Wonderful Video Chat About Microservices in Healthcare, With Real Code Examples!

[This post is part of a series I am writing as a HIMSS17 Social Media Ambassador (four years in a row!) in the run up to HIMSS17, in Orlando, February 19-23. Stop by and meet me at the first ever HIMSS Makerspace, booth 7785 in the Innovation Zone!]

Youtube Archive of Firetalk Event

Learn about microservices in healthcare from the co-developer of the first programming language specifically for creating microservices, @JolieLang! A recent Firetalk (19 viewers, 71 messages) got into actual programming code! For general background about microservices in healthcare, read my From APIs to Microservices: Workflow Orchestration and Choreography Across Healthcare Organizations. There’s also an excellent 5-minute Youtube explanation of microservices. You’ll see the obvious connection from microservices to workflow and workflow tech, since a microservices are like tasks in workflow management system. They need to be orchestrated to create complete workflows. Furthermore, since Jolie microservices are intrinsically distributed, as soon as you write them, one can imagine building health IT applications with workflows orchestrated across multiple health IT organizational silos. I’d love to network with anyone I can interest in Jolie at HIMSS17. You can contact me through my Twitter account @wareFLO or this blog’s Contact Me page.

The code Claudio Guidi refers to was written by Balint Maschio. It’s a toy, but executable, program illustrating how microservices written in Jolie might serve medical images. Claudio spent about twenty minutes discussing the Balint’s code, most of the time in the orchestrator service file named server.ol. Claudio is very good about systematically referring to line numbers in the Jolie code. When he does so, just scroll down to inspect the code while continuing to listen to Claudio. Server.ol refers to other services, which you can get to via the Github link. He briefly discusses OrchestratorInterface.iol, so I’ve appended that code below as well.




For my own experiments writing Jolie microservices, see the postscript to my more general post about microservices in healthcare.

See you at HIMSS17! By the way, I have my own booth this year. I’m running the first makerspace at a HIMSS conference. It’s Booth 7785 in the Innovation Zone.

@wareFLO On Periscope!


Workflow Discussed At Connected Health Conference! IMO Healthcare Needs More BPM (Business Process Management)

I’m delighted to see workflow being discussed at the Connected Health Conference!

Here are some of my own #Connect2Health tweets about workflow.

There’s a great book to learn about true workflow automation in healthcare.

Please check out the latest edition of Business Process Management In Healthcare. I contributed a chapter and wrote the foreword!

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Hello world! (Moving From ChuckWebster Dot Com to Wareflo Dot Com)

I’m moving my blog from chuckwebster dot com to wareflo dot com (@wareFLO being my Twitter handle). I am taking the opportunity to reorganize the over 650 posts I’ve made since 2009 (including 400 plus draft posts I’ve apparently not completed!). You may notice an occasional broken link or missing image. Please excuse the dust and construction!

Oh, I hope you have a wonderful 2017!

PS Follow me on Twitter at @wareFLO!

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Price, Cost, Quality, & Value Transparency Require Workflow & Process Transparency


I tweet a lot about the important difference between price transparency and cost transparency. (I was a premed-accounting major…) A couple years ago lots of folks talked of cost transparency, when, in my opinion, they really meant price transparency. I kept corrected people. I eventually gave up. Though I should note that most of the time I see price transparency correctly used now. But it got me thinking about the relation among price, cost, quality, and value on one hand, and my favorite subjects, workflow and process.


Usually one starts with an outline. However, in this case, there is diagram, which I explain, in detail, later, which shows how everything fits together: price, cost, quality, value, workflow, and process.


Here is some background. What do people usually mean by workflow and process? Systems thinking is all the rage in healthcare. What is the relation among systems, workflows, and processes, at least to this systems engineer…?


Productivity 101. Economists usually speak of labor productivity, but it is a more general notion that that. It is simply outputs divided by inputs. To double productivity means to double the output due to the same level of input, or to maintain the same level of output while cutting input in half,… and so on. I’m sure you get the basic idea. It is similar, by analogy, to amplification in electronic circuitry. Your radio takes a very week radio signal and turns it into a very loud audio signal. Highly productive systems, organizations, economies, workers, can do a lot with only a little.


The above and below slides seem redundant to each other. Need to consolidate.



This is perhaps the meatiest slide of the slide deck, and therefor requiring the most explanation.

