Business Process Management’s Royal Road to Healthcare Runs Through Care Coordination

I see convergence between care coordination platforms and business process management tech used to implement them. The following slide crystalized this for me.

An Accountable Care Organization, or ACO, is a virtual enterprise of primary care physicians, specialists, and hospitals that coordinate care for a population of patients and are “accountable” for both cost and outcomes. There’s much discussion of what kind of IT infrastructure is needed to create successful ACOs. The above tweeted slide is an example. That it was retweeted at least thirteen times indicates some agreement, or at least interest, in the health IT Twittersphere I inhabit online.

As an experiment I cross-indexed “care coordination” and “workflow engine” with BPM or “Business Process Management” or “Workflow Management System.” I found lots more links than I tweeted and embedded below. I arbitrarily stopped at ten or eleven. But even just those are pretty interesting. For example, I found an expected mix of academic presentations and papers, but I knew I’d find that. Researchers have zeroed in to what they called process-aware information systems (in healthcare) for over a decade. More interesting was all the vendor-related content. I’ll alternate between the two categories below.

First of all, there’s this slide from a non-academic source. It simply mentions a workflow engine being used to manage alerts and messages to providers. Workflow engines are the essential component of what used to be called workflow management systems, but now are called business process management systems or suites. Later links will explicitly invoke need to BPM tech in building care coordination platforms.

The following slide is from an academic presentation. The layers proceed in abstraction from medical guidelines based on medical experts and research, down through medical pathways based on cooperating care team members to treatment plans and processes. I really like the definition of care pathways: “Aim to model a timed process of patient-focused care, by specifying key events, clinical exams and assessments to produce the best prescribed outcomes, within the limits of the resources available, for an appropriate episode of care.”

What we need are models, executable models, at a variety of levels of abstraction, but consistent with each other, of both what we need to do and how much it will cost. And our healthcare information systems need to represent, reason about, and systematically improve these models. What was the above presentation called? “Personalized Care Pathways using Business Process Management & Artificial Intelligence.”

I am also reminded of a recent webinar given by Siemens Health IT discussing “contextualized” and “re-contextualized” process models. Above is a slide from that presentation. Adapt a process model to the patient and setting, tell a Business Process Management system to execute it. If the patient and setting changes in important ways, re-adapt the process model and continue with execution by the BPM system.

“Workflow engine closed-loop task execution escalation rerouting reprioritization” … exactly what I wrote about in my 2010 MedInfo paper, “Clinical Intelligence, Complex Event Processing and Process Mining in Process-Aware EMR / EHR BPM Systems.”

The above tweet links to a chapter in a book of research papers. The cool thing is I can actually embed the page from that chapter in that book from which I quoted. So, here it is.

This “invisible layer” between user interfaces and health information systems? This is the workflow technology that makes care coordination possible, that is, both flexible (by tweaking executable process models) and scalable (through their execution). I’ve written about the need for this layer of workflow interoperability and usability in my blog post, “From Syntactic & Semantic To Pragmatic Interoperability In Healthcare.”

The phrase “teamwork, collaboration, coordination” occurs in the abstract from this paper, which asserts Business Process Management software will be necessary to achieve those three necessary elements of care coordination. Elsewhere I’ve written about the science and technology of coordination, another name for BPM and related technologies.

Above, the authors explicitly define Care Process Management as using Business Process Management to manage clinical processes. Vendors often rebrand BPM because sometimes they feel the word “Business” has negative connotations to clinicians. You’ll also sometimes see Healthcare Process Management for the same reason. However, if you poke around in the footnotes, you’ll usually see some sort of reference to BPM. Even if “Business” is suspect, the allure of “[Something] Process Management” is irresistible. Interestingly, I’ve seen vendor phraseology evolve away and then back to the B in BPM. BPM has a several decade-old track record, going back to workflow management systems. It’s a track record vendors can point to harness some of that credibility.

The next few tweeted quotes, paraphrases, and links, just round out my sample of results returned by Google. Feel free to jump to my conclusion.

The above tweet is actually to a published research paper. I include it here because it evinces another interesting trend I’m observing. Folks who sell real-time location tech, to track people and equipment, are developing their systems into complete workflow solutions. I see the same thing happening with nurse call systems. When you are a necessary piece of the workflow, the next value-added strategic step is to begin to manage more-and-more of end-to-end workflow. We’ll see these and similar vendors (such as in Enterprise Content Management) both develop proprietary workflow solutions and embed or talk to third-party business process management suite vendors.

I’ve been tracking diffusion of workflow tech into healthcare for over two decades. I find it absolutely fascinating, the end-run about electronic health records. At one time, about a decade ago, I was sure that EHRs would evolve into true EHR workflow systems. Instead, EHR feature sets were “pinned” by Meaningful Use. As a result, EHRs are increasingly viewed as a necessary evil, to get data from the point of care. Once you get that data, the only way to create population health management systems that can affect clinician and patient behavior at the point-of-care *and* do flexibly and scalable, is to leverage workflow technologies such as workflow management systems and Business Process Management systems and suites.

Increasingly, the Royal Road for BPM into healthcare appears to run through care coordination, a function for which EHRs should have been ideally suited. Regardless, healthcare application architecture is finally evolving out of the dark ages into a more process-aware world. I’ll leave you with a finally tweeted slide from one of my presentations. It shows, on the right, the evolution of workflow representations, away from Java, C#, and Mumps captive in hardcoded dungeons. Instead, representations of workflow will be stored in ways that both humans and machine can understand and use in their unique and complementary ways. Human’s will create and improve workflows. Workflow engines will execute and monitor workflows. Workflow Management Systems, Business Process Management systems, and flexible Case Management (for hard to represent workflow), are finally arriving in healthcare.

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