Integrate Clinical And Financial Health Plan Systems to Provide Unified View Of Data And Workflow

[I’m attending AHIP Institute 2016 in Las Vegas! Tweet me () for a “Tweetup!” :)]

(Get my whitepaper! Business Process Management (BPM) in Healthcare!)

I have an unusual pre-med major. Straight As in the number one ranked Accountancy program in the world (University of Illinois, Champaign-Urbana). I was also working on a masters degree in Industrial Engineering, focusing in usability and workflow.

I can still remember a giant light bulb going off over my head, during my first year of medical school. To maximize quality and minimize cost health IT needs to better integrate clinical and financial information systems.

At the time, in those early days, this was just an idea. There were no such systems. The clinical and the healthcare financial domains were complicated enough, and there wasn’t even the infrastructure across which to communicate. This lightbulb idea seemed like a pipe dream.

Today, of course, many people have had this idea, and there are many products and services aiming to bridge this traditional divide. I’ve been tracking the evolution for decades. There is no better single technology for integrating clinical and financial data and workflow than modern workflow technology.

This integration requires interoperability, for sure, but a special kind of interoperable above and beyond traditional notions of sending and decoding a message. It requires what I call workflow interoperability, also sometimes referred to as pragmatic (term from linguistics) or task interoperability.

Modern BPM has many sterling qualities, including the ability to rapidly prototype and then deploy mature products and then to continue to change and improve those products…. Including more useable user interfaces, because all and only data and options relevant to each step of a workflow are shown to each users… But modern BPM is also used, though mostly outside healthcare so far, to integrate wide varieties of legacy enterprise systems based on disparate technologies. If that doesn’t describe a crying need in health IT, I’ll eat my BPM hat. Take a look at this following slide I tweeted from the recent Appian World conference.

“Spider in the web”! Connecting disparate systems and technologies? Need sound familiar? Healthcare IT!

SOAP, email, JMS (Java Messaging Service), SQL, REST, (and bunch of enterprise systems): sound familiar? It should remind you of what are called interface or integration engines in health IT. However, modern BPM application platforms are different, and in my mind, better, in an important way: they have customizable user interfaces. This is the task interop, pragmatic interop, workflow interop layer that is so, so, immature in much of today’s health IT. Of course, if you want to create your own UI apps, you can, because you can call into BPM platforms and return both data and workflow state (something else that is missing in a lot of health IT today).


On Periscope!

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10 Reasons Health Plans Should Double-Down on Modern Business Process Management

  • Reason 1: Health Insurance Is About Risk Management: Health Plans Need to Manage Process Risk Too
  • Reason 2: Accelerate Development of Innovative Customer-Centric Mobile Health Plan Products
  • Reason 3: Systematically Improve Customer Health Plan Member Engagement With New Products
  • Reason 4: Integrate Clinical And Financial Health Plan Systems to Provide Unified View Of Data And Workflow
  • Reason 5: Maximize Health Plan External and Internal Workflow And Process Transparency
  • Reason 6: Enable Health Plan Workflow And Process Changes Necessary For Accountable Care
  • Reason 7: Harness Social, Mobile, Analytics, Cloud-Enabled Health Insurance Application Development Platforms
  • Reason 8: Bring Modern BPM’s Unique Value to Member, Provider, Medical, Benefits, and Claims Management
  • Reason 9: Leverage Modern BPM for Health Plans in the Regulatory and Compliance Space
  • Reason 10: Turbocharge Health Plan Operational Processes With Same BPM So Successfully Used In Other Industries

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