Cognitive Technology for Goal-Driven Healthy Habits: An Intelligent Systems Approach

I am truly delighted to do my research in preparation for today’s #HITsm tweetchat with @melissaxxmccool. I have such fond memories of her marathon Blabs (3, 4, 5 hours?). The topic of today’s chat came up frequently: How Technology Helps and Hurts Healthy Behavior Change.

I usually introduce myself an industrial engineer who went to medical school, hence my interest in healthcare workflow and workflow technology. I don’t often mention I when to medical school and then studied Cognitive Science, which was one half of my MS in Intelligent Systems (the other half being Artificial Intelligence). The CogSci portion included psychology, linguistics, philosophy, and neuroscience. As a graduate student, playing my way, I worked on computer models of aphasia, dementia, and depression. I even spent a week studying with the man who founded of cognitive therapy, Aaron Beck, in Philadelphia.

I took a look at using tech to change patient behavior from the point of view of cognitive scientist. In doing so I hit on this paper (full text freely available!), Habits, Action sequences, and Reinforcement Learning. It summarizes and synthesizes a number of topics I studied decades ago. Topics I feel are relevant to using tech to move human behavior away from unconstructive toward constructive.

Believe it or not, (and I suspect you’ll believe it, given my workflow-centric reputation) there is a workflow angle. A workflow is a sequence of actions, consuming resources, achieving goals. Humans evolved from more basic animals. These animals exhibit, what may be thought of as, instinctive workflows. A fixed action pattern is species-specific characteristic sequence of behaviors (actions), which, once triggered, runs to completion. For example, if an egg is displaced from a nest, certain geese will roll the egg back into the nest, even if the egg somehow magically disappears. They continue to maneuver the imaginary egg back into the nest. The animal kingdom is rife with FAPs. We even know a lot about the neural networks that generate FAP behavior.

What do FAPs have to do with human behavior? Well, FAPs are a lot like habits, a sequence of behaviors, automatically executed, in the presence of some “releaser”. They happen automatically, seemingly without purposeful or mindful control. Of course, unlike FAPs, human habits are not instinctive. Through a variety of techniques, we can break old habits and create new ones. However, doing so is difficult! This is where technology comes it.

However, before we get to how technology might be useful in this respect, it’s useful to have a model of what is going on inside our heads. The degree program I mentioned, Intelligent Systems, viewed robots, software artificial intelligences, humans, and even some animals, as “intelligent systems” that, to vary degrees, shared certain properties and characteristics, including perception, memory, action, reasoning, and learning. Further, intelligent systems research combined techniques from cognitive science (psychology, linguistics, neuroscience, philosophy) with artificial intelligence and machine learning, to actually create computer simulations of these intelligent agents, to better understand them. We’d create software simulating them, and then we’d conduct experiments, comparing their behavior in response to manipulated environment stimuli, and to intelligent agents in the real world. Sometimes we’d even “break” the intelligent agents, to try to simulate mental and neurological disease. As I mentioned previously, I worked on a variety of such projects, from aphasia (language difficulties), dementia (memory, reasoning, personality), and depression (where I actually published a number of papers!).

All of that, and it is a lot of personal history, is backdrop for what I will do next, which is describe our human mind as if it is computer simulatable intelligent systems, with an eye toward thinking about changing bad habits into good habits.

The Habits, Action Sequences, and Reinforcement Learning paper describes an intelligent system in which there are two complementary but also competing information processing modules. One module is “closed-loop” meaning it has a model of the world and in that model of the world it behaves (acts on its world) to move the world toward a preferred goal state. The perceiving-reasoning-acting loop is closed in the sense that the difference between the current world state and the preferred goal state is continually fed back to the intelligent system so it can continually chose actions that will eventually achieve it’s goals.

Contrast above with the second behavior module. This module is similar to a Fixed Action Pattern. It has a set of “hardcoded” workflows, sequences of behavior, which, once triggered, execute from beginning to end, without reference to whether they move the world from a bad (less preferred) state to a good (more preferred) state. The great thing about these automated personal workflows is they are fast, consistent, and require no thought. The bad thing about these automated personal workflows is that they are fast, consistent, and require no thought. If you change the environment, “good” habits can become “bad” habits.

The two systems can profitably work together. Once one’s environment changes, fall back on the closed loop thoughtful goal-oriented behavior. Over time find new personal workflows that work, then turn them into open loop fast, consistent, and “thoughtless” workflows. This frees up the closed loop goal orient system to focus on other, higher level, more strategic issues. Also, you can think of an intelligent agent has having different bundles of related workflows for different environments. As it move through these environments, different clumps of workflow potential become active. Let’s suppose an intelligent agent has about a dozen different environments it frequently or occasionally needs to navigate. Eight or nine may be stable and the current open loop personal workflows are perfectly appropriate. However, several environments may be problematic. So our closed loop problem solving systems focus there. Over time, as all of our different occasionally frequented environment change, each is dealt with in turn, converted from open loop to closed loop and back to open loop personal workflows. But imagine if all your environments change at once! That is indeed stressful and even your wonderful dual system, open and closed system partnership, can be overwhelmed!

On a moment-by-moment basis, current thinking is that these two, open loop and closed loop, modules compete with each other. Consider the following quote:

“some have suggested that these processes may compete for access to the motor system…. in which the goal-directed and the habitual systems work in parallel at the same level, and utilize a third mechanism, called an arbitration mechanism, to decide whether the next action will be controlled by the goal-directed or the habit process”

So, now let’s think about how technology might be used to help these two, open loop and closed loop, systems work together.

Let’s consider the open loop personal workflow system. How might we extinguish is highly automated responses, in preparation for instituting new, healthier responses?

  1. Prevent the workflows from being triggered in the first place.
  2. Detect when the workflows are executing and disrupt them.
  3. Emphasize the negative consequences of these workflows running to completion.

This last device is interesting because it is essentially attempting to convert open loop behavior into closed loop behavior.

I can imagine technology being used in all three ways.

  1. Don’t go there! (You know what always happens if you do…)
  2. Look! Squirrel!
  3. Ouch. Be honest with yourself. That hurt! (But also be constructive, give yourself a brief scold, and lay plans to avoid triggering similar future behaviors, or at least figure how to stop one if it get started.)

At the same time we are trying to hobble destructive open-loop personal “workflows,” we need to enable constructive closed-loop personal workflows.

  1. Make the future preferred world goal state particularly vivid.
  2. Figuring our how to solve new problems, or old problems in new ways, is hard. Provide help.
  3. Once you find a tentative solution, capture it! Institutionalize it in some way, to make it more the more likely to execute open loop behavior than the old destructive open look behavior.

