Interoperable Healthcare Workflows: A Vision for the Industry (Notes From A Keynote)

[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 recently attended the inaugural Healthcare Business Process Management Notation Workshop, in San Diego, California. It is not often one has the luck and foresight to be present at the start of something important. This felt like the start of something important.

What was the subject of the workshop? BPMN stands for Business Process Modeling Notation. It is a set of symbols and conventions for representing workflows and processes. In some cases, it is used not just to represent, in a standard format, workflows and processes, but also as a “program” that can be executed by a workflow engine in a business process management systems. This approach to application development is sometimes referred to as “low-code”, “less-code”, or even “codeless” application development. Analysts, who are not themselves traditional programmers (as in Java or C# programmers) can work together with users and domain experts to draw workflows and create screens to create fully functional software applications.

Diagrams of workflows being executable by workflow engines is still a relatively alien concept to healthcare, though workflow management systems have been prevalent in other industries for decades. I looked around for the best possible quote, describing the relationship between BPMN and workflow engines, and think it is worth including in the preface to my notes from the workflow keynote.

“BPMN 2.0 and Workflow Engines

One of the most common technologies to describe a business process is the ‘Business Process Model and Notation’ – BPMN 2.0 standard. BPMN was initially designed to describe a business process without all the technical details of a software system. A BPMN diagram is easy to understand and a good starting point to talk about a business process with technician as also with management people. Beside the general description of a business process, a BPMN model can also be executed by a process or workflow engine. The Workflow Management System controls each task from the starting point until it is finished. So based on the model description the workflow engine controls the life-cycle of a business process.” (Microservices, Verticals and Business Process Management?)

On to the workshop! It was organized by Ken Rubin (VA, Standards & Interoperability, OMG, Healthcare) and Denis Gagne (Trisotech, OMG BPMN) At one point I raised my hand, just before we joined our breakout groups, and asked Ken the following question:

“Is our aim portable workflows between healthcare organizations, passing data between organizations via workflows, or virtual workflows across organizations?”

To which Ken answered: Yes.

Shane Mcnamee, MD, VA, kicked off the workshop with his keynote: Interoperable Healthcare Workflows: A Vision for the Industry.

It was the best depiction by a clinician of healthcare current workflow state versus ideal future workflow state, intelligible and comprehendible by a workflow management and business process management audience, as I have ever heard. I took detailed notes. Here are his major points.

The following is not word-for-word. To some extent it is a direct transcription from my notes. To some extent I paraphrase Dr. Mcnamee. However I believe I did justice to the substance of his remarks.

  • Dr. Mcnamee explained his military rehabilitation medicine background.
  • As rehabilitation patients flow through the healthcare system, everything should “just happen” for them.
  • When we are sick and vulnerable, we shouldn’t have to captain our own healthcare within and across systems of care
  • It’s difficult for even physicians to navigate through these complex systems of care.
  • Health IT has worked on the interoperability problem for years. We can technically exchange data in some places. We are slowly increasing ability to exchange meaning as well.
  • But what is the purpose of the data flowing back and forth? It is so we can DO things for people. Data has to drive the process of healthcare.
  • When we step back from mere data exchange and semantic interoperability, how is true process interoperability possible?
  • Where we see success today, there are great case managers and nurse always on the phone bothering people, but you also see a lack of IT tools.
  • Dr. Mcnamee introduced a fictional, but representative, case study: globetrotting Eva is pregnant, carries her antepartum record everywhere, and is captain of her own healthcare process.
  • Dr Mcnamee feels as if he is in a dark cave with a tiny flashlight (his computer) and folks are asking for help. He looks around the cave, finds data, synthesizes, and send them off into the deepest darkest part of the cave. And hopes the everything happens as it should.
  • The better clinicians aren’t necessarily the smart clinicians, but those who know how to get things done.
  • They know which phone numbers not even bother to call. As an intern Dr Mcnamee copied all the phone numbers of the lab personnel. Then he called each one until he knew who would answer. Much of healthcare is knowing where the secret doors are.
  • Lack of assurance the right things will happen for individual patients as they flow through healthcare is troubling, to the patient and provider.
  • Every patient has their own, slightly different, healthcare pathway.
  • Compared to a factory model of healthcare, where there are consistent pathways, in healthcare there are as many pathways as there are people.
  • The VA has spent a lot of time and effort over last year and half optimizing BPMN, placing the BPM engine, itself, at the core of the Enterprise Health Management Platform.
  • We seen challenges and gaps with respect to BPMN but hope BPMN can become what we need and adopt to deliver care seamlessly across the country, with “tooling” at both ends, like a railroad has for loading and unloading equipment.
  • We are beginning to develop care pathways in BPMN. If you know anything about healthcare, there are a LOT of different care pathways, at different institutions, across institutions. There is just a ton of care pathway content out there, but can’t be shared and adopted with powerpoint of electronic tools is problematic.
  • No docs can follow an 300-page care algorithm.
  • Our biggest challenge? How do we figure out who is supposed to do what? How is what they do managed safely? These chunks of knowledge are episodic, through perhaps stack or embedded. They include decision support, medications, lab orders, consultations, finances, anything that is part of care delivery over time for a group of similar patients
  • We use Red Hat’s BPM engine. Here is a BPMN diagram for colorectal screening. Age and risk profiles drive recommendations.
  • There’s lots of discussion about how to deal with BPMN being so deterministic. We need to more flexibly cope with probabilistic behaviors.
  • What should go into a BPMN model, and how should it interoperate with the data systems beneath it, to deliver the right care to the right patient at the right time?
  • The other piece is “Who?” Where do we send tasks, how, how to detect failure to accomplish something by a specific time and then handle escalations…
  • How does the BPMN modeling we are doing integrate into actual workflow, especially in terms of integration with existing EHRs? (in terms of data access, transformation, and write back into these systems). What is the user interface and user experience? Is BPMN driven workflow embedded? Is it off to the side of the EHR? How do we introduce modeled workflows to EHR users and what we can do with these modeled workflow in a way that we don’t do what so much health IT does, which is just make things more complicated.
  • We, patients (and clinicians), want a system that understands us, knows what our needs are, monitors and makes sure that things get done over time, so that when I show up, sick and vulnerable, and the least able to to take charge, I shouldn’t have to be the captain of my of my own healthcare. We believe BPMN can move us in that direction.
  • Eva needs to be able to live her live, and have her healthcare process served up by any healthcare organization across the country.
  • We are right on the cusp of of process integration in healthcare. Major organizations and products are beginning to manage workflows, but they are proprietary.
  • What’s going to happen if we don’t put something down quickly, and move people toward it, is we will have process silos. You may have a fully process-integrated hospital, and another such hospital across the street, but the processes won’t be connected.
  • We need a virtual community of practice in conjunction with various test beds. Cleveland medical institutions are an excellent testbed. The HIMSS Innovation Center is in Cleveland. We need to build infrastructure, so that in order for our vision to actually happen, we need an environment in which it can happen. Test environments and conference rooms are insufficient. We need to study interoperability across actual institutions.

