2016 National Health IT Week Blab, I Mean Firetalk, Was Fun! 23 Participants, 50 Comments (w/@MichaelGaspar)

For the second year in a row I hosted a group social video chat. Last year it was Blab (Replay Mid National Health IT Week Blab: Many Thanks to Participants!), this year Firetalk. We had 23 participants, from all of the world, including New Zealand and India. For a bit more information about how well Firetalk replaces Blab, Firetalk Group Social Video Chat as a Replacement for Blab in the Health IT Social Media Community.

If you join Firetalk, please create a channel and publicize it (on Twitter, obviously) so we can all subscribe to each other! I’m at http://firetalk.com/wareflo.

@wareFLO On Periscope!


How Easy Is It To Integrate Availity APIs Into Your Payer-Provider Workflow? Very!

[I am writing this blog post in preparation and support for the upcoming #AskAvaility tweetchat Optimizing Payer and Provider Communications hosted by @shimcode and @HIT_MMartin(@Availity), at 1PM EST, Friday, September 30!]

The following (non-HIPAA sensitive) structured data was pulled across the Availity API (@AvailityAPI) into this blog post via execution of PHP in real-time when you viewed this post in your Web browser. (API stands for Application Programming Interface.)

Member Info (JSON string)nn

Member Info (JSON object)

object(stdClass)#367 (6) {
string(4) “ZENA”
string(6) “MARDIN”
string(4) “H123″
string(6) “Female”
string(1) “F”
string(28) “1942-09-15T04:00:00.000+0000″

Member Info


Back when I was a CMIO/programmer, we integrated a lot of third-party services with our EHR. In fact, we were constantly contacted by vendors and customers to integrate with this or that partner. We asked two questions of ourselves. Does it serve a need? How easy is it to add to our IT workflows? Clinicians and business people answered the first question. Programmers answered the second.

What’s the best way to see how easy it is to integrate a third-party into your health IT workflows? By taking a quick whack at it. See how far you can get with only a minimum amount of effort. In other words, the proof is in the (eating of the) pudding. It’s the only certain way to tell for sure whether the pudding is tasty, or the integration is (potentially) easy.


Sometimes, over a long weekend, a programmer (sometimes, me) sat down with an SDK (Software Development Kit) just to take a wee keek (as the Scottish say), and showed up Monday morning with a working prototype! This put a very different spin on the first question. Instead of a manager saying, sorry, we already have too many other priorities, they said, how soon can you finish this so we can sell it…

So, this morning I logged into the Availity – Developer Center for Health Care APIs to take a whack at it. I wanted to see how easy and fast it is to pull structured data into this blog post, using PHP (in which WordPress is written). It didn’t take very long at all! At the beginning of this post you saw a subscriber JSON string, a PHP JSON object, and name, gender, birth date, payer, and requesting physician NPI.

By the way, here is some entertaining context! (At least to me…) I attended the AHIP Institute this spring and I did what I (almost) always do. I search every website of every exhibitor for evidence they use workflow technology (workflow/process/orchestration engines, editors, mentions of Business Process Management, and so on). I tweeted I was doing so and then I tweeted what I found.

In the mean time Availity is waving its Twitter hand and tweeting: us, us, us! If you are interested in healthcare workflow, you have just got to come talk to use about our API platform and how it’s used to improve payer/provider workflow. The following is from my post AHIP Institute blog post, AHIP Institute Trip Report: Business Process Management & Workflow Engines.


The following conversation was interesting because Availity wasn’t actually on my initial list. However, they saw me tweeting about AHIP vendors and workflow and basically demanded I come to their booth. I’m glad I did. As Mark Martin explained, they provide the APIs (and a portal) that can be consumed by workflow tech. In fact, if you think about it, even if you have the best workflow engine in the world, you still need data to achieve whatever strategic goal you set. Availity goes beyond currently, typically available standard APIs to empower necessary administrative workflow between healthcare organizations. I love it. Thank you for your enthusiasm, seeing my #AHIPinstitute tweets, and reaching out about this important topic.

When it comes to healthcare APIs, the proof is in the (eating of the) pudding!


Thanks Availity!

@wareFLO On Periscope!


