The Intelligent Workflows Behind Engaging Patient Experiences

The intelligent workflows behind engaging patient experience… what do I mean by that? Well, I mean something similar to “the systems behind the smiles”, i.e. the “robust systems and processes” employees need to simply assume exist, so their minds are free to extend fantastic service. Healthcare needs both, great people and great workflow. I tend to focus on the workflow tech necessary to deliver great workflow, but first I must acknowledge healthcare’s great people.

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The next couple of paragraphs are somewhat procedural. Basically they describe *my* workflow, in analyzing the Patient Engagement Summit slides for examples of workflow thinking and technology. Feel free to skim, until you get to the output of my workflow, the highlighted slides themselves, and my commentary.

Anyone who follows me on Twitter (@wareFLO) or reads this blog (EHR Workflow Management Systems) knows I am a persistent continual advocate for wider use of workflow technology in healthcare. (For primers see my 5-part series or my 45-minute Youtube video.) True workflow automation is essential for usability, safety, and interoperability. It’s also essential for scalable, systematically improvable systems of patient engagement.

I was delighted to find that slides for today’s and tomorrow’s Patient Engagement Summit in Orlando are available to be downloaded. So I do what I always do, as a first cut. I search for every use of the word “workflow”. It’s mentioned seven times on the conference website and seven times in the slide sets. Promising!

Since slides sometimes mention workflow in images, which are unsearchable, or talk about workflow or workflow technology, but use different words, I read the sixteen slide decks from beginning to end. I bookmarked 46 slides. Then I sorted the slides in order of priority, from most relevant to my interests, to lease. The rest of the post features that best of the best, so to speak.

Over all the Patient Engagement Summit is a great conference. However, given my narrow interest, The Intelligent Workflow Behind Engaging Patient Experiences, five presentations really stand out. Here are some of the slides, interspersed with my comments, plus links to related material.

  • Robert Wachter, MD – Patient Engagement 2015: Balancing Hope and Hype as Healthcare (Finally!) Enters the Digital Age
  • Jessica Greene, PhD (George Washington University) Patient Activation: The Key to Better Outcomes
  • Melissa Anselmo (Beth Israel Deaconess Medical Center) – Open Notes: The Power of Sharing
  • Edward Martinez (from Miami Children’s Hospital) – Patient Engagement and Care Coordination Technologies for Improved Outcomes
  • Debra Albert & Susan M. Murphy (from University of Chicago Medicine) – Drive Engagement With Interactive Care

There’s definitely a post-EHR feel to the Summit. While “workflow” is mentioned seven times, “EHR” is only mentioned five times (and “EMR” just once). However, of course, like workflow, it’s often simply assumed in the context of many slides.

Dr. Wachter presents the following, sobering series of slides.

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President Bush calls for what we now call Electronic Health Records in 2004. They will avoid mistakes, reduce costs, and improve care.

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Federal spending on EHRs, through the ONC, has increased 71 thousand percent, from $42 million to $30 billion.

The next two slides are admittedly anecdotal. But I think Dr. Wachter assumes his audience knows about ongoing debate about whether EHRs achieved their goals or not. Just a couple days ago, USA Today referred to this as “the battle of the studies.” But it’s the job of a conference keynote to avoid dry statistics and tell a story, at which Dr. Wachter excels.

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On one hand, implementing an EHR made this doc’s staff not even knowing how to to their job.

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(Frownie face added for emphasis…)

And on the other hand, NOT having an EMR is literally becoming an employee perk!

For more of Dr. Wachter’s views on the effects of Meaningful Use (the Federal initiative to subsidize certified EHRs) read his widely circulated (and commented upon, wow!) piece Meaningful Use. Born, 2009, Died, 2014?

Thank heaven at the rest of the Patient Engagement Summit is a potent potential antidote to current malaise about EHRs! And the following slides prove it.

The next three slides, from Jessica Greene, PhD, presents definitions of patient engagement and levels of patient activation.

Patient engagement is the action they take. In fact, I often say that patient experience is what happens to patients; and patient engagement is what they do back to the system that generates their experience. (There are interesting workflow implications to this formulation. Since workflow tech involves intelligently and actively “pushing” actionable content to users, what arrives in the patient’s InBox, so to speak, is part of experience, while what they do in response is part of engagement.)

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The following slide reminds me of a distinction between data and information. Information is data that makes a difference, to knowledge, to action, to consequences.

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The following slide describes four levels of patient activation and engagement. Very useful for designing those intelligent workflows of patient experience and patient engagement I referred to earlier. I think there may be a useful conceptual “zeroth” level, in which the patient is completely self-unaware and lacking in competence or confidence to actively pursue and maintain better health. How to build the systems that more effectively and efficiently and flexibly move patients from level zero to level four?

This sort of layered conceptualization is critical to operationalizing ideas like patient activation and engagement. And they do have to be operationalized, if they are to eventually turn into the systems of people and technology necessary to scale and systematically improve.

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I like the following slide from a presentation about an OpenNotes initiative because, (A) it lays out a workflow, and (B) there’s that Plans step or state. It seems to me that OpenNotes projects would be excellent candidates for the use of workflow platforms. Users and designers could design the workflows, and workflow engines could execute the workflows. I also foresee a time when subsets of content could actually intelligently trigger workflows.

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The following ten slides, by Edward Martinez (from Miami Children’s Hospital), is a figurative treasure trove of workflow automation applied to patient engagement. The presentation title is Patient Engagement and Care Coordination Technologies for Improved Outcomes. As far as I am concerned, it deserves Best In Show for the Patient Engagement Summit.