The basic point of this slide was simply to translate a general systems engineering idea into a healthcare systems engineering idea. Price and cost are inputs to a “service line”, a bundle of workflows and processes necessary to provide a specific healthcare product or service. Think, the price, versus the cost, of a hospital procedure, such as an appendectomy. The price is set by market and/or regulatory forces. The cost is the expense to the hospital. This expense depends on the costs to the hospital of labor, consumables, durables, rent, etc. These costs also depend on prices in markets, but from the point of view to THIS organizations, they are costs. (Just as the prices the hospital charges are costs to patient and/or payers.) I know it is confusing. They are the same. And they are NOT the same. From the point of view of the healthcare organizations, the difference between price and cost is retained by the organization as profit (in the for-profit instance) or surplus (in the non-profit instance).

Firms use internal cost information to set prices. In general, they charge what a market will bear, unless constrained by regulations. However, if they cannot charge at least as much as their known true costs, in the long run, they will go out of business, leave the market, drop that service line, or figure out how to perform the workflows more inexpensively.

Quality is the degree to which a workflow and/or process fits the purpose of the workflow, that is, satisfy the goals of the workflow. Quality exists irrespective of price. However, value is a relationship between quality and price. In principle, if you know price and you know quality, then you know value, so transparency with respect the price and quality should be sufficient for transparency with respect to value. (I’m sure it’s more complicated… but I’ve got to make some simplifying assumptions somewhere, otherwise this whole hot mess is simply too complicated to think about at all!)


Sooo…. what’s missing from discussion of healthcare price, cost, quality, and value transparency? Workflow transparency, also known as process transparency.


Umm, already covered this. Reorder or consolidate.


Reorder or consolidate.


Reorder or consolidate.


Reorder or consolidate.


If you are providing me a product or services, why should I care how you do it? As long as the price and quality are right, I should like to view you as a “black box”, right? The problem is that healthcare workflows are so complicated, and they meander over and through so many healthcare, and health IT, systems, it’s getting harder and hard to figure out where to draw the boundaries between black boxes.

In fact, a big, big trend in business today is to take your back-office and enterprise workflows and processes and make them into front-office self-serve workflows and processes. Millennials don’t want to deal with you face-to-face, by phone, or through email. Just give them an app, so they can check the status of something, cancel something, or to modify some workflow or process, in real-time, to their satisfaction and convenience.

The only technology that can manage these, previously blackbox-enclosed, workflows is workflow technology. It models the workflows (sequences of smaller black boxes, called activities or tasks). It executes the workflows. It makes the workflows available, at scale, to folks outside the black box. They can make blackboxes transparent, at least regarding workflow, but that is actually a really big deal.


I need to work on this slide some more. The basic thing I’m trying to convey is that the route to making a service line, and entire bundle of workflows and processes, transparent in operation, is to break up the blackbox into smaller, interacting black boxes. In workflow management and business process management parlance, these are activities, tasks, steps, etc. They have inputs and outputs to each other. They cause things to happen to a patient, and they receive actions from a patient. They drive costs and provide information for the firm. What keeps all the ducks in a row? Workflow engines, which are single most defining architectural feature of workflow management and business process management systems.


Above is a typical list of features and advantages of process transparency. In a 2015 five-part series published in Healthcare IT News I wrote at length about task and workflow interoperability. I was writing about healthcare B2B task and workflow interoperability, not C2B (customer to business) or B2C (business to customer) interoperability/visibility/transparency. However the general principles hold for all three combinations. (Though one does wonder, what might C2C interoperability/visibility/transparency mean for healthcare…. for perhaps patient family members and bird-of-a-feather disease-centered support communities and support groups.)

This is what wrote about task visibility (transparency)…


This is what I wrote about workflow visibility (transparency)…



OK! We covered price, cost, quality, and value transparency, and then workflow or process transparency. What is the relation between the former and the later? In the long run, not only can we not optimize the former without the latter, in many cases, we cannot even measure important aspects of the former without the latter. A majority of healthcare costs come from expensive human labor. The only practical, scalable way to measure this costs is through some form of activity-based cost accounting. These activities are the same activities that workflow management systems and business process management systems model, execute, measure, and monitor.


In my 2015 series I noted two categories of people and organizations laying foundations and pursuing workflow interoperability in healthcare: health IT companies and organizations, and companies from the workflow management/business process management industry. Since then two more groups joined the fray. On one hand we have the citizen developers and citizen integrators, who are creating new health IT systems and workflows. On the other hand, we have standards organizations, such as HL7 and OMG (Object Management Group), both of which are beginning to address standards and technology necessary for task and workflow interoperability. (By the way, I just came back from a workshop on this subject, the Healthcare Business Process Management Notation Workshop, in San Diego.)