Communication Ethics in Healthcare and Health IT


Today’s #HCLDR (Healthcare Leadership) tweetchat topic, What to Say When the Wrong Thing Was Said, hosted by @researchmatters, reminds me of a paper I wrote and presented over two decades ago (in Hong Kong!): Communication Ethics and Human-Computer Cognitive Systems. I discuss communication ethics and its relevance to designing intimate human-technology interfaces. My paper is mostly about humans using and communicating with intelligent tools, from intelligent prostheses to smart robots. In this post I retrieve some of those ideas and apply them to ethical human-to-human communication.

Communication Ethics

“Communication ethics, traditionally, involves the nature of the speaker (such as their character, good or bad), the quality of their arguments (for example, logical versus emotional appeals), and the manner in which presentation contributes to long term goals (of the individual, the community, society, religious deities, etc.) (Anderson, 1991 [in Conversations on Communication Ethics]). These dimensions interact in complex ways”


“Consider Habermas’s (1984) ideal speech…. Communication acts within and among cognitive systems should be comprehensible (a criteria violated by intimidating technical jargon), true (violated by sincerely offered misinformation), justified (for example, not lacking proper authority or fearing repercussion), and sincere (speakers must believe their own statements). These principles can conflict, as when an utterance about a technical subject is simplified to the point of containing a degree of untruth in order to be made comprehensible to a lay person. Thus, they exist in a kind of equilibrium with each other, with circumstances attenuating the degree to which each principle is satisfied.”

Medical Ethics

“Four principles—observed during ethically convicted decision making—have been influential during the last decade in theorizing about medical ethics (Beauchamp & Childress, 1994): beneficence (provide benefits while weighing the risks), non-maleficence (avoid unnecessary harm), self-autonomy (respect the client’s wishes), and justice (such as fairly distribution benefits and burdens, respect individual rights, and adherence to morally acceptable laws). People from different cultures and religions will usually agree that these principles are to be generally respected, although different people (from different cultures or ethical traditions) will often attach different relative importance to them.”

Pragmatic Interoperability

In another series of posts (five parts! 10,000 words!) I wrote about the concept Pragmatic Interoperability. Key to pragmatic interoperability is understanding goals and actions in context, and then communicating in a cooperative fashion. Healthcare professionals are ethically required to cooperate with patients. Implicature part of the linguistic science of cooperative communication.

“We’ll start with implicature’s core principle and its four maxims.

The principle is:

“Be cooperative.”

The maxims are:

  • Be truthful/don’t say what you lack evidence for
  • Don’t say more or less than what is required
  • Be relevant
  • Avoid obscurity & ambiguity, be brief and orderly”

I think most, or all, of the above ideas are relevant to figuring out that to say next, when the wrong thing was said. I will be looking for examples during the Healthcare Leadership tweetchat.

Healthcare Leadership Tweetchat Topics

T1 Beyond classical adverse events like wrong-site surgery or incorrect medication dose, adverse communication events can also occur in healthcare. What types of troubling or harmful communication issues have you experienced that affected your care?

T2 Perceptions vary. Patients may perceive something as a problem, whereas the healthcare team just sees business as usual. How can patients help clinicians understand that perceived problems are as important as actual problems?

T3 What steps can help (quickly) establish rapport between health care practitioners and patients so that if communication goes off-track, each is better equipped to address the problem or perceived problem?

T4 If nurses or other care team members observe poor communication between a physician and patient, what is their obligation–how should they attempt to address the situation?

Health 2.0 Fall Conference Sponsors Using Business Process Management and Workflow Engines

I searched every website of every Health 2.0 Fall Conference sponsor, 87 in all. I found three companies that emphasize Business Process Management (BPM) and/or workflow engine technology. As I am always trying to encourage more use of workflow tech in healthcare and health IT, I am writing this post to highlight these progressive Health 2.0 sponsors.

The three progressive bringers of workflow technology to healthcare and health IT are…

From the Kainos Evolve website:

(about use of Alfresco Business Process Management software: very complimentary!)

“When we set out to design our Mobile-Enabled Healthcare Platform one of the biggest decisions we made was to use Alfresco for our Business Process Management (BPM) and Electronic Content Management (ECM) services. This decision had a major impact on our product, and we’re convinced we made the right choice, so I wanted to walk you through how we made it.”