Regarding the arbitration mechanism, both the open loop and closed loop personal workflow system spring into operation, race along in parallel, and then demand that they be given control. In this last regard, a basic insight is this. One way to become more “meta-cognitive” is to have some sort of model of yourself. This model can be used to explain and understand, and to guide what to do. I think this model of you and intelligent system in eminently teachable and learnable. In fact, cognitive theory works a bit like this. One of its goals is get you to think like a “personal scientist”. Scientific thinking involves weighing evidence and conducting experiments. Simply viewing yourself as a “scientist” is itself esteem elevating. I think something similar might be true of viewing yourself as an intelligent system.

Anyway, back to what technologies could be useful.

The stimuli that trigger personal workflow are often spatially and temporarily circumscribed and specific. Here wearables and the Internet of Things can be the eyes and ears of a system to detect you may be heading into a bad workflow stimulus rich environment. If a bad workflow can’t be avoided, and starts to execute, workflow execution itself can be detected. (This is currently an active area of artificial intelligence and machine learning research, recognizing which goals, plans, and workflow of an intelligent system are currently active.) Once the bad workflow is detected, mid-execution, send notifications, call someone to call you, ring the fire alarm, whatever it takes (no, don’t ring the fire alarm unless there is a fire, but you know what I mean!)

And if, heaven forbid, that bad-bad-bad personal workflow can’t be prevented… document it. And do so in such a way that the next time it can be held up and waved in front of the intelligent agent… NO, YOU REALLY DON’T WANT *THAT* TO HAPPEN AGAIN, DO YOU?

Relative to closed-loop problem solving and workflow creation, preferred workflow goal states might be vividly representing using virtual or augmented reality. (THIS is what you’ll look like in that bathing suit, this is what will feel like when you walk across that graduation stage!)

Relative to helping to find new workflows that work, that’s what many workflow and task management systems do. They help manage potentially useful tasks, to string them into candidate workflows, and then, when executed, keep track of state (success, in progress, timed out, failed, escalated, etc.)

Finally, one you find new workflows that work, you need to move that insight and actionability down into the system that senses whether you are in danger of executing one of the bad-bad-bad workflows, and offers a different, more constructive workflow instead. Increasingly, every single digital device we interact with is aware of each other and work together. They will talk to your fridge and your minibar. They will, if necessary, act on your behalf, perhaps even stepping to literally prevent you from doing what you are about to do.

Yeah, scary. But also, possibly, fascinating, in positive and constructive sense.

A lot of the technologies I just listed already exist in bits and pieces. Some are already being woven together, to act in purposeful and useful manner, at our behest, to help break and make personal workflow habits. In a sense, there will be (at least) two intelligent systems: you and the system you create around you.

@wareFLO On Periscope!


Health IT Marketing and Boomer, Gen X, and Millennial Workflows

I gotta brag. I’m not an anthropologist, but I love reading about anthropology, and lots of my friends in medical school were medical anthropologists. I use ideas from anthropology to inform my systems engineering thinking about health IT. With some trepidation, I finally waded into the anthropology of health IT, and wrote a blog post. Eventually I sent it to the former HHS CTO, who happens to have an anthropology degree. And she tweeted this!

That’s my brag! Made my week, it did!

Since that Eat Your Beans post, I’ve been thinking a lot about digital and computational anthropology … wait! Don’t run away! This really is connected to health IT marketing and generational divides. First, just a little background. Anthropology is the study of human societies and cultures and their development. The theory of generations (generations X, Y, Z, did you know that “Boomers” are Gen I?) was proposed in 1923 by Karl Mannheim, a sociologist. Sociologists and anthropologists both study societies and how humans behave. Sociologists focus on the big picture, such as social groups and society. Anthropologists drill down into the nitty-gritty of individual behavior in groups. If you put the word “computational” in front of something, it usually means the nitty-gritty is so nitty-gritty that there is enough detail to actually simulate behaviors. Closely related to computational anthropology is digital anthropology, in which anthropologists study interactions between humans and digital technologies.

Aha! Digital anthropology is clearly relevant to how “generational perspectives are influencing healthcare technology, and additionally, how can we (as health IT leaders) can strive to incorporate and include diverse generational needs into the industry roadmap” (from this week’s #HITsm chat). But computational anthropology is also relevant to “including every generation in our health information technology thinking”.

The rise of computational anthropology is fueled by so-called “big data.” Digital technology is so woven into our professional and persona lives, that its “data exhaust” (love that term!) can be used to track us, understand and empower us, but also raises enormous ethical and privacy issues. The fascinating thing in this latter regard is that the field of anthropology has adopted a sophisticated system of ethics regarding dealing with data about human behavior. In some ways, it surpasses current health IT principles for handing sensitive personally identifiable health data. For example, consider the following from the Wikipedia entry about digital anthropology…

“Online fieldwork offers new ethical challenges. According to the AAA’s ethics guidelines, anthropologists researching a community must make sure that all members of that community know they are being studied and have access to data the anthropologist produces. However, many online communities’ interactions are publicly available for anyone to read, and may be preserved online for years. Digital anthropologists debate the extent to which “lurking” in online communities and sifting through public archives is ethical.”

Lurking during a tweetchat potentially being unethical? Wow!

But let’s assume, for the moment, that anthropological ethics and Internet-Of-Things cybersecurity issues can be adequately managed.

How might ideas from digital and computational anthropology potentially guide a health IT marketer?

The first thing to realize is that digital anthropology is applied anthropology, from which marketing research increasingly incorporates methods. In fact, there is a Journal of Business Anthropology (a sub-discipline within applied anthropology) and the sub-discipline of marketing anthropology. Anthropology is an increasingly popular minor among marketing students. Degrees in digital marketing anthropology are surely just around the corner.

What about workflow? Digital anthropology can be used to collect and interpret consumer and patient life-flows (essentially “workflows”, but more general than mere work settings, including family and other personal activities). Computational anthropology provides representations and models into which these data and interpretations can flow and inform. At the top of this list are agent-based simulations. Agent-based simulations are really cool. So cool, I recently attended the Anylogic user conference in Nashville to learn more about agent-based simulation. Anylogic develops and markets the most sophisticated agent-based simulation software on the market. Anylogic can also simulate more traditional discrete event simulations (popular among industrial engineers for simulating patient flows, where I got my start in healthcare workflow) and dynamic systems. Agent-based simulations simulate “agents”, which are basically simplified representations of humans, though I am sure they could simulate other kinds of agents, such as cattle behavior at the level of individual cows, and so forth.

Here are some of the various workflow notations compatible with AnyLogic.

With so much compute power available today, look at the scale of current agent-based simulation research! Surely human behavior after a nuclear attack is an important public health topic!

Here are a couple animations driven by agent-based simulation.

The following is a simulation of conference attendees interacting with the lunch queue. This not as impressive as either of the previous agent-based simulations, but there is the thing. It was created, from scratch, in just a couple hours in front of an audience. Each of the “attendees” (in the simulation, not the audience in which I sat) is essentially a tiny, virtual workflow system. Each attendee is modelled as a state machine, which is the formal terminology for a model of workflow being executed by a workflow engine while interacting with environment inputs.

