Workflow Tech & Business Process Management In Healthcare: Transcribed Podcast

[Transcribed just in time for #HIMSS17!]

Janet: When you get up this morning, did you shower, brush your teeth, do your hair, pack lunches, get everybody out the door on time to catch school buses, commuter buses or get in the car and go to work? Guess what? You were using a workflow. Today on Get Social Health I’m talking with Chuck Webster, he is the Workflow King. I think you’re going to enjoy this conversation on Get Social Health.

Intro Voice Over: Welcome to Get Social Health, a conversation about social media and how it’s being used to help hospitals, social practices, healthcare practitioners and patients connect and engage via social media. Get Social Health brings you conversations with professionals actively working in the field and provides real life examples of healthcare social media in action. Here is your host, Janet Kennedy.

Janet: Welcome to Get Social Health. Today on my podcast I’m going to get to be the 101 level student because I’ve got Chuck Webster with me. He’s known as @wareFLO in Twitter and in social media. We’re going to talk about workflow process. Keep in mind that I’m representing the marketing social media side of the house and I’m not heavily involved in an IT operations process. For those of you in the same boat as me, we’re going to really dig in and do some 101, however, if you’re on a more technical side of the house you can just laugh along with us. Chuck, welcome to Get Social Health.

Chuck: I’m so excited that we finally pulled the trigger on this. I think we’ve been talking about doing it for I think about a year.

Janet: It’s been a long time. I know we even scheduled a few times and both had emergencies come up. I don’t talk about technical very often, I have to admit because I’m a little uncomfortable, it’s something I don’t know what I’m talking about but since I set the groundwork that I get to ask all the dumb questions, we can move ahead with this.

Chuck: Okay.

Janet: All right. You are known as @wareFLO and of course it’s not @workFlow, did somebody already have that Twitter handle?

Chuck: No, actually someone did but maybe I would have grabbed it but wareFLO no W at the end is what the linguist call a portamento which is a combination of two different phrases and so ware is software and flo is workflow so software workflow and then I capitalized the F-L-O at the end just to be a little distinctive.

Janet: I see, I would have said it means so where is this going but in many ways that actually works too.

Chuck: No, no, no. Actually, also there’s wearFLO as in you wear something. I gave a keynote to the Society for Health Systems in a conference last year and the topic was wearable workflows so that works too.

Janet: Very cool. We may get to that. Let’s go back a little bit and tell folks who you are who may not know who you are. I see an MD after your name but that’s only two of about a dozen letters so can you give me a little bit of background of why you’re a perennial student? What have you gotten your degrees in?

Chuck: My mother says I’m killing myself by degree. I started out in engineering and I became interested in healthcare cost, savings, efficiency sorts of things. I ended up with a BSA, a Bachelor of Science in Accountancy at University of Illinois which by the way is the number one school over here. Because I started in engineering I had taken all the chemistry, physics and biology necessary to apply to medical school. I was going to get a PhD in Health Systems Engineering and my advisor when she found out that I had taken courses necessary for medical school said, “You know, you really ought to go to medical school because the MD is the PhD of healthcare.”

She would do these incredible studies of where to put the air ambulances in the state of Illinois and the doctors would just kind of ignore her because she was a PhD which they are an ivory tower sort of person and they don’t even know what the PhD is. It’s not a real doctor, the MD is the real doctor and all of that. I have two other Master’s. One is in Industrial Engineering so industrial engineering is all about usability and workflow. I spent a year in aviation human factors helping to design jet cockpits. Then I spent a year in hospital workflow, actually working with the folks and the student Hospital of University of Illinois, did computer simulations of patient flow.

I ended up getting also along the way a Master’s in Artificial Intelligence, that has to do with things being smart enough to understand what needs to be done and help the users. I have one more degree which is an ABD, all but dissertation which means I did all the courses didn’t finish the thesis. That is in Computational Linguistics which is natural language processing. I did that or didn’t do that at Carnegie Mellon University of Pittsburgh.

Janet: Golly gee, Chuck. Through all that, how do you contribute to society, truly?