Dr. Mcnamee was the first of excellent eleven speakers. In particular, Denis Gagne gave an excellent overview of BPMN and two related notations: CMMN (Case Management Model and Notation) and DMN (Decision Model Notation). I took lots of notes.

The second half of the day was devoted to breakout section. I took a lot of notes. To me most interesting what discussion of relationship between BPMN and FHIR (???). Are they complementary? BPM engines driven by BPMN models need access to data FHIR exposes. Is there overlapping responsibility? Future drafts of FHIR may include models of task and workflow. Fascinating, especially since FHIR is so famous in health IT, while BPMN is well known outside health IT, but much less so within health IT.

I hope you will want to learn more about BPMN and the workflow tools and Business Process Management systems that use BPMN. And you may wish to attend the next BPMN in Healthcare workshop, this March, in Reston, Virginia.

Here are a couple of related posts I have written.

Relative to the subject of workflow management systems, business management systems, and interoperability in general, check out my twin five-part series.

By the way, the workshop gave away a copy of Business Process Management in Healthcare, Second Edition, for which I wrote the foreword and contributed a chapter. You can find my forward, chapter, and link to the book in ????).

You can find PDFs of the slides from the presentations on the workshop agenda page.

However, here are some of the slides I snapped with my phone.

The final diagram! There, roughly, three levels. At the bottom level are is System A and System B, each containing data and their own internal business logic. At the very top level is a well-defined, but not executable, representation of workflow across System A and System B. In between is executable BPMN. Of course, “executable” means there is something to execute the BPMN, a BPMN compatible workflow engine, implied but not shown.

FHIR was on our mind!

The interoperability stack! Process Semantics Interoperability (and above) corresponds to Task-Workflow Interoperability and Pragmatic Interoperability, in my previous series of articles.

A HIMSS17 Conversation about Data, Workflow, and Actionability with David Freeman, Quest Diagnostics

[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!]

Actionable data. What is it? Why does healthcare need it? What is its connection to workflow? Inquiring minds want to know!

(The lunch bag and apple? Inspired by
Quest Diagnostics Lunch & Learn panel, which I moderated
on the Monday of the HIMSS17 conference.)

Are you one such inquiring mind? If so, you are in luck. This blog post is a series of questions and answers from David Freeman, of Quest Diagnostics, about these topics, and more. I’ll be tweeting links to the individual Q/As during HIMSS17. I hope you’ll weigh in an add a comment to this post (I’ll tweet it!). Or respond to any of the tweets. My comments are in italics, questions in bold.

1. Let’s set the stage: who are you and what do you do for who?

I am general manager for Information Ventures at Quest Diagnostics, an exciting effort that leverages our valuable lab data, along with data from partners, to derive insights which drive better outcomes. Through collaborations with progressive healthcare-solutions companies and our own clinical and technology expertise, we are committed to providing insights that are actionable; not just for physicians and patients, but for therapy developers, health plans and health systems. Quest has a long history as a trusted healthcare provider, yet we are now so much more than lab testing. We are also an insights company, and we’re now actively engaged in innovative collaborations and new technology development that turns those insights into actions that help patients, caregivers, health systems and health plans across the entire ecosystem align to improve care quality, value and satisfaction.

My role in all of this is to forge partnerships that can benefit from Quest’s vast collection of data and analytics assets. These partnerships span everything from population health to precision medicine and value-based care. One notable example is IBM Watson, where we’re helping advance precision medicine by combining cognitive computing with genomic tumor sequencing. It’s exciting to be involved with an initiative aimed at leap-frogging conventional genomic services as a better way to target oncology treatments.

On the technology side, we’re leading in health information technology (HIT) too. We’re at HIMSS because we now play an important role in helping health insurers, health systems and providers use data and analytics to improve care, lower cost and better manage populations. QuestQuanum, our suite of internally developed technology solutions, brings forward our expertise generating insights from data, including our own industry-leading dataset of more than 20 billion test results, as well as connectivity with nearly 600 EHR platforms and half the physicians and hospitals in the U.S. Our origin story, unlike some in HIT, started within healthcare, and we believe that puts us in a unique position to drive meaningful change.

[CW]Very cool! By-the-way, when I was an EHR CMIO/Junior Programmer, I cut my teeth on building our very first lab interface to Quest. I have fond memories of how smoothly that went! (Great workflow!)

2. Define data. Define workflow. How should they work together? What are some obstacles to doing so?

Data represents potential, but in its most common form – raw and unorganized – it can do very little. Everything on a patient’s record, from a single lab test to an HCC code, does have value, but in isolation those data points can offer limited insights. If a physician at the point of care had hours to pore over data, she’d likely discover useful trends, but the scale would still be limited. Today, there are experts tasked with mining data for trends and insights, but pulling insights and making them actionable at the point of care is still a great challenge. Harnessing big data is a big job but we believe tremendous value will be unlocked by shifting from retrospective analysis to near real-time analytics.

Workflow is what enables physicians and others at the point of care to ensure the highest quality in the most efficient manner. Critical, highly-considered steps are required for each patient visit, and deviation from this process leads to costly disruption, which can impact quality and affect outcomes. For this reason, not all technology is well-received in a healthcare setting – if it fails to consider highly structured workflows and tight interdependencies it will have limited utility, no matter how innovative it may seem.

