2004 EHR WfMS Tutorial Slide 8: Flexible Workflow: Five EMR EHR Workflow Usability Principles

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Fifth, if an electronic health record workflow management system is not natural, relevant, supportive, and consistent, the underlying flexibility of the electronic health record workflow management system allows one to adapt, tweak, adjust, and customize the electronic health record workflow management system until it becomes natural, relevant, supportive, and consistent.

008-flexible-emr-ehr-workflow-usability-principles

Flexible Workflow: EHR Workflow Usability Principles

  • Natural
  • Relevant
  • Supportive
  • Consistent
  • Flexible

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Related links:

(2006 EHR WfMS Tutorial) Slide 48-55: EMR EHR Usability Principles and Workflow: Flexibility

(There much more content about this topic in the 2006 tutorial.)

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2004 EHR WfMS Tutorial Slide 7: Consistent Workflow: Five EMR EHR Workflow Usability Principles

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Fourth, an electronic health record workflow management system is more consistent. This consistency is important because–if you think about a football play, everyone has a role and understanding of what they are supposed to do relative to each other in terms of their interleaved behaviors. When that football play is practiced over-and-over consistently–accuracy, precision, and speed all increase.

007-consistent-emr-ehr-workflow-usability-principles

Supportive Workflow: Five EMR EHR Workflow Usability Principles

Supportive Workflow: Five EHR Workflow Usability Principles

  • Natural
  • Relevant
  • Supportive
  • Consistent
  • Flexible

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Related links:

(2006 EHR WfMS Tutorial) Slide 30-35: EMR EHR Usability Principles and Workflow: Consistency

(There much more content about this topic in the 2006 tutorial.)

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2004 EHR WfMS Tutorial Slide 6: Supportive Workflow: Five EMR EHR Workflow Usability Principles

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Third, electronic health record workflow management system is more supportive its users. A workflow management system knows on an activity-by-activity, patient-by-patient, user-by-user, minute-by-minute basis what exactly is going on and what remains to be accomplished. This information can be feed into todo lists and status screens that let everyone build a shared mental model of what patient is waiting where, for how long, for what task, and who is responsible and provide means to empower users to go an accomplish any tasks that might otherwise fall between the cracks.

006-supportive-emr-ehr-workflow-usability-principles

Supportive Workflow: EHR Workflow Usability Principles

  • Natural
  • Relevant
  • Supportive
  • Consistent
  • Flexible

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Related links:

(2006 EHR WfMS Tutorial) Slide 42-47: EMR EHR Usability Principles and Workflow: Supportiveness

(There much more content about this topic in the 2006 tutorial.)

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2004 EHR WfMS Tutorial Slide 5: Relevant Workflow: Five EMR EHR Workflow Usability Principles

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Second, on a screen-by-screen basis, electronic health record workflow management system shows more relevant information and more relevant order entry options than does an electronic health record without workflow management.

005-relevant-emr-ehr-workflow-usability-principles

Relevant Workflow: Five EMR EHR Workflow Usability Principles

  • Natural
  • Relevant
  • Supportive
  • Consistent
  • Flexible

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(2006 EHR WfMS Tutorial) Slide 36-41: EMR EHR Usability Principles and Workflow: Relevance

(There much more content about this topic in the 2006 tutorial.)

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2004 EHR WfMS Tutorial Slide 4: Natural Workflow: Five EMR EHR Workflow Usability Principles

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First, an electronic health record workflow management system more naturally fits the task structure a physician’s practice.

004-natural-emr-ehr-workflow-usability-principles

Natural Workflow: Five EMR EHR Workflow Usability Principles

  • Natural
  • Relevant
  • Supportive
  • Consistent
  • Flexible

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Related links:

(2006 EHR WfMS Tutorial) Slide 1-2: Workflow Management Systems: Key to EMR EHR Usability

(There much more content about this topic in the 2006 tutorial.)

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2004 EHR WfMS Tutorial Slide 3: Five EMR EHR Workflow Usability Principles

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Workflow Management Systems technology promises to increase the usability of electronic health records in at least five ways.

003-emr-ehr-workflow-usability-principles_0

Five EHR Workflow Usability Principles

  • Natural
  • Relevant
  • Supportive
  • Consistent
  • Flexible

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Related Links:

(2006 EHR WfMS Tutorial) Slide 15-22: EMR EHR Usability Principles and Workflow: Introduction

(There much more content about this topic in the 2006 tutorial.)

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2004 EHR WfMS Tutorial Slide 1-2: What (Exactly) is EMR EHR Workflow Management?