Chuck: If you intersect the domains that is accountancy is about cost, industrial engineering is about workflow, artificial intelligence is about knowledge representation, and medicine, at the intersection is workflow technology because you’re representing cost and models of tasks and you have engines that are doing things efficiently. Pretty much the stuff that I just go on and on and on and on about right now if people think of me as Dr. Workflow or the Workflow Bearer or the King of all Workflow in Healthcare. Some novelist say that the plots are really just driven by characters. If you have a set of characters, there are certain way you throw them together in an environment and then the plot just happens. It’s like the stuff that I’m interested in which is healthcare workflow and workflow technology is very much driven by the degrees I got decades ago.

Janet: You’re really a living Venn Diagram?

Chuck: I am, in fact, I want to give a slide sometimes a presentation. You know, you have that slide about yourself? It literally is a Venn Diagram. I have four circles and they are all intersected and they are labeled cost, workflow, representation and medicine. At the intersection is workflow technology or what’s called Business Process Management today.

Janet: I really want to talk about BPM or Business Process Management in a minute but let’s go back a little bit to your early career where you’ve finished all these you’re schooling and now you’re going to start to apply it. Were you always focused in the health care space?

Chuck: Yes but I’ve kind of systematically kept, if you think of me as an octopus with a bunch of legs so I keep the other seven legs in other areas. I’m a bit of a dilatant in a sense that I delve into other industries so I spent a year in aviation human factors so I follow what’s happening in the aviation industry. My wife is a well-known consultant in customer service and leadership in the hospitality industry. I do this systematically because there’s all kinds of stuff you can borrow, safety from aviation, high touch experience from hospitality. I’m always borrowing from other industries.

Janet: It’s only a matter of time before we have the Disney Doctor course. It’s coming in time.

Chuck: You know what, I think it already exist.

Janet: I’m wondering about when you first started talking about workflow in healthcare. Obviously, you need to be speaking to senior C-level executives at hospital systems. Did they get it? Was it an alien concept? Is this something that they were very comfortable grasping because this is kind of a technical world and not super soft skill? Was this something you have to evangelize about what exactly is workflow and why is it important?

Chuck: Basically, education and evangelizing and marketing all work together because I was chief medical informatics officer for an electronic health record vendor for over a decade, a small one. Not so coincidentally I mean I sought them out it made sense. They were an electronic health record built on workflow management technology, workflow engine, users could design their own workflows and then the engine would interpret them. People complain about workflow all the time. It doesn’t fit what they want to do well then in this case you can change the software’s workflow to fit the human workflow. However, in selling that to the rest of the world you had to educate people. A lot of people think workflow is boring. Maybe it is but it still, all purposeful human activity involve some form of workflow which is a sequence of actions consuming resources achieving goals.

It’s a little dry and it’s a little foreign because health IT is really all about data not about workflow which is part of the problem, in my opinion. There’s a lot of both education and in treaties trying to tantalize people to get them interested in workflow and then once you got them interested, got their attention kind of the education component and then finally I’m really not all about workflow. I’m really about workflow technology which of course as soon as you start talking about technology and then people’s life start to glaze. It has been an upward battle for a couple of decades but I see lots of interesting flowers blooming in the spring, so to speak. This moment, particularly over the last three to four years in health IT regarding better workflow, better software that supports human workflow better.

Janet: I’m picturing in my mind Leonardo da Vinci and his mind mapping. Am I on the right track? Is that really what we’re talking about is here’s all these things that happen, now, how do they come together?

Chuck: Okay. Up till now where in I talk about all these different domains and how they connect, yes, but I think you put your finger on it. You know how when you draw a mind map, you label a concept and then you put down another concept and you draw an arrow between them and you use this for brainstorming and for people to communicate. Imagine that your mind map is of a workflow, that is you’re actually drawing the workflow. The workflow has three steps and each step has certain qualities or processes or resources or goals and you draw little arrows off to those things and when you get done you’ve got this 12 or 13 balloons with a dozen or 18 lines and some labels but then you push a button and it turns into an actual application.

Something a computer, this was created by a non-programmer and it’s at the level of the domain so you can have a doctor and say, “Okay, describe your workflow.” The doctor describes their workflow and then you’re going to have the specialized software called a workflow engine that actually goes and mechanically looks at their drawing and says, “Okay, this is the step I’m on. This is the screen I need to show this person. Now that step has been completed. Now, this is the screen I need to show that person,” I’m trying to pivot here from this idea of mind map is a graphical representation of something to the idea of a graphical representation of workflow which is essentially what workflow technology is.