When data-driven insights meet workflow in a stepwise fashion – inserted when and how it’s needed, meaningful actions can be taken. It’s our mission to understand how that data can be most useful and present it in a form that works for the user. If the goal is better lab utilization – right test, right patient, right time – then we will present that data in a clear and useful manner so it can inform an action, perhaps, for example, not ordering a test that has already been ordered. We can also present that data to the patient, giving them a unique view so that they can better advocate for their care. In the end, it’s about removing the primary obstacles to deriving value from data – analytics and access in near real-time and at scale.

[CW]”Synergy” is an interaction between two areas or activities to produce an effect greater than the sum of their individual effects.

3. Is it possible to have good data but bad workflow? How does Quest exploit synergies between data and workflow?

It is indeed possible to have good data and bad workflow. In fact, much of the data captured at the point of care is good; it is just not actionable. Making that data actionable involves many important steps, from combining and cleaning datasets to analytics and subsequent application to unique workflows. You cannot pay attention to some of these steps and ignore others.

What makes Quest’s approach different from others is how we apply rigor borrowed from two worlds: the healthcare setting and the IT setting. This marries data analytics and workflow in ways that accelerate adoption and utility. Whether the customer is focused on revenue cycle management, lab utilization or quality metrics, we’re able to provide an HIT-enabled report that fits within a rigid workflow that must account for myriad dependencies. There is no one-size-fits all approach because no two health plans, health systems or individual practices are alike.

QuestQuanum puts us in a unique position to connect patients, providers, payers and ACOs with actionable insights based on lab, clinical, quality, claims and other health data. This reflects a new way of thinking about Quest and our broader ability to harness insights and technology to deliver better healthcare. Our national connectivity, big data, technology and clinical expertise uniquely position us to provide the kinds of technology solutions that will improve quality, lower costs, engage patients and optimize financial performance. In effect, we are aligning data with workflow so that stakeholders across the ecosystem – from plans to patients – can tap into the value most useful to them whenever and however they need it.

[CW]I’m looking at something Quest calls “Data Diagnostics™ Quality Reports.” Specifically I am looking at the sections, “Current Status” (No Current Action Required, Action Required) and “Clinician and/or Facility” (“Contact information for the clinicians or facilities most recently involved with the specific measure for the patient”).

4. My workflow “Spidysense” is tingling! Is there a workflow angle here?

You’re correct, Data Diagnostics reports are designed to ensure that all data are actionable for physicians in the workflow, as they meet with patients. If they see “Action Required,” the physician can take that action immediately, inside the EHR, without needing to navigate to another application and log in.

In certain circumstances, a physician may need to consult with another clinician or facility, but even that step can be executed from within the EHR. Presenting the specialist’s contact information at this point in the workflow ensures that proper steps can be taken to verify recent procedures, HCC codes and other information vital to the current exchange with the patient. Once again, providing this information later in the “process” reduces the likelihood that it will have value for the existing physician/patient engagement. Providing it during the visit is transformative and supports maximizing that patient-provider encounter. For example, if a patient has been brought in as part of a population health initiative (all diabetic patients who haven’t had an A1C test in the last 3 months), Data Diagnostics will provide a list of all the open quality gaps that can now be closed during that encounter.

Data Diagnostics reports simply bring more information and insights into an existing workflow. That data, pulled from Quest’s 20 billion lab results and Inovalon’s clinical datasets representing more than 139 million unique patients and then analyzed and presented with existing claims and EHR data, are valuable. But the fact that all that data are aligned with workflows in near real time is transformative because it means that this can happen on-demand. This needn’t be a prolonged data mining exercise to prepare for each patient, but instead it brings insights to physicians at the moment of decision – when it’s needed most.

[CW]Some sterling qualities of healthcare workflow technology include: Actionability: Stuff happens automatically, or almost automatically. Transparency: While stuff is happening, you can easily see what has been accomplished versus what is not, and why. Flexibility: Workflows can be easily modified and improved.

5. Tell me about how Quest helps achieve actionability, transparency, and flexibility.

Our technology is designed for high-actionability, visibility and flexibility, so it certainly fits what you outline as the “sterling qualities” you’d like to see. We aren’t workflow technology, however; instead, we offer a technology suite that is built to turn healthcare data into insights and align with established workflows, so it will be embraced and adopted. So, I guess you could add a fourth quality: utility – people use it because it has a demonstrable impact on efficiency, performance and, most important, patient outcomes.

When you break down Quanum, you see our focus on turning data into insights that drives specific actions. Whether that’s to order or not order a test, or whether there are specific actions that could lead to increasing quality scores or more accurate diagnostic coding, we drive to engage around the action itself. The ability to see what’s happening, what you call transparency, is also built into our offering. We think of this as visibility – the ability to see more data related to the patient and have confidence that it’s updated with sufficient frequency so that it improves decision-making.

The last piece is flexibility – there must be a focus on adjusting to changing workflows as the system learns and adapts. We certainly enable that. New diagnostics tests reach the market regularly, quality metrics change and the models that govern value-based care are in constant flux. As that happens, however, our technology can adapt, making it possible to have a workflow that is always ready to insert data where it can matter most; chiefly as a single point of truth that aligns health plans, health systems, practices and clinicians around the singular goal of delivering the best care to individuals based on their needs.

[CW]I read Quest’s recent white paper, Finding a Faster Path to Value-Based Care. Data is obviously incredibly relevant to value-based care.

6. How and why is workflow also relevant to value-based care?

Value-based care is predicated on the notion that all steps in the care delivery continuum are optimized. How this happens, and with what sets of data, depends on the relationship between the health plan and the health systems and all constituents involved, from the quality manager and practice manager to the physician and his or her patient. Value-based care relies on data, but that data must be actionable and be fully aligned with how work is done – in its flow.

If data exists but cannot make its way from a quality manager to the point of care, then it’s outside the workflow and may not have an impact. Likewise, if the data used at the point of care isn’t aligned with specific goals for quality, population health or other objectives, the exercise is more about optics than real alignment for change. The only way to make an impact is to align data to specific value-based care models that can be tracked and tweaked within a feedback loop.

Our study, Finding a Faster Path to Value-based Care, produced some interesting insights, but none more so than the misalignment between plans and physicians. This doesn’t mean the objectives aren’t in sync but rather that they don’t always see the problems the same way. When that happens, the data may not address the most pressing issues and, even more importantly, the insights don’t make it to the workflow level where real impact is possible. Once we bridge this chasm, we can create alignment about what’s really happening at the point of care – what’s really happening in the workflow – and that’s when real value-based care is achievable.