“Workflow processes are a fundamental part of our platform. We have a number of core principles that we use to help guide us when we build product. Firstly, everything we build must be driven by the user need and all our applications must be mobile first, interoperable and extensible. eForms and Workflow is one way we make our platform extensible. We want our customers to use our tools to quickly build forms and model entire care pathways. We want them to do this independently without having to wait on features to be added to a product roadmap. But in a modern healthcare environment, traditional BPM is not enough. We need tools that are simple and easy to use, yet flexible.


Clinician’s behavior can not always be mapped using rigid processes. We need modern tools enabling ad-hoc tasks to be generated, dynamic processes to be modelled, simple collaboration between care providers and care recipients and analytics to measure and report on outcomes.”


ECM and BPM are traditionally two very distinct things. When we embarked on this journey we had a very clear vision to select the best tools for the job. This meant we wanted the best ECM product and the best BPM product from the best vendor in each space. We performed two separate and distinct evaluation exercises and I fully expected to be working with two products from different vendors. But midway through our journey it became clear that Alfresco offered something unique that didn’t exist anywhere else on the market. Yes, they have two separate products – Alfresco One for ECM and Alfresco Activiti for BPM, but in combination what they have created is something greater than the sum of its parts and so unique that I don’t really recognise it as either ECM or BPM. In fact, these terms describe something that I don’t really relate with. When I see the words ECM and (especially) BPM I think complex, heavy-weight, closed. Stale. Alfresco have created something different – something simple, something light-weight, something open. Something fresh. I don’t know what the term is to describe this. It’s not ECM and its not BPM, but its definitely the future.

From the Axway website:

Axway ProcessManager Key Capabilities

Use the BPMN-based graphical modeling environment to design processes and specify attributes

ProcessManager’s graphical modeling environment is based on the Business Process Management Notation (BPMN) 1.1 standard, which allows business analysts to represent business process logic and patterns by drawing a diagram.

Business analysts can then specify the attributes for the process objects, such as:

  • Relevant communication service (e.g., OFTP 2) for an incoming order
  • Back-end integration service for processing the order in the ERP system
  • Transformation service for converting the file (e.g., EDIFACT or XML)
  • Routing mechanism

The modeled process can then be tested and refined before it is put into production.”

And from BPM Visibility Paves the Road to Operational Excellence:

Business Process Management Systems (BPMSs) are extremely powerful, as they allow process automation and offer visibility on how an organization performs in its overall value creation network.

In fact, BPMSs can also provide visibility without automating anything, simply by consolidating flows of events. For instance, probes can be used to fetch information from legacy applications and generate events, which are consolidated by a BPMS providing visibility on parts of process instances about which one has very little information. Another important usage of non-automated processes is the control of events coming from business partners, ensuring that every collaboration’s participant provides the appropriate information at the right time (and in the right format) as defined per the service level agreement.

BPMSs make many aspects visible, most notably these two: the proper state of process instances and the different variables associated with each step, such as its cost or completion time. Hence, BPMSs can help predict the future state of an organization based on its current situation. For instance, BPMSs can help identify a potential bottleneck before it arises, and can easily correct it through something called “dynamic resource re-affectation.” BPMSs can also provide real-time visibility on specific customer cases and answer important questions (e.g., “Where is my order?”), ease human work and interactions, and identify who is responsible for what and who did what. A BPMS is simultaneously the rearview mirror allowing you to understand what happened, the windshield through which you view what is about to happen, and the steering wheel empowering you to modify and adapt your course of action.”

From a review of CareCloud:

“CareCloud has an innovative workflow engine and systems architecture”

“automatic notifications when anything takes place in your medical practice with a live feed. In real time you will know when charges are posted, when a patient checks in, or if an appointment gets rescheduled”

From the CareCloud website:

Accounts Receivable Best Practices: Automated Workflow Engine

By way of context, every year for the past 6 years I have searched every single HIMSS conference exhibitor website (1400+!) for “workflow engine” or “Business Process Management” (15% in 2016!). Health IT is gradually, but ever more quickly, moving from a purely data-centric orientation to a more balanced emphasis on both data and workflow. The primary area in which this trend manifests itself is in software architecture. The best known specific terms-of-art associated with workflow technology are workflow engine, workflow management, business process management, process orchestration, and process-aware (academia), to name a few. As workflow engines and BPM become better known in healthcare and health IT, the increasing presence of these phrases on health IT conference websites is but one harbinger of a much needed transition from data-only, to data-and-workflow, emphases.