Janet: Right, I have a picture in my head and I wonder if this is the correct vision here. You have a meeting and people are walking through, “I do this then I do this and I do this and I do this.” It all goes into this really smart machine. Now, is this machine just translating it into a capturable process something software driven or is it able to actually use some of your artificial intelligence to say, “Wait a minute, you’re out of step here. You’re in a wrong sync here and wouldn’t it be better to have step four as step three?”

Chuck: Yes, absolutely. You’re seeing workflow technology and now academics call this process-aware technology and when they say aware they don’t mean it gets conscious. They just mean that it can introspect, it has a representation of a process and they can reason about it. A lot of these systems have got machine learning that can watch the behavior of the system and spot the bottlenecks or spot the rework. If some step happens over and over again well then maybe you need to change the workflow so it doesn’t happen over and over again. In the natural language processing world there are technologies out there which you basically feed the software a bunch of natural language.

Basically, the corporate documentation, it’s full of organizational charts and lots of workflow descriptions and you feed them into the system and it actually constructs a workflow diagram that you can then critique so you can either take one that is created by hand compare it to the evidence and then improve it. In some cases it can perhaps even create a draft version to show that humans can look at it and critique it. Ultimately, it’s the proof is in the pudding, that is when the workflow engine runs against a representation of workflow it either creates a nice experience that is efficient and effective or if it isn’t, if there are points that are raw or rub or sharp and you can go in and people can go back and iteratively improve it. It really fits into what the health IT people call agile development except it’s agile development at the level of workflow.

Janet: Have you ever found in working with groups where you might have a number of people part of this process who don’t normally interact with each other that you come out with a workflow that is totally contrary or so different from the way they had envisioned it because they didn’t realize that this piece over here needed that piece or that maybe here’s like, “Yeah, we do this everyday,” it turns out if they did it the way they said they did it it’s a three week process?

Chuck: All the time. I mean, even before workflow technology came along. If you got a bunch of people together and by hand you got them all in the room together and I did this at a community hospital in Pittsburgh where we cover the walls of a board room with the white butcher paper and we used sharpies and we brought people in from all over the hospital and so the workflow from this department would lead to the workflow in this department, would lead to the workflow in this department and we try to create a giant workflow diagram of all the processes, all the workflows in the hospital. People would say, “That’s not the way it is,” and someone else would say, “No, it is the way it is.” Then so there’s a way of getting people on the same page so literally in this case, sheet.

Now, that you can take data out of electronic health records in other systems when someone clicks on a button, they did something at a particular time. Now we have evidence based workflow. You can show people, with this called process mining, process mining is like data mining except it’s applied to all of that time stamp data that’s in the electronic health record and other health IT systems. You can generate a process map, you show that to people and they’ll say, “That’s not what I do.” You say, “Let’s drill down here, you’re on this screen and you click this button on this date. You didn’t do that?” They’ll look at it and they’ll say, “Yeah, I did do that. I guess you’re right, I forgot to tell you about that.”

Janet: Who could remember all the details number one? Give me an example of how this workflow might work. Is this something you’d use to say, “Hey, why are lab results taking so long?”

Chuck: Yes, absolutely. Imagine you’ve got this loop where you’re writing something, you’re clicking on something and then some time passes and then something arise. In between, a bunch of stuff has to happen like specimens have to be collected and then within the laboratory information system there are multiple steps of workflow and levels of quality assurance and so forth and all of that in our current workflow oblivious health IT systems it’s opaque. It’s a black box so you push the button, you don’t know what happens and then finally get it. If it takes too long, wouldn’t it be great if you had a process map that showed you every little step of the journey that your lab order went through and you can then say, “Wait a minute, why did it sit here for a week?” Someone can go, sometimes it’s a red face they go, “I was on vacation.” Then you can change the workflow so it doesn’t happen again.

Janet: Cover that from a patient’s perspective, “Why do I care about workflow? How would it apply to me?”