[CW]This next question requires a bit of personal background; I beg your patience.

Many years ago I was an accounting student with an interest in science. A wild and crazy idea occurred to me: declare myself a premed-accounting major! But I had to do my research first. I went to the library and looked through books on health policy and health IT (not many yet, at the time). I found a chapter about integrating clinical and financial information systems. It was like wandering in the wilderness and finding a compass. Of course! Clinical systems generate benefit. Financial systems calculate cost (among other things). The only way to maximize healthcare’s benefit/cost ratio (AKA “value”) is to integrate clinical and financial systems (including payer systems).

7. Given that Quest’s Data Diagnostics faces both providers and health plans, what is Quest’s vision for integrating and optimizing health information to maximize healthcare value?

Data Diagnostics and the entire Quanum site is about integrating and optimizing health information to drive value for patients. Your idea to combine pre-med and accounting wasn’t that crazy after all. You were just ahead of your time. At a basic level, value-based care is the logical marriage of clinical systems with financial accountability, including all the complexities involved with risk, reimbursement and other changing policies. Our partnerships and technologies are designed to bring data into that complex equation, not to the benefit or advantage of one party, but in a way that aligns all parties around common goals.

Take Data Diagnostics. Harvard Pilgrim considers the solution a benefit to its members, as they believe it will result over time in lower premiums for better care, but the benefit also accrues to physicians by lifting the burden of adhering to multiple, complex quality requirements. Likewise, it helps practice managers who own quality scoring and risk management adherence. The idea is that one large and expanding set of data, informed by powerful patient-specific analytics, can mutually benefit many across the ecosystem, engaging everyone in the common pursuit of higher value without a disproportionate amount of effort falling to one player – it’s the data and analytics that do the heavy lifting in near real-time.

[CW]Quest started as a clinical laboratory and reporting company. Lab results represent a large majority of patient healthcare information. They significantly influence clinical decision making. Lab results were among the first examples of successful healthcare interoperability. (Our Quest interface was our first EHR interface to a remote clinical data source.) One could argue clinical laboratory reporting is a natural place to pivot from toward more comprehensive sharing of clinical information among those who need access.

8. I’m interested in your thoughts on the evolution of healthcare interoperability and workflow integration in healthcare.

Quest recognized some time ago that surviving and thriving in a heterogeneous healthcare IT landscape required a sustained investment in interoperability. Lab data fills a unique role in healthcare as it provides a common quantitative framework for assessing a patient’s health status, which is why it’s ubiquitously used in diagnostic decision making. To facilitate that universal ability to order lab tests and receive test results from any provider’s information system, Quest has systematically created bi-directional interfaces to the point where we can receive test orders and return results from more than 650 EHRs, reaching more than half of the physicians and hospitals in the U.S. This is an enormously powerful pipeline where actionable information can be requested and received, within the workflow, in near real time.

Interoperability is mistakenly seen as a technology objective alone. The opportunity is much greater, however; value-based care depends on actionability, visibility and flexibility, as you pointed out in an earlier question. This means that it’s not simply about putting data into larger lakes for analysis, but also tailoring that information to drive engagement at and across all levels. And not just inside a hospital, but across health plans, health systems and practices. Data are a driver, and we can help with that, but the real change comes when workflows begin to adapt and show some semblance of interoperability.

Solutions like Data Diagnostics aren’t just focused on performance across a single health plan or health system, but instead as a more system-wide driver of value alignment. Yes, this is a much larger vision, but if access is the missing piece for many across the larger ecosystem, anything we can do to foster greater interoperability beyond clinical laboratory reporting is worth our collective energy and investment.

[CW]As you know, I track emerging workflow technologies everywhere in (and outside of) healthcare. Over the years, I’ve watched report generation systems evolve into report workflow management systems. Further, reports are less-and-less about mere reporting and more-and-more about enabling users to easily trigger actions based on, and even from within, interactive reports.

9. Where do you see Quest’s Data Diagnostics in an evolution from data toward workflow?

I hope I’ve made my point that Quest is focused on enabling users across the healthcare ecosystem to more effectively meet objectives for value-based care. In this sense, we see our role as much more than report generation or workflow management. There are systems that focus solely on that, but we’re not one of them.

QuestQuanum isn’t about an evolution from data to workflow, but instead about make data more actionable and ensuring it aligns with established workflows. Until recently, data was stuck in silos and, even when liberated from those silos, it wasn’t made actionable and directed at known issues that prevented us from crossing the value-based care tipping point. This is particularly true because there is a fundamental difference in providing retrospective data as opposed to providing predictive analytics – allowing providers to receive information that is actionable before a gap in care develops, for instance. Data Diagnostics is unique because it sets out to do just that.

While Data Diagnostics reports don’t provide diagnoses, and are not intended to second-guess or verify a clinical diagnosis, they do help health plans, health systems, clinicians and others across the ecosystem collaborate to manage the transition to value-based care and population health models (specifically those serving Medicare Advantage, managed Medicaid or commercial Qualified Health Plan patients). It’s not about compliance or checking boxes, but instead about meaningful changes that connect actions at the point of care with priorities that even transcend those of a single provider, system or payer. As a healthcare provider for decades, we’re proud to play a role in turning insights generated from data into actions that can be applied across workflows. By doing this, we can improve patient outcomes and clearly demonstrate the value we all deliver each day.

[CW]I think you have likely gathered I’m a workflow geek. Around seven years ago I set out to systematically use social media to connect with other workflow geeks. Most of the folks who follow me (11,300+, have more than an average interest in healthcare workflow and using health IT to improve that workflow. We’re very inclusive. We continually popularize workflow thinking and aim to grow our club.

10. Imagine you are the keynote speaker at our first Healthcare Workflow Conference. What would be the opening lines of your keynote address?

Each of you sits at the center of the most complex and costly system every developed: modern healthcare. You are part of a set of shifting interdependencies upon which lives literally depend. To make truly fundamental advances in the cost and quality of healthcare, insights will need to move from outside of the workflow to within workflows. This means that the what, how and when of healthcare analytics has to evolve.

[CW]Thank you David! I love talking about healthcare workflow and how health IT can truly improve it. I can tell you do too!