Yes, it will certainly be interesting see how all these task/workflow/process transparency/interoperability stakeholders get along with each other!


To summarize my argument, why price, cost, quality, and value transparency require workflow and process transparency….

Prices and costs are different concepts. Therefore price transparency and cost transparency are different concepts. Prices, and therefore price transparency, are influenced by markets and regulations. Costs are determined by resource expenses (people, consumables, rents) and technology (methods for transforming resource inputs into outputs). Competition pushes prices toward costs (which is why cost transparency is necessary for long run price transparency). Quality is how well workflows and processes fulfill their needed intended purposes. If we know price and quality, then we know value. And some form of workflow technology is necessary to monitors all the activities that make up the workflow and processes that transform inputs into outputs.


@wareFLO On Periscope!


Business Process Model and Notation BPMN Healthcare Examples and Papers

[This post is part of a series I am writing as a HIMSS17 Social Media Ambassador (four years in a row!) in the run up to HIMSS17, in Orlando, February 19-23. Stop by and meet me at the first ever HIMSS Makerspace, booth 7785 in the Innovation Zone!]

I’m attending the Object Management Group Healthcare Business Process Modeling Workshop (press release, registration) at the beautiful Loews Coronado Bay Resort, near San Diego today.

This post consolidates a large number of papers and examples of using Business Process Model and Notation (BPMN) in healthcare that I reviewed during preparation for the workshop. I’ve been advocating workflow technology in healthcare for over two decades (My Foreword and Chapter in Business Process Management in Healthcare, Second Edition). In fact, I may have been the first to discuss, at length, Business Process Management (BPM) based health IT systems, including Electronic Health Records (2004, EHR Workflow Management Systems: Essentials, History, Healthcare). BPMN is not the only workflow notation relevant to process-aware health IT systems. Nor do all workflow management systems rely on a formal notation at all. However, as awareness, understanding, and use of BPMN spreads in healthcare, workflow management system and business process management technology will also surely spread, which is a good thing.

Here is some information about the Healthcare Business Process Modeling Workshop.

“Experts from the medical field and business modeling will discuss how OMG’s business process modeling standard can streamline the portability of clinical processes and workflows that govern how protocols are followed and care is delivered in healthcare organizations. For example, the agenda includes:

  • The Usage of BPMN™ for Obamacare
  • Using BPMN to Operationalize Clinical Knowledge
  • Integrating Clinical Information Modeling with BPMN
  • Modeling the Cognitive Side of Care Processes. Case Study: The Treatment of Atrial Fibrillation
  • Modeling Cancer Treatment Processes in BPMN and HL7 FHIR®”

“Within the health segment today, provider organizations each have their clinical processes and workflows that govern how protocols are followed and care is delivered. One of the operational challenges in becoming a “learning” organization lies in the ability to adapt and evolve those processes to embrace emerging best clinical practice, and to perform continuous improvement based upon care delivery and care outcomes within your own institution. Further, the professional societies and colleges continue to evolve and mature their guidelines, and staying current with those means incorporating that medical knowledge into your care pathways.

In a landscape where clinical knowledge and medical workflows are often either embedded in electronic health record (EHR) systems, or manually configured at an institution or site level, accommodating these changes can be timely, difficult, or near impossible to realize. Moreover, these rules are often expressed in “geek speak” and not in a language that can be owned and managed by the clinical community.

Business Process Modeling Notation (BPMN) is a non-healthcare-specific representation of business processes and workflows that has both broad adoption and a robust set of support tools. BPMN has enabled other vertical sectors to model these needs en route to creating reusable knowledge artifacts that could be shared and in fact interoperate across systems and organizations. Recent work in the industry have uncovered gaps in how BPMN should integrate with the healthcare workforce to support truly portable, patient centered processes. To put it in a different light, BPMN standards have helped define the baseline for What should get accomplished in any given health care process. The implementation of BPMN in healthcare is increasingly challenged by Who should be responsible for any given task.

This workshop is geared toward exploring the specific and unique needs of the clinical health landscape, investigating BPMN and the extended set of BPMN enhancement standards to determine the viability, coverage, and gaps when considering this approach for solving the healthcare challenges described above. Of particular interest is an exploration on how best to integrate BPMN with the healthcare workforce.”

Enjoy my research review preparing for the Healthcare BPMN Workshop! (By the way, there are lots of cool looking healthcare BPMN diagram examples!)

Not healthcare specific, but useful background…

Healthcare but not BPMN…

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