Watch the above animation and just think of the possibilities for modeling different generations and their interactions with digital technologies! Increasingly we have the data. We have means to model workflow behaviors and execute workflow models. We can study personal and professional workflows executing within interactive environment. And we can do so within and between demographic generations within families, among friends, and between patients and healthcare systems.

Sound like science fiction? Workflow research really is finally moving out of the healthcare organizational setting and into patient’s lives. Check out this diagram of workflow interactions and information flows between a patient outside of a healthcare organization and the healthcare organization itself (from the recent Healthcare Systems Process Improvement Conference in Orlando).

Also see out my previous post, Actuarial Science, Accountable Care Organizations, and Workflow.

“Workflow⁰ is a series¹ of steps², consuming resources³, achieving goals⁴.”

⁰ process
¹ thru graph connecting process states (not necessarily deterministic)
² steps/tasks/activities/experiences/events/etc
³ costs
⁴ benefits

If one modifies my definition of workflow, though within my subscripted limits, to …

“Process is a series of events, consuming expected resources, achieving expected benefits.”

… you’ll arrive at a stochastic process closely resembling actuarial science’s generalized individual model (page 35 in Fundamental Concepts of Actuarial Science, a great review or introduction by the way!).

During my student days, we spent a lot of time estimating parameters and distributions, and then predicting behaviors of these stochastic processes. Sometimes we did so analytically with complicated equations (Markov Models). Sometimes we fell back on computer simulation (Monte Carlo).

A quick review of actuarial science literature indicates many of these same techniques are used today.

Back to the subject at hand…

Patient journeys are workflows. If they are workflows, then we can model them, inform and test those models with data from digital medical anthropology research, and then simulate those patients interacting with digital healthcare technology using ideas from computational anthropology.

If you Google generational differences, you’ll find hundreds of tables that look like this.

These generational difference tables compare and contrast live experiences, goals and values, resources and constraints, and typical behaviors of Baby Boomers, Gen Xers, Millennials and other generations. Adapt these insights to adopting and consuming digital health technology and information. Collect increasingly available data (subject to ethical constraints). Use data to inform and drive simulations of personal and professional life-flows and workflows. Compare simulations to what we observe in the real world. And then systematically improve these simulations.

In doing so we will gain greater insight into the differences and similarities between different generations regarding adopting and consuming digital health technology and information.

Consider this scenario, one I believe will be possible within five short years.

Consider a population health system covering five million members. Imagine 20,000 medical and administrative staff (by the way, I just pulled that number out of a hat). Further, imagine various pieces of the IT systems being proactive, that is, agent-like. Roughing in the models would start with a combination of generational differences and risk stratification. Patient states include well, acutely ill, chronically ill (and if so, which chronic conditions). Staff states include off-duty, on-duty, ideal, and busy (and if so, which patient-directed activities are they qualified for). Now imagine you are a health IT marketer. Instead of working for a health IT vendor or health IT oriented marketing and PR agency, you’ve made the transition to working for a health system. You’re job is to understand and facilitate the diffusion health IT technologies into the homes and hands of covered population health system members. Here are some additional states: unadopted, adopted-but-not-optimized, optimized. Now, based on a variety of data, from qualitative and quantitative applied digital anthropology research, estimate the probabilities of transitions between states. (Possible role for machine learning here!) Workflows are series of these state transitions, which can be simulated, to fit various other data sets and generate predictions. For example, which kinds of health IT technologies (apps, calls, chatbots…) introduced to who (Boomers, Gen X, Millennials…) influence transition probabilities between which states (well, acutely ill, chronically ill…), and probabilistic models of impact on population health system resources (number of personnel required, kinds of personnel), under different assumptions about which technology initiatives are undertaken (which kinds of patients are supplied with which kinds of health IT technologies). If you think this kind of simulation requires astounding amounts of data, it does. But we now live in the Big Data era. The data is there or potentially there. The real problems with this simulation are managing its complexity and data ethics issues. However, if researchers can undertake an agent-based simulation involving between 10 million and 20 million individuals in the aftermath of multiple Manhattan nuclear blasts, then agent-based simulations of health IT diffusion and effects on clinical outcomes and costs are surely at least almost already possible!

If I have stimulated your imagination and interest, check out my Health Standards article, Marketing Workflow Is An Incredible Opportunity To Differentiate Health IT Products, And You!, which ends this way:

“Workflow: It’s not just for industrial engineers anymore!”

I’ll see you at the Including Every Generation in our Health Information Technology Thinking #HITsm tweetchat! Noon EST today.

Further reading:

@wareFLO On Periscope!


What Is Business Process Management, or BPM? My Own Short Informal Description

A colleague asked me for a three or four sentence description of business process management. I managed to whittle something down to five sentences!

Business process management (BPM) is a “process optimization process” approach and technology. BPM includes discovering, modeling, and executing models of processes and workflows. During model execution, tasks are tracked to completion or escalated, resulting in fast, consistent, error-free task management. BPM software is exceptionally agile, because executable models of processes and workflows are so easily changed and optimized. Increasingly, many applications not traditionally categorized as BPM software, such as customer relationship management (CRM) and interface/integration engines, are embedding BPM-like functionality and behavior.

Digital Transformation of Healthcare with Business Process Management: Two Books To Consider!

[This post was written in preparation for today’s Digital Transformation in Healthcare #HITsm Tweetchat!]

I’m always looking for ways to get health IT and workflow technology folks together, in real life and on Twitter. For example “digital transformation” is a popular phrase and concept. It describes the changes due to digital technology in all aspects of human society. More specifically, it’s about transforming business activities and processes. Processes? Workflow! So, workflow technology, also called business process management, is in the digital transformation conceptual mix. In fact, there’s a wonderful book about BPM and digital transformation coming out the 20th of this month.

Digital Transformation with Business Process Management: BPM Transformation and Real-World Execution

I obtained an advanced peek. I highly recommend it!

From the foreword, Nathaniel Palmer:

“Today’s BPM platforms deliver the ability to manage work while dynamically adapting the steps of a process according to an awareness and understanding of content, data, and business events that unfold. This is the basis of intelligent automation, enabling data-driven processes adapting dynamically to the context of the work, delivering the efficiency of automation while leveraging rules and policies to steer the pathway towards the optimal outcome. For these reasons, BPM is the ideal platform for digital transformation.”

The introduction and case study abstracts are available online.

If you are intrigued with the idea of using workflow technology to transform healthcare organizations, I hope you’ll also consider Business Process Management in Healthcare, Second Edition.

I wrote the Foreword and contributed a chapter, the full text of which are available here (Foreword) and here (Marketing Intelligent BPM to Healthcare Intelligently).

And, since this is your digital transformation lucky day, here are some recent articles about BPM and digital transformation.

Transform your ideas about transforming healthcare with business process management!

@wareFLO On Periscope!


Why is Health IT behind in workflow-friendly technology and process awareness? How do we fix?

Republished from Health Standards.