11. Where can folks attending HIMSS17 find out more about Quest’s healthcare data-driven workflow strategy. Any relevant events to attend?

Quest Diagnostics is hosting a lunch-and-learn panel at HIMSS titled, “Extending EMR Value—Technologies for Making Data More Actionable.” Our panelists, Lidia Fonseca, Quest’s Senior Vice President and CIO, and Kenneth Mandl, MD, MPH, Harvard Medical School & Boston Children’s Hospital, Chair SMART Advisory Committee, will share best practices for using data to drive decisions that improve financial performance and patient outcomes. The panel will also explore health IT solutions that extend EMR value, why they’re important and which investments to make now. The lunch-and-learn is Monday, Feb. 20th at 1pm in Room 203C. Attendees can also visit Quest at Booth #4451 to learn more about our HIT initiatives.

Have a great HIMSS17!

I will! Thank you for answering all of my geeky healthcare data/workflow questions so well!

I’m speaking at #HIMSS17! Extending EHR Value – Technologies for Making Data More Actionable

Monday, from 1:00pm to 2:00pm, at HIMSS17, I’m moderating an invite-only Lunch & Learn panel, Extending EMR Value – Technologies for Making Data More Actionable.

I’m speaking for 10 minutes, giving an industry perspective on “actionable data”, and then moderating a panel of experts (Kenneth Mandl, MD, MPH, Harvard Medical School and Boston Children’s Hospital; Lidia L Fonseca, Senior Vice President and Chief Information Officer, Quest Diagnostics).

Here is the panel description:

In 2017, payers and providers require more actionable insights from their data. Progress will be made, however, and through its historical health IT connectivity across half of U.S hospitals, Quest Diagnostics will share best practices for using data to drive decisions that improve financial performance and patient outcomes. This session will explore health IT solutions that extend EMR value, why they’re important and which investments to make now.

I look forward to synthesizing my views on actionable data (I might mention workflow…), and then listening to panel presentations, discussion, and answers to questions from the audience.

Stay tuned. I’ll write up and publish what I learn.

@wareFLO On Periscope!


Patient/Payer/Provider Collaboration: The Workflow Tech Angle (Learning Healthcare Systems!)

[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!]

#HIMSS17 is a great opportunity to revisit my 2016 Actuarial Science, Accountable Care Organizations, and Workflow post, in which I predicted what ACO IT will look like in ten years.

(adapted from the The Patient Experience “Stack”)

I’ll recapitulate my five predictions of what ACO IT will look like, in ten years, here.

1. ACO IT will leverage process-aware workflow engines executing models of patient/payer/provider workflows

2. ACOs will simulate behavior of patient/payer/provider workflows to predict population health outcomes and costs.

3. ACOs will focus on patient/payer/provider pragmatic workflow interoperability, not just data interoperability.

See my two five-part series on Task-Workflow Interoperability and Pragmatic Interoperability.

4. ACOs, using activity-based cost integrated with business process management, will know exactly what each patient/payer/provider workflow (enrollment, chronic diagnosis, procedure, claims processing, etc.) costs.

5. Virtual ACO enterprises will systematically optimize system-wide outcomes, experience, and expense across patient/payer/provider workflows. If each of the above predictions, 1-4, become true (workflow tech infrastructure, workflow simulation, pragmatic workflow interoperability, and exact costs tied to specific workflows), ACOs will become truly intelligent learning healthcare systems.

Practically speaking, how does this optimized healthcare workflow nirvana relate to our present circumstances? Particularly regarding payer/provider collaborative workflows?

Let’s take a look at quotes regarding payer/provider collaboration and workflow.


Payer-Provider Collaboration In Accountable Care Reduced Use And Improved Quality In Maine Medicare Advantage Plan

“The patient population in the pilot program had 50 percent fewer hospital days per 1,000 patients, 45 percent fewer admissions, and 56 percent fewer readmissions than statewide unmanaged Medicare populations. NovaHealth’s total per member per month costs across all cost categories for its Aetna Medicare Advantage members were 16.5 percent to 33 percent lower than costs for members not in this provider organization. Clinical quality metrics for diabetes, ischemic vascular disease, annual office visits, and postdischarge follow-up for patients in the program were consistently high.”

Health Data Management:

“No single program reimburses for the end-to-end PHM workflow–and this makes it difficult for physicians and practices to embrace value-based reimbursement…. If payers coordinate their efforts to ensure that, together, their programs reimburse for more PHM workflows and outcomes, providers will have the critical reimbursement mass they need to invest in value-based care.”

From Availity’s blog:

“Providers aren’t taking full advantage of proprietary portals because they have so many different ones to navigate, and each has its own unique design and workflow…. A better approach is a multi-payer platform, which allows providers to log in to one site and process transactions for multiple payers using a common navigation and workflow.”

TriZetto (under the Payer-Provider Collaboration heading):

“bidirectional technology platform enables data availability to provide real-time administrative and clinical tools integrated directly into the physician’s workflow, thereby enabling new care delivery models”

The American Journal of Managed Care (“the leading peer-reviewed journal dedicated to issues in managed care”)

With respect to physician engagement, it was imperative to not change their workflow or at least to find common ground and include them into discussions on why those changes were important

What are some specific payer/provider collaborative workflows that we must support with the right information technology? Here are some examples:

  • Streamline workflows for provider contracting and engagement
  • Support provider workflows directed at optimizing patient experience and engagement
  • Simplify provider workflows for claims and encounter data

Collaboration is intrinsically about workflow. Therefore it’s worth reviewing the Wikipedia entry for Collaborative Workflow.

“Collaborative workflow is the convergence of social software with service management (workflow) software.”

