2006 EHR WfMS Tutorial Slides 82-89: Hospital EMR/EHR BPM: Usability, Workflow, Analytics

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From (EHR) Workflow Management: Models, Methods, and Systems.

Workflow management systems (and now business process management) ideas, terminology, and technology are finally beginning to gain traction in the health information technology industry. A great deal of credit for this progress is due to Soarian from Siemens, which is based on the TIBCO Staffware workflow management/business process management platform. Soarian’s use has won a major award from the Workflow Management Coalition.

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A Major EHR WfMS

“Soarian embeds workflow management technology, providing means to coordinate services between departments, and across the institution. If orchestrates care, coordinating all the services provide to each individual patient, and making optimal user of people and resources.” (electronmedica 69 (2001) no. 2)

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Siemens Soarian

  • Smart User Interface
  • Workflow Engine
  • Embedded Analytics

[connect smart to intuitive and intelligent]

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Smart User Interface

“Soarian permits intentional and optimized workflow process designs. It provides an intuitive graphical environment for designing reengineered workflow processes.” (electronmedica 69 (2001) no. 2)

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Workflow Engine

“Soarian enforces the execution of these reengineered processes. It tracks the progress of individual work steps, and automatically escalated failed or expired work steps to the appropriate individuals.” (electronmedica 69 (2001) no. 2)

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Embedded Analytics

“Soarian provides embedded analytics. It automatically gathers detailed information regarding process execution throughout the institution. This information enables the detailed analysis needed for further process refinement, and the completion of the Quality Cycle.” (electronmedica 69 (2001) no. 2)

[see my process mining post, paper, and video]

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Siemens on Workflow

“At Siemens, we define workflow as the process of moving patients, resources and information across the healthcare continuum… Our solutions track the sequence of next steps by eliminating manual tasks and departmental lines and handoffs. They proactively push information such as coverage and medical-necessity issues to people who need it, while driving clinical tasks — delegating work to the right person and the right time.”

Retrieved from (now broken link):

http://www.medical.siemens.com/webapp/wcs/stores/servlet/CategoryDisplay?storeIT=10001&catelogID=1&langId=1&categoryId=19021&catTree=100001,19021

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Finally, here is Soarian’s graphical workflow editor. You can see that it resembled MS Visio, but with a major difference. Diagramed workflows are executable. This is what I mean when I refer to executable process model [link] elsewhere. Instead of a Java or C# programming writing code that is incomprehensible to users who best know their workflows, the “code” is this is based on this diagram, which iscomprehensible to users who best understand their workflows. The workflow is constructed from clinical workflow domain specific terminology:

  • Triage Patient
  • New Neuro Deficit
  • Nurse EHR Evaluation
  • Nurse TPA Assessment
  • Thrombolysis Candidate?
  • Physician Eval
  • STAT CVA Eval
  • CVA Confirmed?
  • Thrombolysis Panel
  • CT Head r/o CVA
  • Stat IV
  • Hemorrhage
  • Physician TPA Decision

There’s a great potential fit between user-centered design and workflow-centered design (as I note at the end of my “straw man” article User-Centered EHR Design Considered Harmful (Try Process-Centered Instead)) Note the important role of psychologists and linguists in user-centered design of Soarian in the following passage.

A team of industrial psychologists, linguists, physicians, medical informatics and communication and indus- trial graphic designers developed the user interface for Soarian – its page, language and navigation design…The result is an interface that…will be easy to use and will require little training. The use of a common look and feel facilitates access from any device and supports collaboration across clinical disciplines. Soarian’s user-specific workflow design intents to present screens and data appropriate for each user’s job function and work to be performed…The main-goal of Soarian’s ‘smart user interface’ is to deliver a transparent user interface, which supports the users accomplishing their tasks. That means, ideally the users’ focus attention is only targeted at the task, not how to handle a system…The Soarian process has been added with the principles of user centered design methodology in addition to the wide spread object-oriented-approach (36, 37). This process allows task-oriented soft- ware design rather than feature/function driven…the task-oriented user interface work accompanies the whole solution lifecycle right from the beginning rather than being sent to a usability test after the design already took place…The ‘smart user interface’ is technically divided up in two aspects: the user interface concepts & design [and] the contributions of the workflow engine…This concept is in accordance with the modern understanding of workflow supporting systems and does not create any additional burden of learning or changes on the clinical end users.

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