Why is Health IT behind in workflow-friendly technology and process awareness? How do we fix?


Thank you to Health Standards for allowing me to press my case for using workflow technology to counter healthcare’s Workflow Problem. I’ll argue that we should adopt a new metaphor. Instead of “data silos,” let’s speak of “workflow silos.” Instead of waiting until we understand healthcare workflows to automate them, let’s use workflow technology to create and leverage understanding. Let’s promote a Workflow Triple Aim in service of healthcare’s Triple Aim. Let’s educate, highlight, and recruit the best workflow minds to improve care, outcomes, and costs.

From Data Silos To Workflow Silos

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!

The occasion of my plea to “Think different.” is my response to a special live #HITsm tweetchat that took place Tuesday, 14, at the HIMSS15 conference in Chicago. I wasn’t present, sadly so, since a question I submitted was asked of four health IT experts before an audience of HIMSS15 attendees. I do, however, have the livetweeted #HITsm transcript. I did respond, two days late (oh, I wish I’d been there in person!). Those tweets and my dozen tweeted responses are embedded in a blog post on my Healthcare Business Process Management Blog. As usual, I’d love your comments, here, my blog, or even to the embedded tweets themselves.

Let me focus on three of those tweets.

“T5 Why does the HIT industry lag behind in terms of supporting workflow-friendly technology & process awareness? How do we fix?”
“Missing interoperable workflows, but first need the data to bust down silos, establish what those are”
“We still need interoperable workflows between providers but we don’t yet know what those workflows should be”
Let’s talk about data silos first.

I grew up on a corn and soybean farm, so I happen to know lots (well, probably more than average) about grain silos and elevators.

Let’s consider a definition of “data silo.”

“A data silo is a repository of fixed data that an organization does not regularly use in its day-to-day operation. So-called siloed data cannot exchange content with other systems in the organization. The expressions ‘data silo’ and ‘siloed data’ arise from the inherent isolation of the information. The data in a silo remains sealed off from the rest of the organization, like grain in a farm silo is closed off from the outside elements.”

If one accepts this description of a silo, then one’s thinking tends to head down some paths, but not others. Of course, “busting” silos is more of a World War III metaphor than a farming metaphor. Keep in mind the result of busting a nuclear silo is not the freeing of its content, but its destruction. So back to the farming analogy, which seems more constructive for our purposes. What if we think about silos from the perspective of how they are *actually* used in agriculture?

After the recent HIMSS15 conference in Chicago, I continued to my family farm in NW Illinois. I tweeted pictures of farm houses, antique tractors, and grain silos. I asked a well-read farmer about what he thought of the data silo analogy. He said something profound (which I tweeted at the time), “Seeds are alive & in the spring they know it’s time 2 germinate, they swell & begin 2 sprout”. This dynamic process can actually start in the silo! Further discussion confirmed he did not think of seeds or grain as inert, at all. In fact, they are alive, dynamic, tightly coiled bundles of potential energy (a “spring” metaphor, if there ever was one, and borderline pun, to boot). By the way, a really great book about seeds is The Triumph of Seeds. Seeds are metaphorical supercomputing self-assembling, micro-robots with sensors and actuators. They put today’s Internet of Things to shame.

What’s inside seeds is much more like workflow than data. Data is static, inert, and tactical. Workflow is dynamic and strategic. Workflow acts on data: transporting and transforming.

What about a pile of seeds? Take it from me; big piles of seeds are not static or inert. They are shifting and treacherous. 31 people died in grain-bin entrapments last year. Two young men died in my home county in 2010. (My mom knows the families.) I never worked in a silo. I did sneak into a corn bin once, until I was chased out and given the lecture of lifetime. After that, the couple times I peeked into a grain silo, I saw riptides and treacherous currents, not a static pile of “data.”

What about grain elevators, those collections of interconnected silos one sees throughout our Midwest?

“Grain elevators play a key role in U.S. agriculture, and fulfill three main functions: post-harvest handling and storing of cereal grains and oilseeds, conditioning and preserving of grain, and facilitating the delivery of grain to domestic feeding and processing, as well as overseas, end-use destinations. These facilities have evolved from mere storage sites to large, high-throughput, highly automated, processing plants…. grain elevators represent a key intersection in our food production chain” (Design Considerations for the Construction and Operation of Grain Elevator Facilities. Part II: Process Engineering Considerations)

Consider that phrase,”evolved from mere storage sites to large, high-throughput, highly automated, processing plants”… again, sounds more like workflow, than data, to me.

Seeds, piles of seed, silos, and collections of silos, are in constant motion, channeled by agricultural organizations and technology. There’s a giant grain-to-food conveyor belt workflow from thresher to table.

I’d rest my case, but I have two more tweets go!

From Workflow Oppressed To Workflow Owners

3. “We still need interoperable workflows between providers but we don’t yet know what those workflows should be”

To which I tweeted back:

“IMO we should NOT wait 2 understand workflows B4 using workflow tech, cuz WF can be adjusted!”
“that’s POINT of workflow tech, since workflow is liquid, can implement WRONG WF but fix later”
If you think my ‘workflow silo’ analogy is a bit, well, ouut-theere, just wait until you see my next one! Stick with me!

Throughout the history and evolution of democracy and democratic traditions, autocratic regimes sometimes agree that democracy is good, but citizens need to be taught about democracy first. Only after citizens have matured, can they be trusted to actually vote. This is how revolutions happen. The citizenry see through the ruse, won’t wait, and deposes the despot. The rejoinder to these despots is that one learns by doing. Perhaps badly or imperfectly at first, but this is the only practical route to democratic civil society.

Something similar can be said of healthcare workflow. In fact, I’ve sometimes used the Twitter hashtag #OccupyHealthcareWorkflow. Healthcare, but more specifically, health IT, has a “workflow problem”: usability, interoperability, safety, patient experience, and more… What do all of these have in common? Workflow-oblivious technology (see my five-part series on healthcare workflow tech).

Users of health IT, especially clinical staff and patients, 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?

The key to solving the workflow problem, and repatriating healthcare workflows to their most important stakeholders, is workflow technology. In other industries, when you have a problem X, X technology arises to help solve or manage. Think pollution/pollution technology. Think, healthcare workflow/healthcare workflow technology.

Saying we can’t automate workflow because we don’t yet understand workflow makes sense if you hardcode workflow. That is, if you use third-generation languages such as Java, C-sharp, and Mumps, to automate the series of tasks that make up a workflow. Since you can’t easily or inexpensively change workflow after the code is written, then, By God, you better get the workflow right in the first place.

The problem with this stance is that there is no single correct workflow. Workflow changes all the time. Government regulations change. Patients change. Society changes. Science changes. Medicine changes. Everything is changing, all the time.

What is the alternative, then? Low-code software development.

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 and physicians 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.