“collaborative workflow is derived from both workflow software and social software such as chat, instant messaging, and document collaboration”

The goals of collaborative workflow include:

  1. “Improving effectiveness on joint tasks by removing the communication barriers between team members
  2. Minimizing organizational boundaries and information silos
  3. Allowing online social interaction to be goal oriented, structured, and measured”

“collaborative workflow is a collection of parallel and sequential tasks that rely on communication and coordination to achieve a desired outcome”

Finally, the attributes of a collaborative workflow management system include:

  • Collaboration to accomplish defined goals or tasks
  • Management of a collaborative goal, task, or project from start to finish
  • Integration of collaboration and workflow objects within a secure framework for enterprise applications
  • Project and task infrastructure enabling work to be accomplished in an organized fashion (in contrast to pure-play social software)
  • Skill-based task assignment to teams or individuals
  • Ad hoc projects that span organizational boundaries, and minimize information silos

All of these attributes apply to streamlining, supporting, and simplifying patient/payer/provider collaborative workflows. A goal may be getting well or getting paid. End-to-end, start-to-finish, interacting clinical and financial workflows are the key. We need to model, execute, monitor, and improve all workflows, including patient/provider, patient/payer, and payer/provider. Due to the sensitive nature of this clinical and financial information, we must do so within secure enterprise infrastructure. Social collaboration, even secure social collaboration is not enough. Workflow models must capture and observe healthcare organizational goals and constraints. Roles, of patient, of provider, and of payer, must be modeled and used to drive the right task to the right person at the right time, and make sure it is done right. However, at the same time all this workflow structure is imposed, exceptions and ad-hoc interactions, among patient, provider, and payer, must also be expected, handled, and supported gracefully.

Obviously, APIs (Application Programming Interfaces) are essential to exposing and updating data about patients, providers, and payers within their respective, evolving IT systems (see How Easy Is It To Integrate Availity APIs Into Your Payer-Provider Workflow? Very!). However, APIs are just half the IT battle, when it comes to workflow.

Without workflow, data is just another bottleneck.

It will be the marriage of both data technology and workflow technology that will deliver on the promise of truly optimal collaborative patient/payer/provider workflows.

Luckily, this marriage is happening. Every year since 2011 I’ve searched every website of every exhibitor at the annual HIMSS conference. I look for workflow-related content and trends. A wide variety of collaboration and workflow software vendors are showing up at HIMSS17 for the first (and, by now, even a second or third) time. And a wide variety of indigenous health IT vendors are adding collaboration- and workflow-related functionality to their products and services.

Great collaboration and great workflow, among patients, providers, and payers, requires great collaboration and workflow technology. Look for it.

@wareFLO On Periscope!


@MrRIMP #HITsm Tweetchat on Healthcare Robots: Direct, Indirect & Home Carebots!

Mr. RIMP (@MrRIMP on Twitter & Youtube) is all growed up! And hosting a #HITsm tweetchat all by hisself: Healthcare Robots! #HITsm, from noon to 1PM, EST, is an hour long. Dear little Mr. R put together an hour-long robot-themed mixtape, with lots of music videos about robots! So open two browsers, one for Twitter and the other for this post, and exactly at noon EST (so you all are listening to the same songs at the same time), start playing Mr. R’s mixtape! And, please, comment, positively, or negatively, about the music videos during #HITsm!

From @Techguy’s blog post:

We’re excited to share the topic and questions for this week’s #HITsm chat happening Friday, 2/3 at Noon ET (9 AM PT). This week’s chat will be hosted by Mr RIMP (@MrRimp, Robot-In-My-Pocket), mascot of the first ever #HIMSS17 Innovation Makerspace! (Booth 7785) (with assistance from @wareflo) We’ll be discussing the topic “Healthcare Robots!” and so it seems appropriate to have a robot hosting the chat….

In a first, #HIMSS17 has a #makerspace (Booth 7785), in the HIMSS17 Innovation Zone. It has robots! They are rudimentary, but educational and fun. One of those robots is @MrRIMP, for Robot-In-My-Pocket. Here is an YouTube interview with @MrRIMP. As you can tell, little Mr. R. has a bit of an attitude. He also wrote the questions below and will moderate tweets about them during the #HITsm tweetchat.

From the recent How medical robots will change healthcare (@PeterBNichol), there are three main areas of robotic health:

1. Direct patient care robots: surgical robots (used for performing clinical procedures), exoskeletons (for bionic extensions of self like the Ekso suit), and prosthetics (replacing lost limbs). Over 500 people a day loses a limb in America with 2 million Americans living with limb loss according to the CDC.

2. Indirect patient care robots: pharmacy robots (streamlining automation, autonomous robots for inventory control reducing labor costs), delivery robots (providing medical goods throughout a hospital autonomously), and disinfection robots (interacting with people with known infectious diseases such as healthcare-associated infections or HAIs).

3. Home healthcare robots: robotic telepresence solutions (addressing the aging population with robotic assistance).

Before the #HITsm tweetchat I hope you’ll watch Robot & Frank, about a household robot and an increasingly infirm retiree (86% on Rotten Tomatoes, available on YouTube, Amazon, Itunes, Vudu, and Google for $2.99) I’ll also note a subcategory to the direct care robots: pediatric therapy robots. Consider, for example, New Friends 2016, The Second International Conference on Social Robots in Therapy and Education. I, Mr. RIMP, have a special interest in this area.

Join us as we discuss Healthcare Robots during the February 3rd #HITsm chat. Here are the questions we’ll discuss:

T1: What is your favorite robot movie? Why? How many years in the future would you guess it will take to achieve similar robots? #HITsm

T2: Robots promise to replace a lot of human labor. Cost-wise, humanity-wise, will this be more good than bad, or more bad than good? #HITsm

T3: Have you played with, or observed any “toy” robots. Impressed? Not impressed? Why? #HITsm

T4: IMO, “someday” normal, everyday people will be able design and program their own robots. What kind of robot would you design for healthcare? #HITsm

T5: Robots and workflow? Connections? Think about healthcare robots working *together* with healthcare workers. What are potential implications? #HITsm

Bonus: Isn’t @MrRIMP (Robot-In-My-Pocket) the cutest, funniest, little, robot you’ve ever seen? Any suggestions for the next version (V.4) of me? #HITsm

2/16 #KareoChat: #HIMSS17! What’s Hot? How To Participate? Who To Follow? #HIMSS2117? Workflow!

[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 am so excited! No, not about HIMSS17, though yes I am excited about that.

I am so excited to host my first #KareoChat! Thank you KareoChat! In fact, Thursday, February 16, is my last day in the office, so to speak, before hitting the road. You see, I’m driving from Columbus, Ohio, to Orlando, Florida, hauling a car-load of makerspace stuff to HIMSS17 set up the first ever HIMSS conference Makerspace (booth 7785 in The Innovation Zone). But, no, this KareoChat is not about that, either.

