BPMN May Shake Up Health IT and Lead to True Workflow Interoperability

[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!]

BPMN stands for Business Process Model (and) Notation (sometimes I see the “and” and sometimes I don’t!). You may be excused if you’ve never heard of it. (No offense intended toward my many BPM colleagues, but I’m addressing a health IT audience here.) You may have heard of BPM, or Business Process Management (Management, not Model). BPM is the modern incarnation of what used to be called Workflow Management Systems. In fact, the trade association representing the BPM vendor community is still called the Workflow Management Coalition. Now that workflow is top-of-mind in health IT, a wide variety of stakeholders, from workflow tech vendors to standards initiatives (OMG, BPMN; HL7, FHIR) to concerned workflow citizens (me, folks who follow me on Twitter at @wareFLO), are plotting a more process-aware digital health infrastructure.

The first thing to understand about BPMN is that it is a language. Humans use natural language to communicate with each other about everything. Programmers use computer languages to communicate executable behaviors to computers. The world is full of special purpose languages. SMARTS is a language for describing molecular patterns. Sign language replaces sounds with gestures. BPMN is a language for describing workflows. In some cases, these BPMN descriptions can be executed by workflow engines. In other words, instead of using C# or Java to create executable software, people who are not traditional programmers, can nonetheless also create executable software.

Here is an example of BPMN used to model aspects of an emergency department.

(from Selecting the best configuration for a Hospital Emergency Center)

Here are three frequently used symbols. You may have used something similar to draw a workflow on a napkin.

There are other symbols and these symbols can be modified to represent different kinds of events, activities, and gateways. While my purpose with the blog post is not to teach the BPMN language, just to alert you to its significance and how to get more involved, here is a palette of typical BPMN symbols. You can see that many of them are derived from the above basic BPNN shapes.

If you’d like to learn more, I compiled a list of over a hundred papers and slides about healthcare-related applications of BPMN. This BPMN diagram of diabetes management is the most complex clinically oriented BPMN diagram I’ve been able to find to date. While it may look overwhelming, go ahead and click on the image to download a much higher resolution image that you can zoom around and inspect its various elements. Even if you are not an expert on BPMN, if you are an expert on diabetes management, it should make a lot of sense. If you see some areas of the workflow that you think are incorrect: that’s the point! Clinical modelers can try to get a close as they can to the “right” model of clinical workflow, then enlist the real experts, the so-called SMEs, to move the model the rest of the way toward correctness

BPMN: Diabetes Continuing Care

An excellent visual (though non-clinical) introduction to BPMN is The BPMN Graphic Handbook.

Think about the implications. What if clinicians, who best understand their clinical workflows, could create the very workflow systems they rely on to accomplish their work? Yes. You are right. That could be revolutionary.

But here’s the rub. Most health IT software does not presently generate workflow behavior using workflow engine technology. This is changing though. Every year since 2011 I’ve searched every HIMSS conference exhibitor’s website for “workflow engine” and/or “business process management” or “BPM.” In 2011, virtually zero presence. In 2016 five percent of HIMSS16 exhibitors mentioned one of both of these workflow industry terms-of-art. Furthermore, this year I am seeing a surge in alternative process-aware terminology, such as “orchestration,” on HIMSS17 exhibitor websites, especially those emphasizing cloud and cybersecurity software products.

As yet, BPMN is about where workflow engines were in 2011. BPMN is used by over a hundred software tools and systems, outside of healthcare and health IT. Within healthcare and health IT, there aren’t many workflow engines yet, let alone BPMN-compliant workflow engines. Nevertheless, as a long-time observer of workflow tech trends in the health IT industry, I believe we will to see the BPMN workflow language finally making inroads into healthcare.

Why am I so sure? Because of recent initiative, a group of health IT, BPMN/BPM experts, and clinicians are meeting regularly to plot a course toward healthcare workflow portability and interoperability using BPMN.

In December I attended the inaugural Object Management Group Healthcare Business Process Modeling Workshop in Coronado, California, near San Diego. I listed links to over a hundred papers about healthcare applications of BPMN in Business Process Model and Notation BPMN Healthcare Examples and Papers. I’m tweeting links these papers about healthcare uses of BPMN during HIMSS17 to increase interest in this important new healthcare workflow initiative. I hope you’ll read a couple: fascinating!

I also call you attention to the second workshop on Business Process Modeling in Health (“Getting to Healthcare Workflow Portability with BPMN – An Industry Workshop”), occurring near DC in March.

I’ll close with some observations and predictions.

More-and-more health IT vendors, from radiology to laboratory to speech recognition information systems, have either added workflow engines to their products, are in the process of adding workflow engines to their products, or are at least aware of the need to provide more actionable, transparent, flexible, improvable workflow to their users. Dawning on a subset of this subset, especially among the interface engine and middleware community, is the need for task-workflow interoperability (about which I have also written about using the phrase pragmatic interoperability).

This is my advice. Describe your workflows, such as they are, using Business Process Model Notation. Regardless of whether you yet embed a workflow engine capable of executing BPMN, BPMN descriptions of your workflows will serve a number of valuable purposes.

  • First, while BPMN is not the only workflow language for describing executable process models (see Beautiful Workflows: A Matter of Taste?), it is the most widely adopted standard. As such, it is an excellent entrée to understanding workflow technology in general (over 100 software tools and platforms are compliant with the latest version of BPMN).
  • Second, descriptions of health IT product workflows serve increasingly important health IT marketing purposes. See my HealthStandard post, Marketing Workflow Is An Incredible Opportunity To Differentiate Health IT Products, And You! Imagine asking a potential customer for a model of their workflows, then quickly configuring and demoing to them their own workflow in your software.
  • Third, healthcare organizations are increasingly mapping their as-is (current) and to-be (future) workflows using BPMN. In fact, the purpose and goal of the BPMN in Health OMG group and workshop series, is to provide tools to allow healthcare organizations to model and share intra- and inter-organizational workflows. These same healthcare organizations will also increasingly use models of their workflow to understand and vet health IT purchases.

As a big, big fan of workflow technology in healthcare (see my 2004 paper about BPM in healthcare, EHR Workflow Management Systems: Essentials, History, Healthcare; and my 1995 paper on workflow systems in healthcare), this initiative to develop and share Business Process Management Notation materials and tools is tremendously exciting. As a HIMSS17 Social Media Ambassador, focusing on workflow, I look forward to increasing awareness of this important new healthcare workflow technology initiative.

If I have convinced or at least intrigued you regarding interoperable healthcare workflow, I hope you’ll take a look at my two five-part series on the topic.


@wareFLO On Periscope!

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