating, the end-run about electronic health records. At one time, about a decade ago, I was sure that EHRs would evolve into true EHR workflow systems. Instead, EHR feature sets were “pinned” by Meaningful Use. As a result, EHRs are increasingly viewed as a necessary evil, to get data from the point of care. Once you get that data, the only way to create population health management systems that can affect clinician and patient behavior at the point-of-care *and* do flexibly and scalable, is to leverage workflow technologies such as workflow management systems and Business Process Management systems and suites.

Increasingly, the Royal Road for BPM into healthcare appears to run through care coordination, a function for which EHRs should have been ideally suited. Regardless, healthcare application architecture is finally evolving out of the dark ages into a more process-aware world. I’ll leave you with a finally tweeted slide from one of my presentations. It shows, on the right, the evolution of workflow representations, away from Java, C#, and Mumps captive in hardcoded dungeons. Instead, representations of workflow will be stored in ways that both humans and machine can understand and use in their unique and complementary ways. Human’s will create and improve workflows. Workflow engines will execute and monitor workflows. Workflow Management Systems, Business Process Management systems, and flexible Case Management (for hard to represent workflow), are finally arriving in healthcare.

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