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.


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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!


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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!

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My Foreword and Chapter in Business Process Management in Healthcare, Second Edition

bpm-healthcare-twitter-avatar
(Excuse my mug! It’s my current @wareFLO Twitter avatar.)

Foreword

I am delighted to write the foreword to BPM in Healthcare. Forewords traditionally deal with genesis and scope. I’ll tell you why I, an emissary from the medical informatics and health IT community, traveled to another land, that of Business Process Management (BPM). I hope to convince you that the sky is the limit when it comes to the potential scope of BPM in healthcare. And, finally, I assure you this is the right book to start you on your own exciting path to healthcare workflow technology self-discovery.

I first wrote about “Business Process Management” (BPM) in a 2004 health IT conference proceedings paper entitled EHR Workflow Management Systems: Essentials, History, Healthcare. But I’d been writing about workflow systems in healthcare since 1995. From the Journal of Subacute Care:

subacute

In 2004 I applied the Workflow Management Coalition’s (WfMC.org) Workflow Reference Model terminology to an Electronic Health Record (EHR) ambulatory patient encounter. (The Workflow Reference Model itself dates from 1994.)

business-process

I attended my first BPM conference in 2010 (BPM in Government, which had a healthcare track). At that and many subsequent BPM (and Case Management) conferences I met many of the BPM experts and workflow professionals who co-authored many of the Future Strategies’ publications currently sitting on my own bookshelf. In particular, I’d like to thank Keith Swenson, (My Sandbox, Your Sandbox, in this volume) for answering my incessant questions and welcoming health IT colleagues to BPM venues over the years. Eventually I even became a judge in the annual BPM and Case Management excellence awards.

That’s where BPM in Healthcare comes from in my personal journey. But where is BPM in Healthcare going? The biggest big picture within which to appraise the potential for BPM to transform healthcare is The Fourth Industrial Revolution2. The Fourth Industrial Revolution (also known as Industry 4.0) is not about any individual technology, such as steam power, electrification, or computing (the first three industrial revolutions). The Fourth Industrial Revolution is not even about the Internet of Things (IoT), 3D printing, self-driving cars, artificial intelligence, or big data. It is about the interaction among all these technologies. In other words, The Fourth Industrial Revolution is not about innovative technologies, but innovative systems of technologies. It is about multiple, different, complementary, interlocking, and rapidly evolving technology sub-systems becoming part of an even larger, and way more complex, super-system, a system of systems. Wearing my systems engineering hat, I will argue that the Fourth Industrial Revolution is therefore about processes and workflows.

How do systems engineers manage system complexity? With models. Systems engineers gather data and optimize these models. These optimized models then drive system behavior. Then more data is used to optimize, and so on. In the old days, systems engineers sometimes gathered data with stopwatches and clipboards. I did exactly this, when I built simulation models of patient flow. Today, the Internet of Things and Machine Learning are reducing time scales to collect and process data down to mere seconds. And today, process-aware systems, such as BPM suites, orchestrate and choreograph system processes and workflows, potentially in seconds.

What are “process-aware” systems? These are information systems that explicitly represent, in database format, models of processes and workflows. The models are continually informed by data. The models are continually consulted when deciding what to do, say, or steer next. While process-aware systems “introspect,” they are not “aware” in a conscious sense, but rather in the sense that they can reason with these models; in real-time, in response to their environment and to exhibit intelligent behaviors that would not otherwise be possible.

Currently the industry most adept at representing work, workflow, and process explicitly, in a database, and using this data to drive, monitor, and improve process and workflow is called the Business Process Management industry. Why is BPM so relevant to creating and managing effective, efficient, flexible, and satisfying systems or systems? Because, as Wil van der Aalst, a leading BPM researcher writes, “WFM/BPM systems are often the ’spider in the web’ connecting different technologies” (and therefore different technology systems).

BPM, while not a direct descendent of early artificial intelligence research, inherits important similar characteristics. First, both distinguish between domain knowledge that is acted upon and various kinds of engines that act on, and are driven by, changing domain knowledge. Workflow engines are like expert systems specializing in workflow (warning, a very loose analogy!). Just as expert systems have reasoning engines, workflow systems have workflow engines.