This KareoChat is about #HIMSS17, itself. What’s hot? How to participate? Who to follow? Faster, better, cheaper! Workflow! (Of course!). And finally, imagine that you can step into a time machine to travel 100 years in the future to #HIMSS2117. What might you see?


And the questions are… (drum roll please!)

1. What topics will be top-of-mind at the upcoming #HIMSS17 conference? Number one? Two? Three? #KareoChat

2. How will you participate in #HIMSS17? In person? Exhibit only? Twitter? Presenting? (congrats) Other? #KareoChat

3. @HIMSS & present company excepted, who do you count on for #HIMSS17 1) news, 2) commentary & 3) humor? #KareoChat

4. Imagine #HIMSS17, #HIMSS2117 that is! What #SciFi health IT will be old hat by then? #KareoChat

5. Fast, Good or Cheap. Pick Two! Can #HIMSS17 help get to three? If no, why not? If yes, how? #KareoChat

6. Quick! Google #HIMSS17 +workflow What product (or class of product) pops up on your radar? What’s interesting? #KareoChat

@wareFLO On Periscope!


Newsman Tom Sullivan Usually Asks The Questions: We Ask Tom About #HIMSS17, Heroes, and #HITsm

[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!]

Tom Sullivan treads a fine line. He is a reporter and the editor-in-chief for the influential health IT publication, Healthcare IT News. And he’s on Twitter, as @SullyHIT, and part of a sprawling and energetic #HITsm Health IT Social Media community.

Sometimes the health IT industry seems a bit like The Game Of Thrones. The large companies are like warring families. They join together into alliances to gain temporary advantage. Meanwhile, unbeknownst to the ruling clans, upending technologies — dragons, magic, wildfire — threaten to change everything. Tom chronicles these campaigns and wild cards from a uniquely appropriate perspective, as you will see.

Journalists usually interview, not be interviewed. I asked Tom Sullivan, Healthcare IT News Editor-in-Chief, the same questions he asked HIMSS17 Social Media Ambassadors (including me). Here are his answers.

What are you most looking forward to at HIMSS17?

The surprising. Literally. By that I mean emerging technologies or upstart companies that bring tools no one else has thought off or was able to pull off. I don’t think it’s a stretch to say the show floor is a bastion of innovation and as someone who is fascinated by technology and has made a career out of writing about it, that makes it a fun place.

What issues do you think are top-of-mind for your readers?

Population health, ransomware, security in general, big and small data, analytics, interoperability, of course. That list goes on. We are also seeing considerable and exciting interest in innovation right now. Artificial intelligence, cognitive computing, machine learning. Those technologies really resonate with our readers and, selfishly here, they’re really fun to write about. Just this week I talked to three provider innovation officers kicking off proofs-of-concept with Amazon Echo to improve the patient experience by making voice interaction a realistic part of it.

Who’s your favorite healthcare reporting hero? Why?

I’ll give you two for the price of one. First up: my old man. While he was actually on the sales side of business-to-business publishing and in plastics rather than healthcare he started as a reporter both working in his hometown of Sioux City, Iowa for a local TV station and in Vietnam for the armed forces newspaper Stars and Stripes. I’m including him here because in 1994 he found himself out of a job with two kids in college and a third in private high school. So he took his chances and started a publication, Injection Molding Magazine, and ultimately succeeded on the virtue of serving readers above all else with quality content. Journalistic integrity.

A hero particular to health IT reporting is none other than Jack Beaudoin, the founding editor of Healthcare IT News – and, no, I’m not saying that to toe the corporate line because he has since moved on. Jack started HITN well before Obamacare and the HITECH Act brought health IT into the national discourse and, in fact, even prior to former President George W. Bush establishing the Office of the National Coordinator for Health IT. That took not just real vision but the guts and gravitas to leave a promising career for a speculative opportunity at a time when big, established B2B IT publishers were merely dabbling in healthcare with a new e-newsletter or supplement instead of boldly building entire publications or companies around the topic.

All that said, I have many heroes and could go on and on but will leave it at those two.

What’s your pet peeve? (Either on- or off-line?)

A lot of reporters might list PR pros or some of their techniques, but not me. I appreciate them. Rather, my pet peeve is people who talk but don’t listen. It doesn’t matter whether you are a brilliant CEO or a stranger on the street I am hard-wired to walk away from one-way conversationalists. Perhaps that’s why I’m a writer.

What is something your readers do not know about you?

I started my career in the enterprise IT business-to-business reporting realm at a publication called Mobile Computing & Communications Magazine, followed by a great run at ent Magazine (we received many inquiries from people thinking ent stood for ear, nose and throat but it was an IT pub) and then I spent nearly a decade at IDG’s InfoWorld covering just about everything from app dev to Web services – and I’ve been telecommuting for 18 of those years.

Bonus question: What is your guesstimate re percent of your readers not on Twitter versus readers who arrive via Twitter?

We really get a nice boost traffic-wise from the collective of social media channels and have the thriving #HITSM community and others to thank for that. For me personally social media is about even more than driving traffic to our website. It’s about finding sources, generating story ideas, actually getting to know people and having a human connection with readers in ways that really aren’t possible otherwise.


Tom Sullivan
Healthcare IT News

The Patient Experience “Stack”: From API to Experience Through Workflow

[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!]

When I cross-index “patient experience” and “API” in Google, the number one ranked result is The Untapped Potential of Health Care APIs in Harvard Business Review. It was published in 2015. I’ve read it before. It was tweeted around when first published. Some of what the paper predicted has come true. It’s still a great read. And a great pivot to my favorite topic: healthcare workflow and workflow technology.

Here are some quotes (my emphases):

“Leaders of most internet-based businesses have realized the critical importance of using open application programming interfaces (APIs) to expand the reach of their organizations. If the health care industry followed suit, the impact on the quality and cost of care, the patient’s experience, and innovation could be enormous.”

APIs are programming routines or protocols that allow software applications to share data…. Ultimately, this type of innovation serves the end customer — creating better functionality and experience for the user.”

“Cultural and workflow issues within health systems must be addressed…. At Ochsner Health System, a pilot program to prevent heart failure and hypertension used an API to collect body weight and blood pressure data from over 500 individuals’ connected devices…. results from these and other pilots across the country have shown the potential of APIs to improve care and create a better experience for patients and providers alike.”