In fact, I’m seeing a convergence, between patient experience and user experience. The tech that will make this practical and scalable will be workflow technology. Some of the most sophisticated uses of workflow tech have been in customer- and consumer-facing “Systems Of Engagement”, those systems at the edge of the enterprise (to contrast with “Systems of Transaction”, mission critical processes deep within the enterprise).

At a recent BPM conference I attended, “empathic” workflow was a hot topic of conversation, which was aligning the customer journey of a daughter and her mother regarding a home emergency medical bracelet. Backend and customer-facing workflows and touch points must be redesigned, to respond to their customers’ journey, through experiences of worry and feeling overwhelmed, relieved, anxious and frustrated… It is the ability to change workflows and processes quickly, to quickly improve to workflows serving this mother and daughter, which make this critical alignment possible. Workflow technology will be an essential tool and platform for co-designing healthcare workflows.

Don’t wait to implement healthcare workflow technology until we completely understand healthcare workflow. In contrast to traditional health IT workflow-oblivious tech, it is the implementing of workflow tech that creates understanding of workflow. Instead of blue ribbon commissions and dusty academic research telling citizenry “correct” healthcare workflows, use workflow tech to quickly get to satisfying, shared, co-owned patient and provider workflow. Pave the cowpaths. Then straighten and widen into eight-lane super highways. Health IT that is easily molded to patient and physician workflows, which can then be systematically improved while respecting normal human tolerance for change, is the key to health IT adoption.

Of course, healthcare needs also needs interoperability to achieve this vision. However, focusing exclusively on message transport and translation has had untoward consequences. The lowest level of interoperability, syntactic interoperability, gets messages from machine to machine. The next level up, semantic interoperability, makes sure the content of these messages means the same on both machines.

But workflow interoperability (also task or pragmatic interoperability) isn’t just the end game. It is the begin game too. Do exchanged messages accomplish the goals they are intended to accomplish? Each level helps the other levels. In other words, workflow tech can greatly facilitate lower level message exchange. Modern workflow platforms support a plethora of adaptors and connectors for gluing disparate technologies together. In fact, healthcare interface and integration engines are an important area of diffusion of workflow engines, editors, and analytics into healthcare. A C-level health IT executive just told me he’s getting a BPM systems because it will work so will his regional HIE’s BPM-based infrastructure.

Communication among EHRs and other health IT systems must become more “conversational,” if they are to become more resistant to errorful interpretation. And workflow tech is the best and most natural means to enable these conversations.

Workflow Triple Aim In Service Of Healthcare’s Triple Aim

Finally, the “How do we fix?” tweet:

1. “T5 Why does the HIT industry lag behind in terms of supporting workflow-friendly technology & process awareness? How do we fix?”

There are many different stakeholders and many different skill portfolios, when it comes to the healthcare workflow problem.

You may have heard of the Triple Aim, to improve care, health, and cost. My means to contribute is a Healthcare Workflow Triple Aim, to educate, highlight, and recruit the best workflow minds.

Hence my tweeted response:

Need education
Hilite success stories
Recruit workflow tech
Educate users and buyers of EHRs and health IT about workflow and workflow tech. Find and highlight success stories to promulgate best practices. Bring into healthcare the modern social, mobile, analytics, cloud-based workflow technology called BPM, for Business Process Management. Just as health IT is a large and varied continent (hey, metaphor sighting!), BPM is too. There are different kinds of BPM. So this also means sorting through and adapting workflow technology to healthcare’s unique needs and purposes.

Every year I search every HIMSS conference exhibitor website for content about workflow, workflow technology, workflow editors, customizable workflow, workflow analytics, and business process management and related case management software. I do this to find informational and encouraging healthcare workflow tech stories to share via social media during each HIMSS conference. Five years ago, at HIMSS11, I didn’t even get to the two percent threshold. Every year since, the percentage has doubled — 2%, 4%, 8%, 16% — until this year’s HIMSS15 25 percent plus. The percentage may have actually doubled, but there was so much good and relevant workflow material I literally ran out of time (somewhere in the Qs). I’m seeing a surge of new and embedded workflow tech across almost every category of product and service. Five percent of HIMSS15 exhibitor websites actually mention “workflow engine” (the engine that executes workflow definitions).

As I put it in my HIMSS15 Social Media Ambassador blog post about thirty submitted posts about the Future of Connected Health (in which I highlighted, wait for it, healthcare workflow!)…

“The future is so bright, I gotta wear shades!”

Get ready for the bright sunshine of a healthcare workflow technology spring, and the sprouting of a million workflow blossoms. How’s that for flowery metaphor?

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Charles Webster, MD, MSIE, MSIS, evangelist for great health IT workflow, is the self-anointed King Of All Workflow In Healthcare (AKA The “Workflow Bear” per @OchoTex!)

Marketing Workflow Is An Incredible Opportunity To Differentiate Health IT Products, And You!

Republished from Health Standards.

Marketing Workflow Is An Incredible Opportunity To Differentiate Health IT Products, And You!


Editor’s Note: The following article is a Guest Column from Charles Webster, MD, a health IT workflow expert and advocate for process-aware technologies in healthcare, including workflow management systems, Business Process Management, and dynamic and adaptive case management. You can contact Dr. Webster on Twitter @wareflo or through his blog at To learn more about submitting a Guest Column, Click Here.

Anyone who has wrestled with how to sell a health IT product has wrestled with features and functions versus benefits: what a product is and does versus what important problem it solves and how that will make someone feel. I’ll argue that workflow is the bridge from features to benefits. This bridge is missing in much health IT marketing today. With a modicum of self-study, any health IT marketing professional can use workflow to find clients, understand their products, and tell a vivid and credible story about how they will help health IT consumers prosper.

Back when I took my three-credit undergraduate marketing course, I learned about the original Four Ps of the marketing mix: Product, Price, Promotion, and Place. The Four Ps are now over a half-century old. Since then we’ve had the seven Ps (then eight), the Four Cs (consumer, cost, communication, and convenience), seven Cs, and, finally, four new Ps! (People, Processes, Performance, and Profit.) I could go on about interesting connections among these marketing frameworks (Processes!) and workflow, but I won’t (in this piece!).

Regarding workflow, I took courses about it during an MS in Industrial Engineering. I’ve looked a hundreds of definitions since. This is the short definition I’ve settled on: Workflow is a series of tasks, consuming resources, achieving goals. In marketing terms, you can think of goals as benefits, resources as prices or costs, and the series of tasks as what the product does. All purposeful human activity involves workflow.

So, how is workflow a bridge from features to benefits? Achieving a consumer goal is a benefit. Using a product requires a series of user-product interactions (steps, tasks, activities). Resources consumed? They start being consumed the moment a consumer realizes they have a problem to solve. They continue to be consumed after a product is acquired. And they only stop when a product is finally retired or discarded.

Workflows exist within workflows within workflows, all the way up to, and including, the workflows of life itself. Workflow extends all the way down to the micro-workflow of a series of button clicks.

