Congratulations to the Cardiff School of Computer Science & Informatics and the Velindre NHS Trust Cancer Centre (check out Welsh language version of their website) for bringing the future of process-aware EMR / EHR BPM workflow systems closer to today. Their prototype workflow management system/business process management system for healthcare won a 2011 Global Awards for Excellence in Adaptive Case Management. I urge you to read the full text of the case study.
Wordle based on sixteen short quotes
from the awarding winning application
I regularly scour the Web looking for evidence of convergence between the worlds of EMR/EHR and workflow management systems/business process management (check out the EHR.BZ REPORT on EMR / EHR Workflow, Usability and Productivity). To quote myself:
“The next step in the evolution of ambulatory EMRs is squarely at the intersection between two great software industries: electronic health record systems and workflow management/business process management systems. The hybrid EMR workflow systems that result will be more usable and more systematically optimizable than traditional EMRs with respect to user satisfaction, clinical performance, patient satisfaction, and practice profitability.” (A White Paper About EMR Workflow, Usability, and Productivity in Pediatric and Primary Care)
Eight years before that I co-authored a paper about the first EMR / EHR workflow management system, about which I wrote:
“Developments that are beginning to affect collective thinking of the HIT industry today:
Workflow management systems (business process management today)
Computer-supported collaborative work (groupware and workflow systems today)
Componentized EMR architecture (software modules/plugins and service-oriented architecture today)”
It’s too soon to write “I told you so!” but that delicious moment draws ever closer. Health information technology and business process management industries increasingly overlap and interact, giving rise to much needed hybrid vigor.
Below are quotes from the case study. If you follow healthcare discussions about EMR / EHR usability, interoperability (especially workflow, or pragmatic, interoperability), clinical intelligence, population health management, clinical groupware, collaboration, coordination, continuity of care, they will surely pique your interest. Skim the bold emphases I added and think (“Just think!”) about their relevance to solving many of the problems plaguing today’s generation of EMRs and EHRs.
Mind the Gap! (those strategically placed three-dot thingies)
Teamwork, collaboration and coordination are key aspects of the patient-centric approach taken by modern healthcare….The work described includes tracking care teams and individual team members dynamically as the patient progresses along the dynamic care pathway. It proposes the integration of a Business Process Management (BPM) system into the HISs as it will better support both the individual work of health and care practitioners as well as improve support for team communication, and care coordination throughout the patient’s care….The proof of concept prototype showed that the application of Workflow Technology in the healthcare domain is a very promising development. It can be used to evolve the functionalities of existing HIS, so that they can be used to support implementation of ICP services and associated treatment flow for a patient. It is believed that these functionalities are important as they result in safer more effective and efficient care and treatment. Functionalities of the proposed system include: providing a pro-active system, routing and information filtering….The strength in the BPM systems is in its ability to invoke existing systems at any stage during the process flow in a way which overcomes the system heterogeneity challenge….BPMs can be adjusted to enforce a specific sequence and\or enable an extremely flexible order of processes….At a business level, the system will facilitate multi-professional care team communication and therefore care coordination across the multiple healthcare organisations involved in the treatment of patients….The proof of concept prototype showed that the application of Workflow Technology in the healthcare domain is very promising….Functionalities of the proposed system include: providing a pro-active system, routing, task automation and information filtering. These functionalities are: Pro-active System: this is the primary advantage of using Workflow Technology in the healthcare domain. It is the difference between having a reactive or a proactive system. In the case of a reactive system, which most traditional HISs are, reactions are a response to requests made by users while proactive systems are capable of identifying the need to take an action and activities it activates. The workflow engine within the workflow management system can be coded to fetch triggers, understand which of the users or roles are affected by this trigger, how they are affected and finally, take appropriate actions to inform them. These pro-active functionalities can be used to execute many different actions, such as: alert, notify, refer, schedule and set timers….Routing: this helps the system determine the sequence of the processes and the consequences of any decision made. This is either by suggesting the next stage or automating a set of processes. While routing is a tool that WFMSs provide, routing is only made with a user’s approval or suggestion. This is done by providing a message to the user showing the alternative routes according to the ICPs’ logic and the user can approve any or simply skip it….Task automation: is performed when a number of tasks need to be processed as a set. In this context, it includes tasks that do not require user interaction….Information extraction and filtering: to ensure summary of important information is visible to healthcare professionals when viewing a patient’s records. This aims to facilitate tracking a patient and improving the decision-making process by making healthcare professionals aware of the development of the care process and therefore making better use of their time. This includes improved visibility of: treatment history, milestones, order and time, and acting healthcare professionals….At the system level, the HIS will become more pro-active and capable of performing the following actions: alert, notify, refer, schedule, and set timers. It also provides a flexible system that handles dynamic changes happening during a patient’s treatment. This includes routing the flow and performing automatic tasks. Moreover, the workflow system provides a tool to track patients and ensure continuity of the flow by filtering and extracting important information. The treatment information extracted includes: history, milestones, order and time and involved care team professionals….The coordination problem…need for a more proactive system that facilitates care coordination among care team members…Business Workflow: This is required to model the huge number of processes interacting in a healthcare system. Business workflows support human interaction with the system. This is necessary in healthcare systems, where different care team professionals interact with the system and support the decision making process and therefore the routing of the flow….Activities represent all the treatment and diagnosis options a patient can follow. These options should be modelled in the WFMS and form the main block of the system….A Process: this is the actual workflow map of the clinical guidelines…An Activity: the steps of the clinical guidelines….A Process object: this provides control or audit to the case according to its state….A case: this is the scenario in progress. Each case represents a patient’s treatment flow. For each patient, the treatment pathway is unique and is processed by considering a patient’s health condition and the available resources. The case hierarchy at run time usually shows treatment history, the progress, the state in each and the roles or users involved in different stages.
Again, congratulations…and thank you!