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001-what-is-emr-ehr-workflow-management

My name is Chuck Webster, VP Medical Informatics, at JMJ Technologies in Atlanta Georgia [CW: Obviously, not currently!]. I’m here to speak about What (Exactly) is Electronic Health Record Workflow Management and what are its Empirical Effects on Practice Productivity

(By the way, these slides are screen-captured from an audio-narrated Flash-video based on the slides. Feel free to have a listen, if you’d rather.

002-outline-what-is-emr-ehr-workflow-management

Here is my outline. What is Workflow Managment. Show me some numbers. Why are they so good?

A better outline might have been…

Outline

  • Five EHR Workflow Usability Principles
  • The Workflow Reference Model
  • Four Types of EHR Workflow
  • Survey: Usability, Revenue, Expenses, Time & Quality
  • Why did Patient Volume Increase?
  • Less Not Value-Added Activity
  • More Parallel Value-Added-Activity
  • Better Coordinated Activity Delegation
  • Who is the Workflow Engine?

…but I didn’t want to makes the mistake of spending a lot of time explaining the outline when I could simply demonstrate it by forging ahead!

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Related links:

(2006 EHR WfMS Tutorial) Slide 1-2: Workflow Management Systems: Key to EMR EHR Usability

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2004 & 2006 EHR Workflow Management System Tutorials

Between 2004 and 2006 I gave three-hour tutorials at the old TEPR Conference (Towards the Electronic Patient Record). Here’s a conference description.

tutorial-description

I’ve been meaning to post the slides for years. Now I have. Here’s the 2004 set. Here’s the 2006 set. To the former I added the original speaker notes. To the later I’ve added material from the original associated proceedings papers and from more recent blog posts, white papers, and proceedings papers.

I chopped the slides into blog posts so I can tweet and solicit comments and conversation. While I prepared the slides I noticed two things. The business process management systems née workflow management systems industry (now case management systems too) galloped along. However, while electronic medical records became electronic health records, and mobile, cloud, and social gained mindshare and marketshare, not as much as changed re incorporation of process-aware information technology.

There are more of the 2006 slides than the 2004 slides. For example, 2004 focussed on EHR workflow management systems in the medical office, but I added material about EHR workflow management systems in hospitals to the 2006 set. Also, I tried to stick as close as possible to the original speaker notes for 2004. So the 2004 slides are a shorter read. To the 2006 set I added lots of material from blog posts, papers, and a book chapter, from intervening years. It’s more current, but also a longer read with more distracting (but interesting!) material along the way. That said, there is some material in the 2004 set that I deemphasized in the 2006 set. So, depending on how interested (and obsessive) you are, review both. I cross-linked the two sets of slides via “Related Links” to make that a bit easier.

I plan to continue to add material to the 2006 slide notes. I’ve got a lot of draft content that either didn’t make it into the original three hour session, or which I’ve written since but not published here or elsewhere. In particular, expect new posts about process-aware technology and patient safety, healthcare workflow-in-the-cloud, context-aware mobile workflow, process mining EHR data, and how social computing and workflow computing increasingly overlap.

These slide notes are necessarily “rougher” than my other occasional blog posts. This is because they’ve often been copied from works in progress, such draft blog posts. I spend less time spell checking. Material is appended together with a bit less usual concern for smooth segue. [And I’ll add bracketed stuff, like this, as ticklers and reminders to consider developing a thought further or finding a relevant Web link.]

If you’d like to be notified when I post this new, but related material, the best way to do so is to follow me on Twitter. If fact, if you already follow me on Twitter, you know I tend to tweet links to posts I’ve written (even links to anchors in specific paragraphs in posts I’ve written) in response to news or tweets about EHRs and workflow from others. I’ve just added some more arrows to my quiver, so to speak. I look forward to conversing with you, here on this blog, or on Twitter at @EHRworkflow.


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Top Ten Reasons EHR-BPM Tech Is Not (Yet) Widely Deployed in Healthcare

Why haven’t process-aware technologies, such as business process management (BPM), diffused faster into electronic health records (EHR) and health information technology in general?