Chuck: There’s two interesting angles there. The first is I’ve seen studies that have shown that for a chronic condition and an operation related to it. There may be 20, 30 touch points between health system and individual and you’re talking maybe over a dozen various clinicians and if these people are asking for the same information over and over again or the right hand doesn’t know what the left hand is doing and the lack of coordination is obvious then you’re going to lose confidence in the system. That’s the system behind the smiles. When the hospitality industry you walk in and the room is ready and you go right in but there’s all the stuff, there’s all those back end stuff that had to happen and that front end where you got the staff and they are smiling and they are nice and they are saying, “Yes, ma’am, here you go. Here’s your key.”

They can’t do that, they are not free to live their organization ideals unless they can just count on all the workflows in the systems many of which are IT systems work perfectly. You don’t know and you don’t want to know how all the magical stuff happens but someone has to figure that out and make sure that it works perfect or well enough. The other aspect of that is that patients and humans even if they are not in the hospital they have work, you and I have personal workflows. We have workflows that we use to make breakfast and to multitask between while we’re talking to someone or we know exactly how long something is going to take to wash or to cook.

These, it could be called life flows. Okay? These life flows are interacting with for example, notification systems. In our smart phone, in our smart watches, our fridges, our appliances and all of them are networked together and they all need to be coordinated too. Now, if you’re at home where you’ve got all kinds of healthcare related monitoring, that internet of things IOT level, you also need these life flows to be coordinated. I’ll give you an example. A notification, you got a ding, you look at your smart phone while if you’ve got three smart phones sometimes you hear three dings you’ve got your watch. You need a system that says, “Wait a minute, all we need to do is deliver one notification. We just need to make sure that is delivered in the right time and in the right manner,” that’s kind of a classic workflow management system workflow engine responsibility.

Janet: Wait, wait, can you tell me how to do that because it’s killing me?

Chuck: No, no, it’s funny. Yeah, I can’t remember who it was, I might have been a [Jur Piano 00:19:37] and all of a sudden I heard like about 12 dings on his side. Yeah, smart notifications are definitely coming and that’s going to be … Also for example, patient instructions and reminders to take their medication and so forth. You don’t want seven different identical reminders but you might not be wearing your watch and so the system, you’d say, “Well, we’re going to send it to the watch. Wait a minute, they didn’t respond. Now we’re going to escalate it.”

All those rules that you use when you’re trying to deliver a message and then you don’t receive evidence that the task was accomplished and then it gets escalated to the next level. Then it might even be escalated to a human. You see, if someone doesn’t like push the button on their smart pill dispenser saying, “Yes, I consumed the pill,” you may get a knock on the door from your mom, someone who’s agreed to participate in this semi-automated life flow. I know that sounds like science fiction but there are start ups and folks working on exactly the scenario that I’m talking about.

Janet: Especially from the stand point of our desire to be living at home as long as possible but that does mean that there needs to be some kind of monitoring and some kind of awareness particularly as we have so many generations who are not living near each other.

Chuck: I originally wanted to become an anthropologist and I didn’t do it basically because the job prospects for anthropologist apparently are not so high but anthropology is about workflow in culture and in human groups. For example, when I define workflow to be a series of steps consuming resources achieving goals, a series of steps can be a ritual or a series of steps in some coordinated activity. A field anthropologist conducting ethnography is sitting there writing notes and he’s basically writing down workflow notation of anthropological sort and consuming resources. It’s consuming animal carcasses, it’s consuming the time of folks. It’s achieving goals.

Those goals may be sustenance, safety, protection from the elephants, group cohesion and so anthropologist are very much like industrial engineers in the sense that if they go in and they document these workflows, although the languages and the rotations are different. You can easily imagine these applied anthropologist working together with the workflow where health IT start ups of the world to create the kind of digital support at home so that just fit seamlessly into the living life flows of those folks who are being supported at home.

Janet: That’s a world we all need to have because as we age and the boomer start to outnumber the young people who are able to care for them, we’re going to need more digital tools to keep us mobile, on time, taking our right meds and indeed giving us reminders or giving us connection to other people.

Chuck: I’ll say this, I frequently get into sometimes a rather strong debates and people keep talking about, “I want my data.” Guess what? I don’t want my data. I want my workflow. I want reminders. I want nudges. I want to know what to do next. The only reason people really want their data is because they need to be their own workflow systems. I have to get the data from you so I can take it over to you. What if I didn’t have to get the data from you to take it over to you so that you could then make the decision to remind me to take the pill I need to take? That’s really workflow. What I think people really want is they want control over these life flows and workflows around them that are working on their behalf although even though they are maybe irritating and nudging and nagging unless it’s less about, “I want to be able to download all my files in electronic format.”