Note, workflow tech diffusion into health IT is still a bit under the radar, so to speak. Other Health 2.0 sponsors likely leverage proprietary or third-party workflow engine and process-aware technology. It just isn’t on their website! This will also change, as the sterling qualities of workflow tech — automaticity, transparent, flexibility, and improvability — increasingly become valuable competitive marketing collateral.

@wareFLO On Periscope!


Blockchain, Pragmatic Interoperability, and the Workflow-ization of Health IT

What three health IT trends are top-of-mind for me right now?

  • The “workflow-ization” of health IT
  • Pragmatic interoperability in healthcare
  • Blockchain

These health IT trends are all top-of-mind for me because they are coming together and interacting. Individually, they are notable. Together, they may be transformational, to use a tired and over-used word. But in this case it is completely true and appropriate.

By “workflow-ization” of heath IT I refer to the diffusion of workflow technology into healthcare. 15 percent of HIMSS16 conference exhibitors refer to “workflow engine” or “business process management” someplace on their websites. Five years ago virtually zero exhibitors used these workflow industry terms of art. Health information systems are increasingly proactive, transparent, flexible, and improvable, when it comes to workflow, and therefore when it comes to data too, since workflow drives the creation, transformation, and use of data.

“Pragmatic Interoperability” is a phrase I introduced to health IT in 2014, though it existed outside health IT before then. Pragmatic interoperability is the third leg of the healthcare interoperability stool. Syntactic and semantic interoperability are the other two legs. All of these words, syntax, semantics, and pragmatics come from linguistics. Syntax is about the structure of health data. Semantics is about health data’s meaning. Pragmatics is about health data’s use to achieve goals, and to assign, monitor, and accomplish healthcare tasks. When healthcare workflows cross organizational boundaries, this is pragmatic interoperability. When a message is sent from one healthcare entity to another, does the actual effect of the message match the intended effect of the message? If so, pragmatic interoperability is achieved.

Blockchain addresses one of the most important aspects of pragmatic interoperability: trust. Healthcare needs more than just trusted data; it needs trusted workflows. Back in 2015, in a five-part series titled Task and Workflow Interoperability in Healthcare, I argued that workflow interoperability requires workflow transparency between collaborating healthcare organizations. Also see my 10,000 word, five-part series on Pragmatic Interoperability, the linguistic theory behind Task Workflow Interoperability. By combining blockchain and business process management (BPM) technologies, healthcare can achieve exactly this.

To understand how blockchain and BPM can come together to achieve pragmatic interoperability, you have to understand trust. Trust is a hypothesis about future behavior used to guide practical conduct. I trust you, if I believe you will, though action or inaction, contribute to my well-being and refrain from inflicting damage on me. My hypothesis is supported by rationality (it is in your best interest to not harm me), routine (you’ve always delivered in the past), and reflexivity (I trust you because you trust me). Further more, if your goals, resources, intentions, plans, workflows, and activities are transparent to me, I am more likely to trust you. Pragmatic interoperability can be achieved through workflow transparency.

Untrustworthiness does not require nefarious intent. Simple ineptitude can make you, or your organization, an untrustworthy partner. Does that sound harsh? Please read Atul Gawande’s For the First Time in Human History, Ineptitude is a Bigger Problem than Ignorance.

Is workflow transparency possible? Yes. To support my claim, I draw your attention to an important paper, presented at BPM 2016, in Rio de Janeiro, Brazil, Untrusted Business Process Monitoring and Execution Using Blockchain. The use case is supply chain workflows among five organizations and individuals. As I read it, I imagined a similar paper, with a healthcare focus, titled Untrusted Clinical Workflow Monitoring and Execution Using Blockchain.

If I can see your workflows, I am more likely to trust you. In the paper I just referenced, workflow models, and their execution status, are shared across multiple interacting suppliers and consumers in a distributed manner. Instead of a single central meditator directing workflows among subordinate partners (orchestration), blockchain shares workflows as smart contracts among co-equal partners (choreography). Blockchain keeps everyone apprised as to which steps in which workflows achieve what status. There’s even a cool YouTube video demonstrating, step-by-step, workflow execution and changing workflow state.

(The following paragraph is for programmers! Feel free to skip, or not!)