Second, artificial intelligence (AI) and machine learning (ML) are critically about knowledge representation. Early AI used logic; current ML uses neural network connection strengths.

Finally, many AI systems, especially in the areas of natural language processing and computational linguistics, communicate with human users. When I say “communicate” I don’t just mean data goes in and comes out. I mean they communicate in a psychological and cognitive sense. Just as humans use language to achieve goals, so do some AI systems. Communication between humans and workflow systems is rudimentary, but real. Workflow systems represent the same kinds of things human leverage during communication: goals, intentions, plans, workflows, tasks and actions. These representations are, essentially, the user interface in many workflow systems.

To sum up, The Fourth Industrial Revolution is not about any one product, technology, or even system. It is about innovation in how multiple systems of technology come together. Process-aware technology, such as business process management, will play a key role in gluing together these systems, so they can be fast, accurate, and flexible, at scale.

You could go off and read a bunch of books about BPM. There are many excellent tomes. Then figure out how BPM and healthcare fit together. Or just keep reading this Second Edition of BPM in Healthcare.

If you are a healthcare or health IT professional interesting in healthcare workflow and BPM/workflow technology, you could start here:

References

Aalst, W. Business Process Management: A Comprehensive Survey, ISRN Software Engineering, Volume 2013 (2013), Article ID 507984, 37 pages.

Webster, C. Prepare for a Computer-Based Patient Record That Makes a Difference, Journal of Subacute Care, Vol. 1(3), 12-15, 1995. (http://ehr.bz/subacute1995)

Webster, C. EHR Workflow Management Systems: Essentials, History, Healthcare, TEPR Conference, May 19, 2004, Fort Lauderdale. (http://ehr.bz/tepr2004)

Terminology and Glossary. Winchester (UK): Workflow Management Coalition; 1994 Feb. Document No. WFMC-TC- 1011. BPM in Healthcare (2012) Future Strategies Inc., Lighthouse Point, FL. http://bpm-books.com/products/ebook-series-bpm-in-healthcare

Case Management in Industry 4.0: ACM and IoT – see chapter by Nathaniel Palmer” “http://bpm-books.com/products/best-practices-to-support-knowledge-workers-print


Free! My Book Chapter:

Marketing Intelligent BPM to Healthcare Intelligently!


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What Is The Purpose of A Bee? Preserving Purpose In Medicine


When I heard @StorkBrian and @Paddy_Barrett were co-hosting the #HITsm tweetchat on the topic of Preserving Purpose in Medicine, the following question came to me, unbidden:

What is the purpose of a bee?

You see, Dr. Stork is an inveterate beekeeper. I’ve watched his bees on Periscope and Vine. We’ve discussed beekeeping on Blab (now replaced by Firetalk, get a “ticket” and come to our #NHITweek Firetalk immediately after the upcoming 9/30 #HITsm chat!).

Bees, hives, and honey, constitute one of the most potent collections of metaphors in all of metaphor-dom: busy as a bee, queen bee, hive mind, swarm societies, and honey has been likened to spiritual insight harvested from the ordinary!

I could go all kinds of places with this metaphor. But I will refer you to a wonderful book about work lessons we can learn from bees, called Waggle (named after the dance bees perform to communicate):

waggle-table-of-contents-promotion-page

Check out the chapter titles. Compare to the #HITsm topics. I’m sure you’ll come up with lots of cool metaphorical ideas! See you at the tweetchat!

Here are the HITsm topics!

Topic 1: When we aim to maintain purpose (in healthcare), what is that purpose exactly? What is it you? #HITsm

Topic 2: How can we as physicians work together to build more purpose for ourselves, and work with organizations to promote it? #HITsm

Topic 3: In what ways can healthcare technology work with physicians to improve the EHR experience? What would you change? #HITsm

Topic 4: What are some strategies for preserving purpose in medicine? How can we bring more compassion and caring to healthcare? #HITsm

Topic 5: Will healthcare become less effective in treating the whole person with less in-person visits & the growth of telemedicine & virtual visits? #HITsm

P.S. More about bees and beekeeping in this wonderful video from Brian!

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