  1. Not Invented Here-ism: Most academic and commercial BPM activity occurred, and continues to occur, outside the US, mostly in Europe.
  2. Complexity: Complicated data structures and simple workflow is complicated. Simple data structures and complicated workflow is complicated. Complicated data structures and complicated workflow (such as in EHRs) is hypercomplicated.
  3. Paradigm Shift: You pick a paradigm and then you stick with it unless you’re forced to change. Health IT initially picked a different paradigm.
  4. Lack of Competition: In other industries, where cost competition is fierce, companies are forced to adopt workflow technology to minimize cost while maximizing flexibility.
  5. Meaningful Use: EHR vendors are stretched thin addressing Meaningful Use requirements.
  6. Screens vs. Workflow: It’s easier for users to appreciate good-looking EHR screens (layout of data and controls over space) than good workflow functionality (sequences of events over time).
  7. Self-interest: Switching to new platforms is risky and threatens current revenue streams.
  8. Billing Emphases: As long as the right codes are generated to maximize revenue, nothing else matters.
  9. Skeuomorphism: Misguided attempts to model EHR user interfaces on paper medical record forms.
  10. STP (Straight-Through Processing): Traditional workflow management systems and business process management systems outside of healthcare once emphasized automating human users out of processes. They required modification to work in healthcare. (Current workflow management systems, BPM suites, and adaptive case management systems are much better in this regard).

New Book Includes My Chapter About Natural Language Processing, Business Process Management, and Adaptive Case Management in Healthcare

Updated 4/13/14: added link to full text of pdf chapter!

chapter-7

I contributed a chapter to a new book: How Knowledge Workers Get Things Done: Real-World Adaptive Case Management. There I am! Listed as a co-author on Amazon. Amaz(on)ing! It (the chapter, in keeping with this blog’s theme) is about natural language processing, business process management, and adaptive case management in healthcare.

Natural Language Processing,
BPM and ACM in Healthcare

Two great information technology industries, health IT and workflow IT, increasingly overlap. Traditional health IT (HIT) has solved many healthcare information management problems, but not others, especially involving complex processes and workflows. Over several decades business process management (BPM) and case management systems have had great success automating workflow and supporting problem solving that requires human interpretation, creativity, and guidance. Nonetheless, within the BPM community a debate has raged over where and what to automate and how to support Drucker’s “knowledge worker.” These issues, and their resolution, are central and critical to a parallel debate within healthcare about usability of electronic health records (EHR) and HIT and effects on physician productivity and patient safety. The BPM and adaptive case management debate is reviewed and lessons drawn for creating efficient, effective, and flexible EHR and HIT workflows. P.S. Plus a dash of natural language processing!

That’s my chapter. The book is How Knowledge Workers Get Things Done: Real-World Adaptive Case Management.

how_knowledge_workers_get_things_done_front_cover

It (the book) is about software systems that support users engaged in a variety of unstructured and structured tasks, sometimes at almost the same moment. The book is highly relevant to design of electronic health records and other health information technology systems. A couple of my blog posts may whet your appetite for getting and reading How Knowledge Workers Get Things Done.

Here’s the book description (full Table of Contents below):

How Knowledge Workers Get Things Done:
Real-World Adaptive Case Management

Highly predictable work is easy to support using traditional programming techniques, while unpredictable work cannot be accurately scripted in advance, and thus requires the involvement of the knowledge workers themselves. The core element of Adaptive Case Management (ACM) is the support for real-time decision-making by knowledge workers. How Knowledge Workers Get Things Done describes the work of managers, decision makers, executives, doctors, lawyers, campaign managers, emergency responders, strategist, and many others who have to think for a living. These are people who figure out what needs to be done, at the same time that they do it, and there is a new approach to support this presents the logical starting point for understanding how to take advantage of ACM.

Keith Swenson points out: “We are seeing a fundamental shift in our workforce, and in the ways they need to be managed. Not only are companies engaging their customers in new ways, but managers are engaging workers in similarly transformed ways.”

In award-winning case studies covering industries as a diverse as law enforcement, transportation, insurance, banking, state services, and healthcare, you will find instructive examples for how to transform your own organization.

In a brilliant move, timing-wise, How Knowledge Workers Get Things Done: Real-World Adaptive Case Management is being published today, October 18th, smack dab in the middle of National Case Management Week (cached).

national-case-management-week

Now, why do I think this is brilliant timing? Well, I’ve been told by more than one person that the phrase “case management” owes some provenance to that same phrase in healthcare (and social work and law too). There’s a brochure covering the history of the idea for National Case Management Week.

Here are the relevant paragraphs:

Case management is a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality cost-effective outcomes.

Care managers are advocates who help patients understand their current health status, what they can do about it and why those treatments are important.

In this way, care managers are catalysts by guiding patients and providing cohesion to other professionals in the health care delivery team, enabling their clients to achieve goals more effectively and efficiently.

Let’s really parse that first paragraph definition of case management.