The aforementioned paper is a good introduction to not only blockchain, but also a number of important BPM concepts, such as orchestration (workflow requiring a central conductor) vs. choreography (true peer-to-peer workflow). The researchers translate BPMN (Business Process Model and Notation) models of workflow into a programming language executed on blockchain nodes (Ethereum Solidity). GoLang and Node.js are also involved, so geek out! The research software is a one-of, but future similar platforms will be wrapped in APIs (Application Programming Interfaces) and access workflow, task, and patient data in other health IT systems through FHIR (Fast Healthcare Interoperability Resources) and non-FHIR APIs (see Blockchain as a Platform) Note: trusted choreography among healthcare organizations, to create virtual healthcare enterprises, is especially relevant to workflows between healthcare competitors (trust, but verify!). Finally, you don’t get something (automated trust/trustless consensus) for nothing. A blockchain implementation of BPM-driven workflow across organizations is slower and more expensive than a similar setup without blockchain. However, I believe both can be managed and made small enough to be tolerable.

I’ve been in medical informatics and health IT for over three decades. As an industrial engineer who went to medical school, I’ve long been frustrated by what I regard as insufficient emphasis on not just healthcare workflow, but workflow technology, in health IT. But I’ve never been as excited about the possibilities for creating trustworthy process-aware cross-organizational health information systems. These systems will greatly surpass current EHR and health IT systems in terms of clinical outcomes, efficient use of resources, and patient and user satisfaction.

Viva la workflow-ization of trustworthy healthcare interoperability!

@wareFLO On Periscope!


Care Innovations on Workflow Management and Telehealth

Telehealth and telemedicine have many implications and great potential for healthcare workflow management. In preparation for today’s #HITsm tweetchat, Remote Patient Monitoring: Opportunities & Challenges, hosted by Marcus Grindstaff (@magrinds), COO of Care Innovations, I looked back over that past four years and picked the juiciest tweets from @CareInnovations to highlight here. Enjoy!

Links tweeted:

The tweets themselves!

My Foreword and Chapter in Business Process Management in Healthcare, Second Edition

(Excuse my mug! It’s my current @wareFLO Twitter avatar.)


I am delighted to write the foreword to BPM in Healthcare. Forewords traditionally deal with genesis and scope. I’ll tell you why I, an emissary from the medical informatics and health IT community, traveled to another land, that of Business Process Management (BPM). I hope to convince you that the sky is the limit when it comes to the potential scope of BPM in healthcare. And, finally, I assure you this is the right book to start you on your own exciting path to healthcare workflow technology self-discovery .

I first wrote about “Business Process Management” (BPM) in a 2004 health IT conference proceedings paper entitled EHR Workflow Management Systems: Essentials, History, Healthcare. But I’d been writing about workflow systems in healthcare since 1995. From the Journal of Subacute Care:


In 2004 I applied the Workflow Management Coalition’s (WfMC.org) Workflow Reference Model terminology to an Electronic Health Record (EHR) ambulatory patient encounter. (The Workflow Reference Model itself dates from 1994.)


I attended my first BPM conference in 2010 (BPM in Government, which had a healthcare track). At that and many subsequent BPM (and Case Management) conferences I met many of the BPM experts and workflow professionals who co-authored many of the Future Strategies’ publications currently sitting on my own bookshelf. In particular, I’d like to thank Keith Swenson, (My Sandbox, Your Sandbox, in this volume) for answering my incessant questions and welcoming health IT colleagues to BPM venues over the years. Eventually I even became a judge in the annual BPM and Case Management excellence awards.

That’s where BPM in Healthcare comes from in my personal journey. But where is BPM in Healthcare going? The biggest big picture within which to appraise the potential for BPM to transform healthcare is The Fourth Industrial Revolution2. The Fourth Industrial Revolution (also known as Industry 4.0) is not about any individual technology, such as steam power, electrification, or computing (the first three industrial revolutions). The Fourth Industrial Revolution is not even about the Internet of Things (IoT), 3D printing, self-driving cars, artificial intelligence, or big data. It is about the interaction among all these technologies. In other words, The Fourth Industrial Revolution is not about innovative technologies, but innovative systems of technologies. It is about multiple, different, complementary, interlocking, and rapidly evolving technology sub-systems becoming part of an even larger, and way more complex, super-system, a system of systems. Wearing my systems engineering hat, I will argue that the Fourth Industrial Revolution is therefore about processes and workflows.

