#HIMSS19 Social Media Ambassador six years in a row. Three HIMSS Davies Awards. Designed first undergraduate medical informatics program. EHR CMIO. Premed-Accountancy major (#1 ranked Illinois), Healthcare Systems Engineer (MSIE, Illinois), MS Intelligent Systems (Artificial Intelligence), ABD (All But Dissertation) Computational Linguistics (CMU). Dr. Workflow. King of All Workflow in Healthcare. The Workflow Bear. Owner of JETS! @HealthITDog and Maker of @MrRIMP (Robot-In-My-Pocket), both on Twitter!.
During the next three days, Monday through Wednesday, I’m attending (and speaking at) the Business Process Management and Case Management Summit (#BPMCM15 on Twitter) here in Washington, DC. I’ll be speaking about “wearable workflow” and the Internet of Things in healthcare, on Tuesday. But I’ll be thinking about the title of this blog post during the summit. There is perhaps no more concentrated venue of discussion of intelligent and flexible task management than the yearly BPM and Case Management Summit. During the next couple years, “Care Management Systems” will come to dominate the health IT vendor landscape. I have strong opinions about which classes of IT architectures will work best for flexible, scalable, distributed, intelligent healthcare task management (basically, they need to be “process-aware). Since the summit is such an excellent place to ask true experts on BPM and case management about how to leverage their technologies in healthcare, I decided to telegraphy my punch, so to speak, and archive the following Sunday morning, talking to myself tweets. Feel free to reply to any of them, from either the workflow tech industry or from health IT. I look forward to the conversation and the “idea sex.” 🙂
“Interoperability is not just the transfer of data, stale pieces of information from one store to another, but instead the flow and use of the various pieces until an action can be undertook or new insight is gained for the care of our patients.” — Donald Voltz, MD (@Donald_M_Voltz and LinkedIn)
You article has brought attention to an area dear to my heart, healthcare workflows. Of note, the idea that we all need different workflows to obtain efficient, effective and high quality results is an important one that often is overlooked for total standardization of workflows. Don’t get me wrong, there is a lot to gain from standardized workflows, however, we have to view this concept in the face of the dynamic, complex and interdependent healthcare environment. Each patient, care path and phase of care is to some degree customized for our patients as we interact and care for them. All patients do not respond to the same amount of a given medication in the same way nor are their social, physiologic, psychological and other needs all met in the same manner. This is a problematic issue in health IT but also one that many of us embrace and work to customize the care we provide to our patients.
I have understand the view point you take on BPM software to help develop and understand workflows in medicine and have been working to solve this complex challenge, albeit from a different perspective, one of a middleware platform built upon a service-oriented software architecture that connects disparate health data sources and allows for the development of customized enhancements of EHR platforms so to address the clinical, quality, regulatory and workflow issues that are not addressed in implemented EHR systems.
The picture you presented about data silos is right on. In medicine, data only becomes meaningful in the care of the patient when it flows. Interoperability is not just the transfer of data, stale pieces of information from one store to another, but instead the flow and use of the various pieces until an action can be undertook or new insight is gained for the care of our patients. To further your argument, I completely agree that we all own a workflow, that which is currently ‘hard coded’ in the systems and the way they have been implemented as well as in the ‘soft code’ of policies and expectations of our peers, patients and co-workers. We all find a way to best work in an environment constrained not only by the technology but by many additional factors. If we are to address the needs of healthcare professionals, we need to understand the work they are doing and how we can harness the power to extract workflows to make it easier, more efficient, effective and expansive. But even greater than understanding, we need a way to develop workflows and share these among ourselves. Technology and its adoption, irrespective of the era in human history, has been about more than the tools. It has lead to enhancements and productivity gains through how it is applied to the problems at hand.
With respect to health IT, you are absolutely correct, we can not and should not code workflows into the EHR systems. This is not a viable solution to build scalable, evolving solutions that can be used across EHR applications. In addition, it does not allow for the issues you raised, changing policies, practices, regulations and emerging technologies. Instead of coding this into EHR systems, we need to think differently and beyond the confines of any single EHR implementation. Until we can share not only data, but also the information that arises when data hits the brain of a healthcare profession across the care continuum coupled with best-practices (which are not static but constantly evolving as we have see in the innovation curves of any technology, digitial or not) that can be shared and enhanced between providers, driven by patient needs, we will be stuck throwing more human power at problems that can be more eloquently solved by technology. This is when we start to realize the value from our health IT investments and when the brightness is revealed.
Wednesday and Thursday last week I wandered around the AHIP exhibit floor asking pointed questions about workflow and workflow technology. What I found reminded me of the Connections TV series:
“the entire gestalt of the modern world is the result of a web of interconnected events, each one consisting of a person or group acting for reasons of their own motivations (e.g., profit, curiosity, religious) with no concept of the final, modern result to which the actions of either them or their contemporaries would lead. The interplay of the results of these isolated events is what drives history and innovation”
I strongly feel there is a similar gestalt, right now, regarding use of workflow tech in health IT. A friend of mine compares it to supersaturated fluid. Health IT conversation is supersaturated with discussion of “workflow.” I believe this discussion is starting to crystalize around opportunities for workflow tech to better manage healthcare’s “Workflow Problem.” Also check out my 10 part series on the coming intersection between health plan IT and Business Process Management.