Janet: Honestly, I don’t want my data because I don’t know what I’d be looking at.

Chuck: Yeah, right.

Janet: It doesn’t really help me. Let me ask you a question about who is this person in a healthcare environment? Obviously, you do consulting work and you come in and you help organizations with specific problems and situations but you’re not there all the time. Is there a position in hospitals and healthcare systems that you would be if you’re there? What is it called? Because nobody’s going to go get five degrees in order to become you.

Chuck: Every year in US [inaudible 00:24:21] reports or whatever you’ll see it will show you a list of ten job occupation that won’t exist in five, ten years. Talking about C-level individuals as being bellwethers. You know, the chief transformation officer, chief innovation officer, chief engagement officer. I’m starting to see chief process officer. You can just Google chief process officer and it will tell you salaries. The thing is that people talk about these silos, silos of data. I say, don’t think about it in terms of silos of data. Think about it as silos of workflow because what you’re trying to do is link up workflows between these silos so that they work together seamlessly.

Yes, you’re right, someone that shouldn’t have to go and get five or six degrees but I was an assistant professor and I designed the first undergraduate degree in medical informatics back in the 90’s, that’s designing a curriculum and as you know because you do curriculum design that’s part of your social media outreach and education is a kind of an exciting and intellectual thing because you got to look ahead into the future, you got to predict where things are going, you got to say, “Okay, I’m going to take a little bit of this, a little bit of this. I’m going to put it together in a certification and a degree or whatever.”

Yes, I think that you’re going to see some of this folks are industrial engineers, some of them are nurses who go and get a certification in IT but kind of fall in with the right group in terms of, I don’t really want to be a data analyst but I don’t mind being a workflow analyst because it’s closer to touching the user whether that user is a clinician or an admin or perhaps even a patient.

Janet: Interesting. I do think that’s very exciting because there are a lot of healthcare providers who have unique skills I think of all the physicians that I’ve interviewed who are really technology nuts. They [laddered 00:26:29] in social media because they really like the engagement, they like the communication method, they like being on a cutting edge and I think once you’ve been experienced in a large system it would be very sad to retire to the golf course because even if you’re maybe too tired to keep up with the very heavy workload of a physician or a nurse, this is such a great application for your knowledge base.

Chuck: Yeah, and the great thing about you don’t have to be a computer scientist to be able to map workflows. If you want to program you got to learn C Sharp or Java and then take database course and operating system course but you have to do all those things in order to create an application. In the workflow technology world it doesn’t matter where they come from, what’s most important is that they understand the domain and that means that they understand their workflows and the workflows of the folks that they are trying to help. You think about business analyst, you think of this as clinical workflow analyst. Then they don’t have to be a Java programmer because these systems are what’s called less code or low code or code less.

You can basically create an application without having to write all of that text down and compile it and fight through. There’s an opportunity to bring the people who really understand the domain workflows together with the platforms that will allow them to create their own applications. They call these citizen developers. It’s happening in other industries. A citizen developer, you think of a citizen soldier. Citizen soldier is someone who is a volunteer or in some countries you have to serve a couple of years but then you have to keep the rifle under your bed like they do in Switzerland, locked up by the way. Citizen soldiers, these are folks that are doing something important for the rest of everybody else because they can and because they should.

I think we’re going to see something like that in healthcare software. We’re going to see citizen developers. I mean, it’s already happening. In fact, it happened for decades and that is there are companies out there that some doctor in some area got together with his brother or sister-in-law who’s a programmer or vice versa and then they built an application that’s now multi billion dollar company. Today, with the technology that can happen much more quickly and less expensively.

Janet: There was actually an article that came out if not this week then maybe last week but it basically talked about innovation needs to be coming from the medical side of the fence and not from the innovative entrepreneurial side of the fence. Many schools have thought on that but the bottom line to this article was it’s really physicians and nurses who know what problems need to be solved, they need the digital health partners to make that come to pass as opposed to the 6,000th app to manage your calorie count.