How do systems engineers manage system complexity? With models. Systems engineers gather data and optimize these models. These optimized models then drive system behavior. Then more data is used to optimize, and so on. In the old days, systems engineers sometimes gathered data with stopwatches and clipboards. I did exactly this, when I built simulation models of patient flow. Today, the Internet of Things and Machine Learning are reducing time scales to collect and process data down to mere seconds. And today, process-aware systems, such as BPM suites, orchestrate and choreograph system processes and workflows, potentially in seconds.

What are “process-aware” systems? These are information systems that explicitly represent, in database format, models of processes and workflows. The models are continually informed by data. The models are continually consulted when deciding what to do, say, or steer next. While process-aware systems “introspect,” they are not “aware” in a conscious sense, but rather in the sense that they can reason with these models; in real-time, in response to their environment and to exhibit intelligent behaviors that would not otherwise be possible.

Currently the industry most adept at representing work, workflow, and process explicitly, in a database, and using this data to drive, monitor, and improve process and workflow is called the Business Process Management industry. Why is BPM so relevant to creating and managing effective, efficient, flexible, and satisfying systems or systems? Because, as Wil van der Aalst, a leading BPM researcher writes, “WFM/BPM systems are often the ’spider in the web’ connecting different technologies” (and therefore different technology systems).

BPM, while not a direct descendent of early artificial intelligence research, inherits important similar characteristics. First, both distinguish between domain knowledge that is acted upon and various kinds of engines that act on, and are driven by, changing domain knowledge. Workflow engines are like expert systems specializing in workflow (warning, a very loose analogy!). Just as expert systems have reasoning engines, workflow systems have workflow engines.

Second, artificial intelligence (AI) and machine learning (ML) are critically about knowledge representation. Early AI used logic; current ML uses neural network connection strengths.

Finally, many AI systems, especially in the areas of natural language processing and computational linguistics, communicate with human users. When I say “communicate” I don’t just mean data goes in and comes out. I mean they communicate in a psychological and cognitive sense. Just as humans use language to achieve goals, so do some AI systems. Communication between humans and workflow systems is rudimentary, but real. Workflow systems represent the same kinds of things human leverage during communication: goals, intentions, plans, workflows, tasks and actions. These representations are, essentially, the user interface in many workflow systems.

To sum up, The Fourth Industrial Revolution is not about any one product, technology, or even system. It is about innovation in how multiple systems of technology come together. Process-aware technology, such as business process management, will play a key role in gluing together these systems, so they can be fast, accurate, and flexible, at scale.

You could go off and read a bunch of books about BPM. There are many excellent tomes. Then figure out how BPM and healthcare fit together. Or just keep reading this Second Edition of BPM in Healthcare.

If you are a healthcare or health IT professional interesting in healthcare workflow and BPM/workflow technology, you could start here:


Aalst, W. Business Process Management: A Comprehensive Survey, ISRN Software Engineering, Volume 2013 (2013), Article ID 507984, 37 pages.

Webster, C. Prepare for a Computer-Based Patient Record That Makes a Difference, Journal of Subacute Care, Vol. 1(3), 12-15, 1995. (http://ehr.bz/subacute1995)

Webster, C. EHR Workflow Management Systems: Essentials, History, Healthcare, TEPR Conference, May 19, 2004, Fort Lauderdale. (http://ehr.bz/tepr2004)

Terminology and Glossary. Winchester (UK): Workflow Management Coalition; 1994 Feb. Document No. WFMC-TC- 1011. BPM in Healthcare (2012) Future Strategies Inc., Lighthouse Point, FL. http://bpm-books.com/products/ebook-series-bpm-in-healthcare

Case Management in Industry 4.0: ACM and IoT – see chapter by Nathaniel Palmer” “http://bpm-books.com/products/best-practices-to-support-knowledge-workers-print

Free! My Book Chapter:

Marketing Intelligent BPM to Healthcare Intelligently!

@wareFLO On Periscope!


What Is The Purpose of A Bee? Preserving Purpose In Medicine

When I heard @StorkBrian and @Paddy_Barrett were co-hosting the #HITsm tweetchat on the topic of Preserving Purpose in Medicine, the following question came to me, unbidden:

What is the purpose of a bee?