  • Case management is a collaborative process of
    • assessment,
    • planning,
    • facilitation,
    • care coordination,
    • evaluation,
    • and advocacy
  • for options and services to meet
    • an individual’s
    • and family’s
  • comprehensive health needs
    • through communication
    • and available resources
  • to promote quality cost-effective outcomes.

To me what is remarkable about this definition of case management is that it also defines what I believe electronic healthcare records should do. Assessment, planning, facilitation, care coordination, evaluation, and, yes, even advocacy are what EHRs should do very well, but do not yet do well at all. By the way, the official tagline of for the National Case Management Association is “Case Management: The GPS for Quality Health Care.” I’ve seen this same analogy in the business process management industry. EHRs and other health IT systems need to become more like GPS for healthcare processes.

I could present, for comparison and contrast, descriptions of case management and business process management (and adaptive case management and intelligent BPM suites). There’s tremendous potential for building EHRs on these platforms. But let me note that there’s quite a debate about evolution of case management and business process management. Terminology is still settling. This debate is healthy. How Knowledge Workers Get Things Done: Real-World Adaptive Case Management is part of this debate. Healthcare will benefit from ensuing products and services.

But I’m not going to do that here. This post is about the new book How Knowledge Workers Get Things Done: Real-World Adaptive Case Management and my chapter Natural Language Processing, BPM and ACM in Healthcare.

So here’s that complete Table of Contents I promised you! (full abstracts):

Contents

  • Foreword: The Process-Driven Business Of 2020 (Connie Moore, Vice President and Principal Analyst, Forrester Research, Inc., USA)
  • The Strategic Business Benefits of Adaptive Case Management (Max J. Pucher, Isis Papyrus)
  • How ACM Drives Better Customer Engagement (Dermot McCauley, Kofax, Inc.)
  • Case Management Forecast: Mostly PCM with a Chance of ACM (John T. Matthias, National Center for State Courts, United States)
  • Types of Business Process (Keith Harrison-Broninski, Role Modellers Ltd.)
  • Distribute Process Knowledge in ACM through Mentoring (Frank Michael Kraft, AdaPro GmbH and Hajo Normann, Accenture)
  • Managing Structured and Unstructured Processes Under the Same Umbrella (Alberto Manuel, Process Sphere, Portugal)
  • Natural Language Processing, BPM and ACM in Healthcare: Memoir of a Radio Interview (Charles Webster, MD, MSIE, MSIS)
  • Case Management Megatrends (Nathaniel Palmer, Workflow Management Coalition)
  • Case Management: Contrasting Production vs. Adaptive (Keith D. Swenson, Fujitsu America, Inc., and Workflow Management Coalition)
  • Section 2: Case Studies
  • Cognocare, an ACM-based System for Oncology (Gold Award: Healthcare)
  • Vision Service Plan (VSP) (Silver Award: Healthcare)
  • Generali Hellas Insurance Company S.A. (Gold Award: Customer-Facing)
  • Fortune-500 Bank, India (Silver Award: Customer-Facing)
  • Paneon GmbH, Austria (Gold Award: Knowledge Worker Innovation)
  • UWV, The Netherlands (Judges’ Choice Award: Knowledge Worker Innovation)
  • MATS Norwegian Food Safety Authority, Norway (Gold Award: Public Sector)
  • QSuper, Australia (Silver Award: Public Sector)
  • State Office of Children and Family Services, USA (Special Mention: Public Sector)
  • Touchstone Health, USA (Finalist: Production Case Management)
  • New York State Department of Financial Services (NYSDFS), USA (Finalist: Production Case Management)
  • Appendix
    • ACM glossary
    • About WfMC
    • Index
    • Further reading recommendations

As you can see from the Table of Contents, there are several healthcare case studies. If you do read How Knowledge Workers Get Things Done: Real-World Adaptive Case Management I hope you’ll come back here to add a comment or two.

By the way, How Knowledge Workers Get Things Done was published by Future Strategies, publisher of many “Unique Books on BPM and Workflow”. I’ve had the good fortune to meet, or interact with online through blogs and Twitter, co-authors and editor, Layna Fischer. So hat tip also to Keith Swenson, Nathaniel Palmer, and Max Pucher

There’s lots of other contributors too. I’ll add embedded tweets about How Knowledge Workers Get Things Done: Real-World Adaptive Case Management below. Many will surely be from chapter authors, or about their chapters from other twepes, in response to book publication.

Amaz(on)ing!

Here’s a complete (i.e. somewhat repetitive) list of recent tweets linking to the book on Amazon.

http://backtweets.com/search/?q=http%3A%2F%2Fwww.amazon.com%2FHow-Knowledge-Workers-Things-Done%2Fdp%2F0984976442