Let’s imagine that a product has three salient features: A, B, and C. For example: HIPAA-compliant user authorization, ability to look up patient info, and direct staff to do something. A, B, and C are steps in a workflow. They accomplish a goal, the goal of the workflow, goal D. But goal D can be a step in a higher-level workflow, such as Help My Patient. And that workflow is embedded in an even higher-level workflow, such as, What I Do Every Day At Work. And that workflow is part of a life flow, How I Live My Life. Think I’m being silly? I’m not. Understanding how a product (the first P in the original four Ps) fits into lives of users is perhaps the single most important strategic insight a health IT marketing professional can impart.

How can you, a health IT marketing professional, use workflow to find, understand, and help health IT vendors and customers?

“Workflow” is becoming a bigger and bigger meme within the health IT industry. What makes the workflow meme so interesting and so strategic, is that workflow, in a sense, glues together all the other memes. Take SMAC, for social, mobile, analytics and cloud, for example. If you are going to create the next great health IT SMAC-based product, in what order does the user do what, at what cost to achieve what benefit? Workflow!

Furthermore, those tens of thousands of health IT products out there? No one product does everything, so products need to be combined into usable (wait for it) workflow. The biggest pain points within products (usability) and between products (interoperability) all critically involve workflow.

Before every HIMSS conference, I search over a thousand conference exhibitor websites for “workflow.” I tweet links to the most interesting content on the HIMSS conference hashtag. Last year over eight hundred of my tweets on the #HIMSS14 hashtag contained the words “workflow” or “workflows”. By the way, I’m delighted to be a HIMSS Social Media Ambassador again!

Early on, honestly, I had trouble finding much of interest about workflow on exhibitor websites. However, starting at HIMSS12, it really started to take off: four percent of websites, eight percent, and last year, sixteen percent. I’m only part way though the websites of exhibitors for this year’s HIMSS15, but I can already see this trend continuing (though I don’t know if it can actually double yet again).

So, “workflow” is in the air, in hallway conversations, in tweets, marketing, technical documentation, user forums, etc. Search in Google and Twitter for “workflow” and X, where X is a subject you already know. If you are already an ICD-10 expert, become an ICD-10 workflow expert. If you’re already a patient experience and engagement expert, become a patient experience and engagement workflow expert. You can pivot from workflow to any health information management area, and you can pivot from any health information management area to workflow. Doing so deepens your understanding and adds tools to your portfolio.

Network about your workflow interest, through contact pages, emails, listservs, blog comments, LinkedIn, and Twitter. Once you’ve started a conversation, ask for details. Ask about workflows. What happens first? And then what happens? And then what happens. What if something slips between the cracks? Do you have any workflow diagrams? Videos? Do you mind if I draw a workflow diagram and run it past you to make sure I understand how you do what you do? Use Visio, PowerPoint, draw on a napkin and snap a photo. You’ll be surprised by the degree you’re forced to prove to yourself that you really understand a product. And your interlocutor will be impressed (or pestered, you still gotta sell your value relative to the cost of their time).

Now that you understand a health IT product workflow, you have a detailed roadmap between low-level product features and higher-level user goals. If you need more context, bump up a level and understand how that workflow relates to even higher-level workflow and goals. If you need more nitty-gritty, drill down to screenshot-by-screenshot micro-workflow.

If above sounds like a lot of work, it is. It’s worth it. First of all, you’ll prove that you really understand the nuts and bolts of a product and how it fits into a user’s world. Second, you’ve got some great content. Workflow diagrams, simplified, annotated, and made aesthetically attractive are great for blog posts, white papers, presentations, and so on. The health IT market is a collection of complicated and intricate micro markets. The biggest, most costly, and (to the point) beneficial differences between health IT products are differences in workflow. Any means to more deeply understand, represent and communicate these differences is all the good: the consumer’s, the vendor’s, and yours.

Everyone is an expert on their own workflow. If you can vividly and credibly show me, an expert on my workflow, that your product fits perfectly into my workflow, I’m impressed. This is what I mean by the title of this column. Marketing Workflow Is An Incredible Opportunity To Differentiate Health IT Products, And You!

Workflow: It’s not just for industrial engineers anymore!

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Charles Webster, MD, MSIE, MSIS, evangelist for great health IT workflow, is the self-anointed King Of All Workflow In Healthcare (AKA The “Workflow Bear” per @OchoTex!)

Healthcare Systems Process Improvement Conference #SHS2017 Tweetchat Off to Great Start!

I started thinking about a Healthcare Systems Process Improvement Conference-themed tweetchat back in 2015, when I saw Jim’s tweet.

This year a bunch of stuff fell into place. I suggested that SHS2017 ought to have what are called Social Media Ambassadors (just like HIMSS17!). I ended up one of 10 SMAs in this year’s inaugural group. I love tweet chats, where folks tweet about related topics at a predetermined time using a common Twitter hashtag. I participate in about a half dozen tweet chats a week (#HITsm, #HCLDR, #KareoChat, #AskAvaility, #MEQAPI, and often another couple of one-off special-purpose chats). So I decided to host a tweet chat during SHS2017.

Then I realized that the #MEQAPI (Measurement, Evaluation, Quality Assurance, and Process Improvement… you can’t get more HSPIish than that!) tweetchat occurs during the afternoon of the first full day of HSPI! Why not have a joint #SHS2017/#MEQAPI tweet chat?

Before we get to the tweetchat tweets, I’d like to highlight a kind DM from a participant.

“I was really pleased by the ethos and approach to the topics today. It’s refreshing as a patient and a clinician.”

To which I replied:

“Thank you for kind words. You happened upon an unusual community. The tweet chat was associated with the annual conference of healthcare process improvement professionals. They (we) look at the bigger picture, but in a practical way. The attendees would appreciate your sentiments. Thank you participating in the tweet chat. I hope we do it again sometime! — Chuck “

On to the #SHS2017/#MEQAPI tweets! (Just a small subset, by the way!)

There were mostly crickets in direct response to this question (should we be concerned?). However there was also lots of good-natured palavering and debate about other stuff. (Not a problem, that’s just like real life conversations!) For example, there was an interesting conversation about consultants between @KarlKraebber and @ShereesePubHlth.

That’s enough examples of tweets from the tweetchat. Tweet chats are way more fun to participate in than read after the fact! However, here are another couple tweets. I include them due to their positive sentiments toward this tweetchat and having another tweetchat next year.

@wareFLO On Periscope!


Healthcare Process Improvement Tweetchat During #SHS2017 Co-hosted with #MEQAPI Thursday, 3PM EST!