You see, Dr. Stork is an inveterate beekeeper. I’ve watched his bees on Periscope and Vine. We’ve discussed beekeeping on Blab (now replaced by Firetalk, get a “ticket” and come to our #NHITweek Firetalk immediately after the upcoming 9/30 #HITsm chat!).

Bees, hives, and honey, constitute one of the most potent collections of metaphors in all of metaphor-dom: busy as a bee, queen bee, hive mind, swarm societies, and honey has been likened to spiritual insight harvested from the ordinary!

I could go all kinds of places with this metaphor. But I will refer you to a wonderful book about work lessons we can learn from bees, called Waggle (named after the dance bees perform to communicate):


Check out the chapter titles. Compare to the #HITsm topics. I’m sure you’ll come up with lots of cool metaphorical ideas! See you at the tweetchat!

Here are the HITsm topics!

Topic 1: When we aim to maintain purpose (in healthcare), what is that purpose exactly? What is it you? #HITsm

Topic 2: How can we as physicians work together to build more purpose for ourselves, and work with organizations to promote it? #HITsm

Topic 3: In what ways can healthcare technology work with physicians to improve the EHR experience? What would you change? #HITsm

Topic 4: What are some strategies for preserving purpose in medicine? How can we bring more compassion and caring to healthcare? #HITsm

Topic 5: Will healthcare become less effective in treating the whole person with less in-person visits & the growth of telemedicine & virtual visits? #HITsm

P.S. More about bees and beekeeping in this wonderful video from Brian!

Process-Aware Healthcare Marketing Automation Workflow Technology

This blog post is really about marketing automation workflow technology, not healthcare marketing automation workflow technology. But hey, I wrote it in preparation for the #HCLDR tweetchat on healthcare marketing. Workflow technology has so much potential for all areas of healthcare, including healthcare marketing! I’ll be on the alert for tweets that I can cross index back to my favorite obsession, workflow tech! See you there… or saw you there, depending on when you read this… Based on the tweetchat, I may circle back and flesh out the relevance of workflow tech-based marketing automation to healthcare marketing in general.

(By the way, “Process-Aware” is the academic phrase applied to IT systems using executable, introspectable, models of work and workflow.)

What is Marketing Automation?



Workflow Builder. Create customized campaigns from templates or scratch



GOAL-BASED NURTURING Every workflow you build in HubSpot can easily be tied to a clear goal, so you’ll always know what is working


How to Build a Successful Marketing Automation Workflow

  • Determine trigger
  • Determine individual steps
  • Make the workflow live

7 Game-Changing Marketing Automation Workflows

  • Hot Lead Workflow
  • Closed-Lost Reason Nurture
  • Re-Engage Notification Workflow
  • New Subscriber Nurture
  • Mini-ABM Hack (Account-Based Marketing)
  • Nurture By Buyer Role
  • Go-to Customer Marketing


5 Workflow Automation Campaigns to Wow Consumers and Marketers Alike


“X2Flow, is an intuitive workflow designer and engine where you can leverage all the data in X2CRM to model simple yet sophisticated flows incorporating a variety of actions and conditions. Drop down menus and drag & drop capabilities are used to establish ‘triggers,’ along with associated conditions which must be met before any flow is executed. Then the flow actions will be automatically performed, allowing your team to focus on the more creative aspects of marketing”



How Small to Mid-Sized Businesses Can Use Marketing Automation to Sell Smarter, Not Harder



What Exactly is a Marketing Automation System?



Design an email marketing automation campaign workflow with campaign builder


Why marketers should learn how to program [that is, draw executable workflows!]



Bislr Brings a Bunch of New Tools for Easier Marketing Automation



Drag and Drop Designer: Define your marketing workflows with an easy drag-and-drop designer. Build multi-step marketing campaigns visually in just a few minutes


The Future Of Marketing Automation


Social Determinants of Health: Eat Your Beans? Or Speak Truth to Power?


Before I got the degrees I have (Accountancy, Industrial Engineering, Artificial Intelligence, and Medicine) I wanted to become an Anthropologist! I still read a lot of anthropology. I consider myself a (rank) amateur anthropologist. And I’ve a bit of anthropology in my workflow work, especially ethnography, the systematic study of people and cultures. In that light, take a look at these three quotes about medical anthropology and the social determinants of health.

medical anthropologists have contributed significantly to understanding social determinants of health… through exposing the processes by and through which people are constrained, victimized, or resist external forces in the context of local social service arenas”

“Evaluation of social determinants of health interventions require rich qualitative data in order to understand the ways in which context affects the intervention and the reasons for success or failure.”