Chuck: The great thing about workflow technology is you’ll often hear folks saying or bemoaning that we don’t have clinicians more involved in the design of software before it is implemented or deployed. Guess what? With workflow technology software you can design it after it’s deployed. You see, because you can put that workflow in there that if you can draw approximately correct workflow you can put it in and it can be changed on the run. You can swap two steps by just dragging and dropping. You don’t have to go all the way back to the health IT vendor. Yes, it’s important that we get clinicians involved in the design of workflow both before and after. It’s that after that is so important because that’s when you actually see whether it works or not, that’s when you say, “Oh my gosh we forgot this, we got to add this step.”

Janet: Let me ask you a question about an actual workflow process. You’ve gone in and you’ve mapped out I don’t know, OR prep or something like that. How often should workflow be reevaluated?

Chuck: Gosh, that’s going to be case by case basis. It depends on how close you … Okay, when you draw out this workflow and then you double click on all the icons and you set some properties, these are the business rules that are about escalation or when this step is executed I want an SMS sent to this phone. If you do a really, really good job upfront then it’s like day one, wow this really works great and then just a couple of little tweaks. On the other hand, if you get something out there that is only halfway thought through and when I say only halfway thought through, a lot of the workflows in healthcare are so complicated and maybe so almost illogical to some people that you really can’t do better than half thought through.

It’s in those situations that you’re probably it’s going to be like an exponential function but I mean, just going to start up high and then it’s going to drop down and get less and less. Now, whether that happens over a week or a month but I will tell you that workflow technology software, one of the things that it does really, really well is it avoids these multi year implementations that you hear about. The electronic health record it took them two years to implement the electronic health record and that’s because the cost of changing the software after it’s been deployed is so high and it’s so laborious that it slows you down and it’s so expensive. That’s when you hear about these 100 million dollar situation. Some which have sunk hospitals or CIO or even CEO careers. With workflow technology you can change the workflows after you’ve implemented it.

Janet: Now, without naming names, do you find that these big companies are actually open to outside consultants or client feedback on what’s not working or are they so wrapped up in their own workflow process that it is like, I don’t know, stopping a speeding train.

Chuck: They’ve maybe getting better but like a couple of years ago I did a focus group, two day focus group at Chime down in Scottsdale with 40 CIOs from UCLA and all across the US. Unfortunately, part of the reaction was, “You know, we really love this workflow technology stuff. We get all the logic that you and I had talked about. The problem is is that meaningful use have sucked all of the air out of the room. We’re so focused on getting that subsidy. We don’t have any excess resources or attention to try anything innovative.” Now, I think this meaningful use becomes a bit longer in the tooth, I think we’re going to see stuff improved, the problem is is that meaningful use is being relabeled and now you got macro and it’s being resold. The jury is out on that.

I think ultimately in every other industry applications have followed an evolutionary pathway. Back in the 60’s and 70’s, all the software was all mixed together. You have two applications and the data is separate. I mean, that’s the classic situation where you have to reenter the data then they pull the data out and they shared it in the database. Then the next evolution they pulled the user interface out so when you click on a button, the application isn’t responsive but the button is the operating system, Windows or Mac OS and the application just says, “Make a button and find out what the user wants.”

Now, what’s happening is the workflow is being taken out of these applications. You can have a bunch of different applications and the workflow is all represented in a single place and the workflow engine is running against it. That evolution that I’ve just described has happened in every other industry. Healthcare, the health IT is 10 to 20 years behind other industries. It is inevitable. The only question is how fast. One of my roles, I have self-anointed roles is to try to accelerate that evolution toward these process aware systems because the workflow obliviousness of a health IT that we’ve implemented, this sounds a bit floored to say but maybe killing us.

Janet: One of the things you mentioned to me in our pre-interview conversation was trying to recruit some of the top minds and vendors in the workflow tech area to come in to healthcare. What’s the problem? Is there no welcome mat out there or they see healthcare as too long of play?

Chuck: A little of both. I go to three or four or five business process management conferences a year and they are looking at the multi trillion dollar healthcare industry in which people estimate a third or a half is wasted in administrative stuff and they say that’s ideal for automating it with workflow technology. On the other hand, healthcare is a foreign country. It’s like when I went to medical school, all these new words and acronyms it’s all very confusing and it’s hard to prioritize. Part of the problem is is that they kind of don’t know how the product ties. I helped them with that. The other thing is that often someone will find them, someone from healthcare who’s like at wits end will go outside of healthcare, they’ll bring in this workflow technology vendor sometimes they are called adapt a case management dynamic, case management business process management and they’ll have a success, a one off.