I’ve previously written extensively about the relevance of various kinds of workflow automation to care coordination. From workflow management systems and business process management, to dynamic and adaptive case management, I’m seeing considerable diffusion to workflow tech into healthcare exactly in the care coordination and population health management space. Many of these systems also have extremely valuable social, mobile, analytics and cloud functionality. So it’s exciting to begin to see this kind of closed-loop workflow functionality emerge in healthcare. By the way, I cross-indexed “Miami Children’s Hospital” and “care coordination platform” to figure out the vendor being used. It’s PatientPoint out of Cincinnati, Ohio. By the way, PatientPoint will exhibiting at the HIMSS conference (booth 4816) in Chicago.

This Care Coordination Technologies presentation starts out exactly where it should. What obstacles face care coordinators and how can care coordination technology help?

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An impressive smorgasbord of self-serve patient services! What I always wonder when I see a relatively exhaustive marketecture such as this: how are these services tied together, and with other stakeholder services, into usable workflows? Luckily, I see plenty of evidence for sophisticated workflow infrastructure.

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For example, take this Care Coordination Workflow. It uses gaps in patient care to generate actions to eliminate those gaps, in this case phone calls (IVR stands for Interactive voice response). This is combining clinical intelligence, complex event processing, and workflow automation in a way that is highly reminiscent of my 2010 MedInfo paper presented in South Africa.

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The following diagram is a top level view of a set of workflows. I have no doubt that there exist highly detailed representations of workflow here. And, I suspect (or at least hope), some of these workflows aren’t hardcoded. Given that PatientPoint is built on a pure Microsoft stack using MS SQL Server and .NET I wonder if they’re using Microsoft Workflow Foundation, which I’ve written about before. This sort of “secret sauce” detail is often viewed as important intellectual property, and thus not usually conveyed in marketing content. So I’m being speculative here. But this sort of diagram, associated functionality, and, most important, a happy customer is a very good sign, from a healthcare workflow technology perspective.

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Again, we’re seeing in these slides the kind of classic, flexible, task management that I’ve been calling for, for years. Note the system only displays actionable information to users, and then posting back to the EMR. EMRs are essentially becoming databases, accessed in real-time by more sophisticated (workflow-wise) workflow platforms.

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Automated workflows communicating with patients in the way they prefer! Of course, if they prefer a human voice, and a real-live person, that’s what this kind of tech can facilitate too. I wrote about this in the fifth piece in my 5 part series about healthcare workflow technology.

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Here we’re seeing ECM (Electronic Content Management) combines with BPM. This is consistent with a trend, increasingly seen in health IT too, of adding workflow tech to ECM systems and content management to workflow systems.

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The next few of slides are very interesting, and not just for the mobile client user interface what a workflow system coordinating and firing off notifications. It’s the trademarked “CareNotify” and “Carrative.” I can’t find anything about them on the web, no matter how I cross-index them…

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…are these potentially new products?

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I’m thinking of all kinds of exciting possibilities here.

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Well, PointPatient and Miami Children’s bear watching. I may be getting ahead of myself, but this could be a prime example of the kind of process-aware tech (that’s what the academics call it) that is the next generation of health IT platform architecture. Of course, only time will tell. And yes I may be getting ahead of myself. I often do. But… exciting!

Last but not least, I’m delighted to see my alma mater, University of Chicago Medicine, represented so well at this Patient Engagement Summit.

Below is a lovely overhead shot of the medical center and medical school, in Hyde Park, by Lake Michigan, in Chicago. I’m particularly taken, because for the first time is several decades I’m staying in Hyde Park during the upcoming HIMSS conference. By the way, I’m a HIMSS Social Media Ambassador, tweeting lots about workflow from April 12-16. If you’re as interested in healthcare workflow as I am, perhaps even the Intelligent Workflow Behind Engaging Patient Experience 🙂 I hope you’ll look me up! (I’m @wareFLO on Twitter, plus my blog’s contact form). I’d also like to put in a plug for a project working on, to create a customizable interactive wirelessly-controlled wearable 3D-printed robot for engaging pediatric patients. See MrRIMP.com for details.

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OK! Back to the subject at hand.

My alma mater is working with one of my favorite companies, GetWellNetwork (booth 6627 at HIMSS15). Why is GetWellNetwok one of my favorites? Because they use, wait for it, workflow technology! I’ve tweeted about this aspect of GetWellNetwork lots.

Interactive Pathways… daily patient touch points before and after hospital visit, cross platform from patient perspective, reduce 30 day readmission, what’s not to like? And, as I said, they’re using the kind of modern workflow tech I continually tout. In fact, I’m seeing some of the most sophisticated workflow tech emerging exactly the patient-facing tech arena.

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Note the following process objectives as part of the Clinical Practice Design Process. Note especially the Clinical Workflow Design and Configuration of Tools. These are exactly the process objectives for which workflow technology is ideal. Instead of “hardcoding” workflows and then users having to adapt to the software, workflow tech allows an organizations, in this case my alma mater (did I mention that?) to systematically move all the way from long-term strategic vision to daily nuts-and-bolts execution.

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All in all, at a 30,000 foot level of abstraction, to characterize a trend I’ve observed in health IT: We’re moving from Systems For Transactions to Systems for Engagement. Here’s a slide from a different conference (a Business Process Management conference, by the way) that draws out this distinction.

Systems For Engagement focus on delivering adaptive user experience. They’re idea for fast-paced change. And they support new work patterns, such as embracing mobile and social.

Workflow tech continues to diffuse into healthcare and health IT, especially with its maturing hooks into social, mobile, analytics, cloud, and even Internet of Things and wearable technology. As a result, health IT, and even EHRs, are becoming more effective, efficient, flexible, and relevant to the patients who encounter it when they have to, and the providers who use it daily.

The end result, one hopes, are more intelligent workflows, better patient experience, and more engaged and healthier patients!

See you, in person or online, at #HIMSS15!


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