Trying to convince poor people to eat vegetables is one thing, acceptable and safe; attacking the inequity in power, money and resources is altogether less safe

That last quote is from Sir Michael Marmot, Chair of the Commission on Social Determinants of Health at the World Health Organization, author of the most authoritative textbook on the Social Determinants of Health, cited over 5300 times in Google Scholar.

The reason I’ve been so interested in medical anthropology, ever since I met of bunch of Med Anthro grad students in medical school, is that “rich qualitative data.” It is the kind of data that systems engineers, such as myself, can use to design products, services, and workflows. This is Applied Anthropology, the “application of the method and theory of anthropology to the analysis and solution of practical problems.” In other words, I’ve aimed to use the methods of anthropology to build systems. This is simply health systems engineering using anthropology as a tool.

I often define workflow to be a series of tasks, consuming resources, and achieving goals. Workflows are represented as models in the computer, and then various kinds of workflow engines operate on them. These are workflow systems. Workflow systems, organizational psychology and culture, interact with each other in complicated ways.

Replace “tasks” with “activities” and you’ll arrive somewhere familiar to anthropological fieldwork. Anthropologists document sequences of activities (particularly rituals). They document resources consumed (animal and non-animal substances, human time and attention). And they speculate about goals served (honoring ancestors, community bonding, satisfying material needs such as sustenance, safety, protection from the elements). Just as workflow professionals do, anthropologists also construct models, of rituals, families, tribes, organizations, etc. Of course, these models not usually recorded in executable formats. Instead they are written about and published in anthropology theses and journals.

Culture greatly influences the social determinants of health. Anthropology is a major contributor to social determinants of health research. Culture and workflow interact synergistically. Field anthropologists understand culture in terms resembling systems engineers understanding workflow. So naturally I am interested in connections between social determinants of health and healthcare workflow.

If you cross index Social Determinants of Health with workflow on Google search, you’ll find lots about including SDoH data gathering in clinical workflow. I’ve included, at the end of this post, some recent tweets with links to material about exactly this. It’s an important topic, but I’m going to pivot in a different direction.

There is another relationship between anthropology and the social determinants of healthcare. Anthropologist study power and the powerless. If you don’t at least acknowledge the role of power, poverty, and powerlessness in poor population health (ppppp!) I submit you are missing much of what is important about the social determinants of health.

I’m not a political person. I don’t tweet about politics much (or sex or religion, for that matter, two other potentially controversial topics). But I also think of myself as amateur political philosopher (I guess I’m an amateur at a lot of things!). If you drill down into the social determinants of health, you land on both political ideology and workflow! Bugger! I love workflow. Political ideology not so much. So this post is a bit of a balancing act.

Medical anthropologists resemble medical professionals, because, well, they are. They take medical courses. They observe strict ethics regarding divulging the identity of their subjects. Many are motivated to diagnosis and improve the health of the communities they study.

One of the most interesting aspects about anthropology, particularly medical anthropology, is a tension between techniques (for gathering data, building theories, leveraging insights) and anthropological social activism. Since anthropologists study power structures and inequity, they are a bit like a journalists torn between documenting and intervening during a news event. They see something unfair, and they are torn between objectively documenting versus getting personally involved. This dynamic can potentially bias the research. I’ve followed debates within anthropology about this tension within anthropological research for decades.

Again, I’m basically just a technocrat in search of tools to better perform my technocratic activities. However I do think it is worth reflecting about not just the technical side of the social determinants of health (collecting, using, etc.), but also the political, economic, and ethical context of social determinants of health as well…

…something to think about, while we debate the finer points of integrating social determinants of health into healthcare, and health IT, workflows.

I’ll end with a couple more quotes.

“a substantial body of scholarly work in anthropology seeks to link wider social, economic, and political forces to local experiences in sickness and suffering

From that 2008 WHO report on SDoH..

“the ‘unequal distribution of power, income, goods and services … the subsequent unfairness in the … circumstances of people’s lives … and their chances of leading a flourishing life’ (p.1) are the primary causes of the poor health of the poor.”

P.S. Here are those tweets about social determinants of health and clinical workflow I promised you!