Sounds great! What’s missing? (Though it’s hinted at in that last quote…)

What is the single most important concept and technology to leverage APIs to improve patient experience? Workflow and workflow technology. Let me lay out my case.

There is a wonderful phrase from the hospitality industry: The System Behind the Smiles. It actually originated in a book about marketing, written by someone who had been extremely successful at selling automobiles. Here is the key quote.

“What’s needed in restaurants, car dealerships, department stores, and every place else is systems–not just smiles–that guarantee good service. Every business is composed of systems. These systems must work together to create a process that is efficient and responsive to a customer’s wants.”

What do systems engineers think when they hear “system”? They think, “workflow” (or “process” in highly automated industries). The reason they think in terms of workflow, not systems, is system is a very general term. However, workflow is very specific term, concerning the order in which things happen and their inputs and outputs. Great patient experience requires great workflow. Great workflow requires great workflow inputs. One of those important inputs is data. Where will this data increasingly come from? APIs.

Lets think about patient experience in terms of a software concept, a “stack.” A stack is a set of layers, each layer depending on the layer below, and adding functionality depended upon by the next layer up. For example, there is the LAMP stack (Linux OS, Apache web server, MySQL database, PHP programming language). You may have heard of such a thing as a “full stack” developer. They are proficient at all layers and how they fit together.

If it seems odd to include experience in a software stack, I assure you it’s a great idea. Even Intel, which makes most of its money from the very bottom layer (silicon), thinks in term of stack all the way up to experience.

I’d like to return to the “The System Behind The Smiles” concept. It really means “The Workflows Behind the Smiles.” Here is a sequence of slides from a presentation I gave last year.

One of the most popular definitions of patient experience is that of the Beryl Institute.

Let’s break it apart to understand what are the smiles versus what are the workflows.

First there is what happens to the patient and how they experience it.

There there are the systemy/workflowy stuff causing things to happen the patient.

Let’s drill down into interactions and continuum of care…

That word “orchestration”? It’s workflow. Or rather it is what is done to create great workflow. For patients to have Smile experiences, all the System workflows need to be perfectly orchestrated. And great orchestration requires great interoperability, to which APIs contribute.

You may have heard of syntactic and semantic interoperability. Syntax is the shape of data and ability to move it between systems. “Shape” is important because data structures must be generated and parsed to travel. Semantics is meaning. Does data mean the same thing before and after transit? In addition to syntactic and semantic interoperability, there is a third layer of interoperability that is less mentioned. Task-workflow interoperability. (This kind of interoperability is also known as pragmatic interoperability.)

The very top of the patient experience stack is, well, patient experience (not shown above). But what’s between the bottom, data-centric syntactic and semantic layers and the top layer, patient experience? You guessed it. Workflow. I’ve written two separate five-part series about this layer, one from a engineering point of view and the other from a linguistic science point of view. Workflow determines patient experience.

If workflow determines patient experience, what technology is most relevant to patient experience? Workflow technology. What is workflow technology? Why is it important to patient experience. How to we accelerate use of workflow technology to improve patient experience?

To understand workflow technology you must understand workflow. Workflow is a series of steps, consuming resources, achieving goals. Workflow faces in two directions, towards people and towards technology. Steps may be tasks, screens, activities, or even experiences.

Similar, by analogy, to database management systems, which rely on on data models; workflow management systems rely on workflow models. These workflow models look a lot like workflows you’ve probably scribbled on a napkin as some point in your life. We draw workflows to think and communicate. The magic of workflow technology is that these diagrams become actual programs, executable by workflow engines. The best known examples of workflow technology today are business process management suites. BPMSs are examples of what researchers call Process Aware Information Systems. But many other technologies, not traditionally identified as workflow technologies, are becoming process-aware. These include customer relationship management (CRM) systems, data science and machine learning systems, chatbots and natural language processing systems, as well as traditional health IT systems, such as laboratory reporting and imaging systems. What all these disparate systems have in common is a pivot from sole focus on data to more equal emphases on data and workflow.

Workflow technology is finally being use to improve both patient and health IT user experience. Two years ago, in a five-part, 7000 word series in Healthcare IT News on task-workflow interoperability, I predicted the following:

“We will see a plethora of clinically- and patient-oriented workflow platforms. Many have already obtained considerable investment and beginning to expand their market footprints. It’s early days yet. But, within five years we’ll see as much, or more, about facilitating workflow at the point-of-care and point-of-health as the emphasis on population health and patient engagement at the recent HIMSS conference in Chicago. In fact, population health and patient engagement are playing critical roles in driving adoption of process-aware workflow technologies in healthcare. If you drill down through the layers of technology necessary to do both, efficiently, effectively, and flexibly at scale, you’ll invariably find some form of workflow orchestration engine. In some cases these will be based on third-party business process management suites. In some cases the workflow engines will be proprietary. It’s often hard to tell which is which, since many vendors do not wish to reveal they are relying on an embedded third-party product.” (Task-Workflow Interoperability)

However, adoption of process-aware workflow technology in healthcare and health IT is not happening fast enough. How to we accelerate use of workflow technology to improve patient experience? I wrote about a healthcare workflow triple aim on the Health Standards website two years ago.

  • Educate all healthcare stakeholders about workflow, workflow technology, and process-awareness. (This post, crafted in advance of the Availity tweetchat about patient experience, is an example.)
  • Highlight healthcare workflow success stories. (For example, every year since HIMSS11 I’ve searched every website of every HIMSS conference exhibitor for workflow related material. I use the #POWHIT hashtag, for People and Organizations improving Healthcare with Information Technology, to publish and organize on social media.)
  • Recruit current and potential healthcare workflow technology solution providers to create and market excellent process-aware workflow solutions. (Talking or writing or tweeting about healthcare workflow and workflow technology all day long won’t accomplish a thing, until and unless actual workflow products and services get into everyday use.)

If I have convinced, or at least, intrigued you, about how healthcare workflow and workflow technology is the missing link between APIs on the one hand and patient experience on the other, I hope you take a wee keek at any of the following posts, articles, or series.

@wareFLO On Periscope!


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!

@wareFLO On Periscope!