This week starts the Society for Health SystemsHealthcare Systems Process Improvement Conference in Orlando, Florida. Its hashtag on Twitter is #SHS2017. From March 1 to March 3 the top minds thinking about improving healthcare workflow meet to present, learn, and network. As an Industrial Engineer (1985, @IllinoisISE) who went to medical school (@UChiPritzker), whenever I go to the HSPI conference, it feels like my natural home. In 2015 I gave the keynote on “wearable workflow”. This year I’m delighted to serve in the inaugural group of #SHS2017 Social Media Ambassadors. Having been a Social Media Ambassador for HIMSS for four years, I approached SHS and suggested the new SHS Social Media Ambassador program. BTW, I’m on Twitter at @wareFLO (a portmanteau of software and workflow), where I am variously known as Dr. Workflow, The King of All Workflow in Healthcare, or the Workflow Bear.

As #SHS2017 SMA my responsibilities include

  • Participating in social media focused activities before, during and after #SHS2017.
  • Shaping important dialogues leading up to and after #SHS2017.
  • Linking to SHS social media outlets to grow SHS’s followership.
  • Posting comments, pictures, videos, or questions in my posts (such as this).
  • Using the #SHS2017 hashtag! You should too. Regardless of whether you are attending #SHS2017 or not!

Depending on where you hang out (me? Twitter!), please link to, join, and participate via the following SHS Social Media Outlets:

If you are interested in any of the following extraordinarily important healthcare topics, please tweet and/or follow tweets containing the #SHS2017 hashtag.

  • Healthcare Process Improvement
  • Healthcare Leadership and Change Management
  • Healthcare Operations Research
  • Healthcare Quality and Safety
  • Healthcare Human Factors

I’ll also be introducing the #SHS2017 community to the other communities I frequent, including

(Did I miss your tweetchat? Let me know!)

During #SHS2017, at 3PM EST on Thursday, occurs the weekly #MEQAPI tweetchat. Founded by @MLoxton, we’re holding a joint #MEQAPI/#SHS2017 tweetchat from 3PM to 4PM EST. A tweetchat is a flurry of tweets about related topics all using the same hashtag during a prior scheduled period of time. If you are also attending #SHS2017, please multitask! If you are not attending #SHS2017, monitor the #SHS2017 hashtag, and retweet the best and most interesting tweets to your followers.

Don’t forget to use BOTH the #MEQAPI and #SHS2017 hashtags in each and every tweet during the #SHS2017/#MEQAPI tweetchat! (I usually copy and past them from a conveniently located text editor open next to Twitter. On my phone, I created a macro automatically expanding from, say “sss” to “#SHS2017 #MEQAPI.)

T0a & T0b will be tweeted more than once during the tweetchat. They are intended to provide a means to bridge between #SHS2017 #MEQAPI virtual and physical world. Even if you are not attending #SHS2017, please browse #SHS2017 presentations and tweet about them!

Here are the #SHS2017 #MEQAPI tweetchat topics:

The following two topics apply at any time during the tweetchat…

  • T0a: If you are attending a presentation at #SHS2017, please, please, please, live tweet (including photos of slides!) during entire tweetchat! #MEQAPI
  • T0b: Looking forward/backward what #SHS2017 session did you enjoy/look forward to most? #MEQAPI

The following topics will be tweeted at 10-15 minute intervals during tweetchat…

  • T1: Healthcare process improvement increasingly relies on software tools: your favorites? #MEQAPI #SHS2017
  • T2: Is “process” different from “workflow”? If so, how? If not, why do people seem to insist on using both? #MEQAPI #SHS2017
  • T3: Is Healthcare Management/Industrial Engineering” an obsolete phrase? If so, what should replace it? #MEQAPI #SHS2017
  • T4: Health IT increasingly *IS* healthcare workflow. What HIT applications hold greatest promise to improve workflow? #MEQAPI #SHS2017
  • T5: How can we bridge the chasm between process improvement & health IT creation & use? #MEQAPI #SHS2017

Many thanks to Matt Loxton (@MLoxton), founder of the Measurement, Evaluation, Quality Assurance, and Process Improvement (#MEQAPI) Thursday, 3PM EST tweetchat. Please come back! It’s every week at the same time!

@wareFLO On Periscope!


Deconstructing and Reengineering #HIMSS17 Twitter Statistics: Symplur vs. Twitter Analytics

This is just a short post about #HIMSS17 Twitter statistics. Since I tweeted tweets containing the #HIMSS17 hashtag the fifth most number of times during #HIMSS17, let’s take a look at how the top five got there.

I just tweeted the tweet above. It shows another tweet from another Twitter account containing a single #HIMSS17, which was immediately retweeted! You can’t get more content-free (but still be included in #HIMSS17 Twitter stats) than that! Of course, my tweet was automatically retweeted by yet another of the high ranked accounts.

These three accounts, @ACharlesPlatt, @sorena997, and @smartmedrt, one tweeting a tweet with just a single #HIMSS17 hashtag, and the other two simply retweeting a tweet with the #HIMSS17 hashtag, ranked first, second, and fourth in #HIMSS17 Twitter stats.

Let’s look at @CI4CC, the fourth of the Twitter accounts ahead of me in the stats. I looked through a couple hundred tweets, but could not find a single tweet that was not simply a retweet.

Why do I care? I think statistics about tweeting during conferences are potentially useful measures of digital audience engagement. However, there are a wide variety of ways to “game” these stats. This is also true for Impressions and Mentions, though the specific mechanisms of gaming are different. Impressions does not take into account either ratios of followers to followees, or numbers of pairs of eyeballs who actually saw or interacted with the tweets (such as is documented by Twitter Analytics). Similarly, Mentions can be gamed by repeatedly tweeting images and tagging up to a dozen-and-a-half-tweeps, or using multiple Twitter accounts.

A Grain of Salt

I’m not complaining. (OK, maybe just a little bit.) I also occasionally RT or tag tweeps. However, this is not my predominate modus operandi. Most of my tweets are of original material I created (such as long-form blog posts about healthcare workflow, or, this year, lots of #HIMSSmakers photos) or links to substantial news, posts, or videos about same or related subjects. In general, I try to not repeat links to the same material. I make an exception during HIMSS conferences. For example, I was interviewed by workflow by HIMSS17 TV. I tweeted that a half-dozen times. I gave an invited state-of-the-healthcare-workflow-industry presentation at a vendor-sponsored Lunch & Learn. I uploaded that to Youtube and tweeted that out multiple times.

My basic calculation and rule-of-thumb is this. If I put a great deal of work into creating a piece of content about healthcare workflow, and the result is particularly compelling, re raising awareness about healthcare workflow and workflow technology, then I’ll tweet that content more than once. As long as I am also tweeting a wide variety of high-quality, unique content about healthcare workflow and workflow technology. I think this is consistent with my brand:

“Everything in moderating — except workflow!”

Why bother to write this post about HIMSS17 Twitter stats? I just think we need to drill down a bit into tweet statistic leaderboards, to understand how and why they work the way they do, and how who is there gets there.