In this blog post I’ll summarize what I found, archive some of my favorite tweets, and consider where we (ragtag band of workflowistas) need to go next.
Before I got to the AHIP Institute, I did what I usually do before a conference with a substantial concentration of health IT exhibitors. I looked at every exhibitor website, searching for the following phrases.
health insurance workflow
“Business Process Management” OR BPM
“workflow management system”
“process orchestration” OR “workflow orchestration”
workflow “patient experience” OR “patient engagement” OR “customer experience” OR “customer engagement”
“customizable workflow” OR “customizable workflows”
workflow “patient experience” OR “patient engagement” OR “customer experience” OR “customer engagement”
“health plan” workflow
The first thing that struck me, when I started walking the exhibit hall, was that, compared to HIMSS15, there was much more mention of workflow tech related terms. I didn’t formally quantity this, but I’d guestimate between five times as much but possibly as high as a magnitude.
Industrial style process model
Robotic process automation
I stopped at booths mentioning anything similar to the above phrases. I expressed interest and asked for elaboration. And, in some cases, I shot what I call a One-Minute Interview. I captured the video using Google Glass, uploaded to YouTube, and tweeted on the #AHIPinstitute hashtag, almost on the spot.
In the following video Marcia talks about “robotic” claims processing tasks. These are routine tasks that are ideal for automating. Just prior to the video she mentioned taking the percent of claims that are completely accomplished without any manual human intervention from 70 percent to 97 percent in one health plan. What a great example of using process-aware health IT to dramatically reduce work for humans, and in doing so, freeing those humans to perform even more important work requiring creative problem solving. Good job Marcia!
I often point out that workflow management system technology is literally decades old in other industries, but is only now diffusing into healthcare. Claims processing is probably the major exception to my general statement. For example, Healthsuite has been at it for 30 years! Certain backroom functions, such as insurance and human resources, are among the most similar to other industries. So it makes sense that true workflow automation is more advanced in health insurance than other areas of healthcare and health IT. I knew this intellectually. But it was still something it actually see evidence of this at AHIP Institute.
One idea that really struck me was this. Health insurance is a reservoir, on the payer side, of workflow technology and expertise I’ve been evangelizing for on the health IT provider side. I believe health payer IT and health provider IT will inevitable merge over the next 10 years. This merge will require not just syntactic (message transport) and semantic (message translation) interoperability, but workflow interoperability) (sometimes called pragmatic interoperability).
Reflecting on #AHIPinstitute… Substantially more sophisticated workflow tech (WF engines, #BPM, case management SW) than provider side …
Might health insurance IT be a major path for diffusion of workflow technology into health IT?! Interestingly, some of the care management IT architectures (determining what the software *can* do, but not what it may currently be configured or used for) I saw were more sophisticated than what I saw on the health IT provider side at recent HIMSS conferences.
However, not all was the completely rosy, when it came workflow technology at the AHIP institute. As I noted in this tweet, some vendors were actually privately bemoaning their own lack of classic workflow management functionality, such as triggers and alerts.
I was a guest of Appian, developer of a Business Process Management-based application platform, at AHIP Institute last week. As announced during HIMSS15 in Chicago, I’m working with Appian to educate healthcare and health IT about modern BPM-based low-code application platforms. (Also see my five-part series on BPM in healthcare.) Appian is a particularly good choice, because they’ve create a plethora of white papers, blog posts, Youtube videos, and related resources about every aspect of modern BPM, including the current reigning high tech quadrivium: Social, Mobile, Analytics, and Cloud (SMAC).
I set up work space kitty-corner from the Appian booth, so I got to watch the steady stream of attendees stop by. Here’s an overhead shot, from my drone, with arrows pointing to the Appian booth and my temporary working area.
Meanwhile, online, @Appian was one of the top Twitter accounts. 🙂
I shot three interviews with Appian booth staff (with Google Glass).
In the following interview Christina Fisher (@CFisherAppian) in three minutes gives us a high-level explanation of using a modern low-code BPM application platform.
Health plan applications should
be simple not only to use,
but simple to build as well,
span the enterprise,
and integrate with existing systems
utilization management, and
I love the notion, implicit in this interview, of tackling interoperability via use of workflow tech to integrate legacy enterprise systems!
In the following video, Chris O’Connell (public sector, including healthcare, at Appian) actually demos LittleBits, a hardware prototyping system for teaching kids (and adults!) about Science, Technology, Engineering, and Medicine (STEM). Pulsing lights! Screaming buzzers! Constellations of LittleBits that look like process models! 🙂 Chris then talks about how both LittleBits and Appian empower non-programmers to build and modify their own interactive smart solutions.