Then the question was how do we pivot from that, we’ve got a foot in this healthcare organization’s door and then it will often be in human resources or in the trans industry, in a payer side. Basically, because those are areas of healthcare that are most similar to other industry so you’re going to see the earlier successful importation of workflow technology in those areas but what happens is CIO gets a look or there are a lot of CIOs that are coming from other industries and they already know about workflow technology. I’ve seen job ads for both CEO and CIO in which the job said, literally this is in the job ad, literally says not only is no healthcare experience required, it is disallowed. “Do not apply if you are coming from healthcare. We want people from the airline industry, the hospitality industry who are using this kind of technology.”

Part of the reason that I’m on social media is that when I worked for a health IT vendor the sales cycle is very long. I mean, nine months or more where you got to wine and dine and get through the right people and then maybe you get shut down right at the end. You’re investing a lot of time in one off situations. I’ve got almost 10,000 followers like a lot of CIOs, CMIOs and so what I’m doing is trying to put a lot of great educational content out there about workflow technology to 10,000 because I don’t know who is going to bite. It’s like fishing. You got to go some place where there’s a lot of fish. I spent a lot of my time creating content getting those people listening to me so I kind of ran on on that but you get my point.

Janet: You also have written recently on this and are going to be in a book. What’s that?

Chuck: In the business process management industry I believe the publisher is a future strategist. They write a line of business process management books and with the workflow management coalition there’s a yearly award. I’ve been a judge for the business process management and a case management awards for excellence. What they do is they just basically send me all the healthcare stuff which I’m happy to do. I think I’ve done it for about five years. I’ve had chapters appear in three or four of their books on knowledge workers and business process management and they’ll be like a talk in the healthcare chapter and that’s mine.

Now, they are putting out together a collection of chapters and chapters that are based on successful applications for these awards for excellence in business process management, case management. One of the chapters is mine which it appeared in the previous edition but I’m also writing the foreword and I’m delighted to do that because obviously I say nice things about business process management and healthcare but I also get to talk about the genesis of my interest which we’ve already somewhat covered.

Janet: Awesome. Chuck, I am so enlightened and for a guy with lots of letters after your name this was an incredibly friendly down to earth and understandable conversation.

Chuck: Thank you for saying that. By the way, Janet, I’ve enjoyed all of our interactions on Blab for example and hoped that we will have more wonderful social interactions. It doesn’t even have to be about workflow, it can just be about healthcare in general.

Janet: Awesome. Okay, I am going to ask quickly you tried out a new platform yesterday called Fire Talk, how it go?

Chuck: It went very well. I was very impressed. It does about 85% of what Blab did and it does a couple of other things that Blab doesn’t do, didn’t do. I encourage people. On Fire Talk I am and that’s seven letters no W at the end. W-A-R-E-F-L-O. What you do is you use your Twitter account or I think also Google or Facebook, you register with them, you have a profile and then you create a channel. That channel is always on. Basically, I put a bunch of YouTubes on there and the YouTube just run in a circle so anytime anybody goes there they can see and a lot of these YouTube or Blabs that I did that I downloaded and put over on YouTube but now I can bring them back in.

Then what happens is you basically interrupt that channel with live video of where you have two or three or four people just like on Blab and there’s an audience and comments and it’s integrated with Twitter and social media and you can schedule something. Now, the thing that’s interesting about Fire Talk, part of the reason Blab went away is it really didn’t have a good monetization strategy. Fire Talk allows you to have free shows but also it allows you to sell tickets so you’re probably going to see musicians and so forth take advantage of that and I’m hoping the fact that they do have a monetization strategy will keep them around because I really like them.

Janet: That’s great. I promise I will be there at the next one or I’ll be hosting one myself soon. Of course you can find me just look for Get Social Health and that’s my Twitter or my website, my podcast and now my Fire Talk site.

Chuck: Yay.

Janet: Chuck, thanks so much for being here. I look forward to our future conversations and you are now my go to workflow man.

Chuck: Viva la workflow.

Janet: All right. Thanks so much for being here, Chuck. I look forward to talking again soon.

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