And I’d like to suggest a possible alternative. Twitter Analytics. They aren’t publicly available. Each Twitter user can only view their own Twitter Analytics Dashboard (see its help document) and here is a screenshot of my Twitter Analytics Dashboard. Feel free to share yours! The workflow is this: just log into Twitter Analytics dashboard, navigate to tweets, adjust date range to from 2/20 to 2/23, capture screen as an image, and then tweet image (don’t forget the #HIMSS17 hashtag). I suspect many Twitter accounts that do not even appear in the top ten of the Symplur leaderboard, are way more impressive than my Twitter Analytics dashboard stats.

Using the Twitter Analytics Dashboard, you’ll get a much better sense of how many people actually “see” and interact with your tweets than most publicly available Twitter statistics leaderboards. For example, Impressions on Symplur is how many people follow an account times how many time it tweets (I think; I’d be happy to be corrected!). In contrast, Impressions on the Twitter Analytics Dashboard is based on Twitter’s estimate of how many Twitter users actually see and engage with your tweets (again, I think; I’d be happy to be corrected!). Using Symplur’s definition of Impressions, @wareFLO had almost seven million impressions w/r/t the #HIMSS17 hashtag. However, according to Twitter Analytics definition of Impressions, 237,900 tweeps actually saw my tweets. In other words, the number of folks who actually saw my tweets is about 3.5 percent of the number of folks who follow me on Twitter. Lots of people who follow me probably didn’t even see a tweet from @wareFLO, while lots of folks who don’t follow me, but monitored the #HIMSS17 hashtag, did see some of my tweets containing the #HIMSS17 hashtag.

Even though 238K impressions is way less than 7M impressions, I’m quite happy with that statistic. First of all, it is more accurate and valid. Second, I aim at a relatively narrow, but none-the-less growing, niche: healthcare workflow and workflow technology. If even half of 238K are interested in healthcare workflow and workflow technology, to me that’s a home run. Certainly, qualitatively, this is consistent with my subjective gestalt impression of a whirlwind hurricane of RTs and replies and DMs concerning my favorite topic of conversation of all time: workflow!

Here are some of the other statistics available on the Twitter Analytics dashboard:

  • Detail expands: Clicks on the Tweet to view more details
  • Embedded media clicks: Clicks to view a photo or video in the Tweet
  • Engagements: Total number of times a user interacted with a Tweet. Clicks anywhere on the Tweet, including Retweets, replies, follows, likes, links, cards, hashtags, embedded media, username, profile photo, or Tweet expansion
  • Engagement rate: Number of engagements divided by impressions
  • Follows: Times a user followed you directly from the Tweet
  • Hashtag clicks: Clicks on hashtag(s) in the Tweet
  • Impressions: Times a user is served a Tweet in timeline or search results
  • Leads submitted: Times a user submitted his/her info via Lead Generation Card in the Tweet
  • Likes: Times a user liked the Tweet
  • Link clicks: Clicks on a URL or Card in the Tweet
  • Permalink clicks: Clicks on the Tweet permalink (desktop only)
  • Replies: Times a user replied to the Tweet
  • Retweets: Times a user retweeted the Tweet
  • Shared via email: Times a user emailed the Tweet to someone
  • User profile clicks: Clicks on the name, @handle, or profile photo of the Tweet author

It is tempting to re-imagine Twitter conference statistics using Twitter Analytics. Instead of Impressions based on tweets containing #HIMSS17 times followers, Impressions would be based on Twitter’s estimates of how many tweeps actually saw and engaged. I’d argue the latter is a much more valuable statistic. Of course, Twitter Analytics apply to a Twitter account as a whole, not only tweets mentioning #HIMSS17. One could export tweets, then slice-and-dice and come up with specific hashtag filtered statistics. But I don’t think that extra work is necessary. Most of my tweets during #HIMSS17 are about #HIMSS17, anyway.

If I am a potential #HIMSS18 exhibitor, intending to leverage Twitter during #HIMSS18, and working with “Twitter Famous” health IT social media thought movers and shakers, take Twitter stats with a grain of salt. Ask to see Twitter Analytics statistics (screenshots, live screenshares, etc.) and compare how many tweeps actually see and engage, not just how many might theoretically possibly do so on an extremely good day.

I’ll see you next year, online before and during #HIMSS18, and inline at #HIMSS18, in Las Vegas. Where, from a purely health IT social media perspective, I guarantee that “What happens in Vegas stays in Vegas” will not apply.

@wareFLO On Periscope!


HIMSS17 Makerspace an Extraordinary Success: Tweets! Photos! Videos!

I have lots of folks to thank for paving the way and making the first ever makerspace at a HIMSS conference a resounding success. I will follow up with a longer blog post doing exactly that. However I want to get this collection of tweets, photos, and videos on the web as soon as possible immediately after HIMSS17. Enjoy!

Replay an hour-long live-streamed Periscope video.

I discuss connection between healthcare workflow and the maker movement.

A first-time HIMSS17 exhibitor shows off his 3D-printed custom battery housing for medical devices (an excellent practical example of 3D-printing in healthcare). Jim also enthusiastically endorses the HIMSS exhibitor experience.

Now for some photos…

I used my laser cutter/engraver to create badges for the HIMSS17 Social Media Ambassadors. Notice that @janicemccallum is the “boldest” (because she was first and I hadn’t dialed in the laser engraver yet, I offered to reburn it, but J liked the metaphor of being first and bold).

Thank you @HIMSS for providing me space for a makerspace!

Here is what the makerspace looked like right after I set it up on Sunday.

Everyday, via tweets on the #HIMSS17 hashtag, I gave away a Raspberry Pi (including accessories), donated by @msharmas of @HCITexpert.

It was so much fun giving away the Raspberry Pi! Got into a great convo with Denise about possible healthcare-related uses of her new RPi. My favorite? Proximity sensors (like those that turn on light when you enter a room) feeding data to the RPi to create a primitive (but potentially effective) home-based ambient activity tracker.

So much fun! Folks would walk around the corner, stand stock still, staring and grinning! Then it was usually one of two responses: What the heck happened here? Did something explode? vs. I know exactly what’s going on here, I’ve got half this stuff at home!

#HIMSSselfie with a couple of my fans… 🙂 (@A_Burkey & @carimclean)

John Lynn (@TechGuy), the busiest man in health IT social media, picks up his laser cut/engraved HIMSS17 Social Media Ambassador badge!

I explain the bits and pieces of a 3d-printed object.


@InnoNurse wins the HIMSS17 Innovation Makerspace grand prize! A Bluetooth-capable, battery-powered, $200 hackable Arduino-compatible biosensor (EEG, EMG, myo, dermal) development board, the BITalino.

What will Danielle make???

Interview with @InnoNurse about her new Bitalino biosensor development board.

LOL! Michael (@HealthData4All) is referring to the amount of time it will take me to put the makerspace genie back in the bottle and transport it back to my second bedroom in Columbus, Ohio! LOL!

Whew! I was tired, but in a good way!

Hmm, I’m already thinking on how to improve the #HIMSSmakers Innovation Makerspace experience! It might just have something to do with #HIMSSworkflow…. !

@wareFLO On Periscope!