Starting about 4:20 Chris addresses similarities between LittleBits and Appian.
Like LittleBits, Appian has discrete prebuilt (software) components,
Prebuilt components are combined to create applications
For example, document management components “snap” together quickly and easily.
Appian puts the power in the hands of the (non-programmer) builder
Empowering mental creativity and agile software change
But this last video is the pièce de résistance from the AHIP Institute. Doug, an Appian engineer, demos not just an health plan provider management app built with Appian, but also pops open the hood to show us *how* the app was made: WITHOUT HAVING TO WRITE ANY CODE.
The importance of non-programmers being able to draw fully-functional, web and cross-mobile device, social media-integrated, cloud-based health and payer IT systems, with lots of adaptors to integrate with backend enterprise systems, cannot be overestimated. It is, in my mind, The Third Way, of health IT software development. Instead of buy prepackaged software and adapting your workflows to the software… Instead of spending way too much money hiring programmers to write applications from scratch that fit your workflows… The Third Way is to use a modern BPM application platform, to quickly create, then modify when needed, native-mobile, cloud-based, social media-oriented process-aware SMAC applications. (SMAC stands for Social, Mobile, Analytics, and Cloud.)
Regardless of whether you are a funded start-up, or an large organization seeking to adapt to new regulatory and consumer-driven health payer and provider economies… create your own applications, the new-fashioned way, and own your workflows.
Please watch the best use of Google Glass I’ve found yet: recording a booth visit! In this case, to the Appian booth (1316) at the AHIP Institute. Stop by for your own demo. Tell them Chuck sent you. Please!
In this case, Doug, a sales engineer at Appian, explains, while demoing, how to create an awesome health plan mobile provider membership app… WITHOUT HAVING TO WRITE ANY COMPUTER CODE! Sorry, I had to all caps that… This is exactly what I am taking about when I blow the workflow technology horn, AKA modern BPM application platform. (BPM stands for Business Process Management).
I’ll keep this blog post short. Except to say, if you are a health IT app developer, PREPARE TO BE WOWED! 🙂 (Read more about what I have to say about Appian here and here.)
Be sure to increase your video resolution to the max, because you’ll want to pause it at various points, to more closely examine the application designer screens.
Sometimes you don’t know why you like something; you just do! I’ve often wondered why I’m so fascinated by workflow. I loved Cheaper By The Dozen when I was a kid (workflow efficiency experts). In college I loved anything involving sequences of symbols (organic chem!). And so I love the whole “low-code” style of snapping together software, so well illustrated by modern BPM application platforms.
I also love LittleBits. They’re collections of small, compatible, electromechanical gadgets that can be snapped together into, well, workflows! Actually, the analogy only just struck me. Sometimes you don’t know why you like something, until you realize the underlying similarity with all the other stuff you like! 🙂
LittleBits are so cool. You can make robots, automatic pet feeders, buzzers that scream when you open the fridge (ha!). You can control them from across the room lots of ways (sound, IR, wireless) and they can even talks to clouds! In fact, as modern Business Process Management (BPM) application platforms are increasingly used to manage the Internet Of Things, I’m just waiting … Who will be the first BPM vender to add LittleBits to its portfolio of software adapters and drag-and-droppable visual programming icons?!
P.S. The National Maker Faire is in just a few days, here in DC. I’ll be there, walking around with my heavily modded LittleBits carrying case… modded so my pet project, Mr. RIMP, has a seat of honor, peering out at an exciting Maker Movement world!
P.S. I’m always trying to connect with Makers in the health IT community. Checkout all my #HIMSSmakers tweets during the HIMSS15 conference. This week I’m at the AHIP Institute conference in Nashville. I’ll be hanging around the Appian booth (1316). Stop by!
P.S.S. Here’s Chris from Appian demoing and riffing on the LittleBits/BPM connection!
I’ve just completed a project. I looked at every AHIP Institute exhibitor website. I searched for a wide variety of synonyms for workflow technology (BPM, workflow engines, process orchestration, that sort of thing). Guess what? I found it. Health insurance is relatively advanced in adopting process-aware technologies. But the funny thing is that you really don’t hear about it much. I think there are a couple reasons.
First of all, BPM is often the secret sauce that makes health plan processes and workflows agile, integrated, transparent, and engaging. Second of all, because BPM is still a technically ‘geeky’ IT topic, it’s not often trotted out for marketing purposes. As a healthcare workflow geek, I’m trying to change this. Hence my series of blog posts.
For the rest of this series, I’ll list benefits of applying modern BPM technology to traditional health plan and payer IT. To put it most succinctly (but to be unpacked in later posts):
“Orchestrating information and business processes across critical back-end systems to ensure both health plan providers and members have smooth, seamless experiences in their dealings with their insurer is the key to success in today’s customer-driven health insurance market.” (@cfisherappian)