Achieving workflow interoperability among healthcare organizations

Health organizations are putting down a new layer of workflow technology on top of existing data layers
By Chuck Webster, MD
07:49 AM
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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.

Regardless of whether you use a full-fledged pure-play BPM platform or a homegrown health IT workflow platform, look for the workflow engine under the hood. It will buy you speed (throughput, patient volume), transparency (ability to track all tasks at all times, letting none fall between the cracks), and flexibility to systematically improve intra- and inter-organizational workflows.

[Part 4: Bridging the gap between data and workflow.] 

When you strip away all the fancy words and acronyms, we are talking about To-Do lists. Putting To-Do items on To-Do lists and letting staff know about them is what workflow systems do very well. They were the reason workflow management systems were invented several decades ago. They've had several decades to improve. To-Do lists help human figure out what to do next, and tell automated systems what to do next, within organizations and, increasingly, across organizational boundaries.

Workflow management systems (now business process management and adaptive case management systems), have literally been around for over two decades. Workflow technology evolved quickly since I wrote that earlier passage (in Part 1 of this series) reflecting back to ten years ago. Within the BPM industry, there are healthy debates about automating structured and routine workflows versus unstructured and ad-hoc workflows (using ACM, for adaptive case management, also called dynamic case management). Workflow analytics, especially process mining, came from BPM research, but can be used to substantially improve workflows of even systems without classic workflow engines. BPM thought leaders talk about "empathic workflow" in which backend enterprise processes and customer journey maps are reimagined and then quickly implemented and systematically improved. I know both BPM and ACM pretty well, for a health IT guy. I've been a judge for both the BPM and ACM annual awards for years. I encourage EHR and health IT vendors to apply for one or both of those top awards in the workflow technology industry today.

A wide variety of entrepreneurs and intrapreneurial healthcare organizations are putting down a new layer of workflow technology on top of an existing layer of data technology. The difference between data technology and workflow technology is key. Most current healthcare data that health IT manages is about patients, not about processes and workflows. Makes sense, for individual patients, healthcare staff and patients need to keep track of symptoms, diagnoses, prescriptions, and so on. This data is about patients.

We need more than data about patients. Real value resides in information about workflows creating patient data. We need data about workflows involved in using patient data, in real-time, to trigger workflows influencing patient and provider behaviors. Then we need data about those workflows. To systematically improve effectiveness, efficiency, and user and patient experience, we need to, and will, collect data not just about patients, but also about workflows serving patients and providers. Much of this will be delivered via modern mobile, cloud, and analytics platforms. Under the hoods of many of these systems? Workflow engines. 

[Part 3: Laying down a definition of workflow interoperability.]

A word is due here about security. I am sure that when I speak of "visibility" of tasks and workflows across organizational boundaries, red flags must go up in some minds. What with all the recent high-profile breaches of sensitive patient data, how can we possibly contemplate making internal healthcare information even more visible to outside organizations? Process-aware workflow technology, within and across healthcare organizations, can be substantially more secure than what we currently have in place. First, modern BPM application platforms have an extra layer of security (against which workflow app developers develop) implemented by professionals who understand security well. Second, knowing an event takes place, or typically takes place, is not the same as knowing the patient data resulting from the event. We get notifications all the time that something interesting just happened. We then have to authenticate ourselves to get the details. Third, need-to-know access control to patient data is can be more finely grained. It can be granted at the beginning of a specific step in a workflow, than then revoked when the step is completed. Fourth, workflow platforms log much more comprehensive and detailed data about who looked at what, when, and in what context. Finally, knowledge of the workflow of how another organization handles data you send to them is important to you in making critical judgments about whether you can trust that organization.

Terminology (not just technology) is in flux. These new systems could be called Care Management Systems. Other names include Care Coordination Platforms or Healthcare or Care Process Management systems. This is a layer on top of EHRs and other health IT systems explicitly intended to coordinate care across providers, track patient events, and manage task handoffs among providers. It is a classic scenario for workflow technology, already being used to coordinate lots of things we consumers take for granted these days, from Amazon to Google Now to systems we don't even know the names for, but just invisibly work. In fact, I don't see these workflow systems as separate from or leveraging healthcare interoperability. They will be workflow interoperability.

Workflow interoperability is coming to healthcare and health IT whether we like it or not (and there will be some legacy laggards who won't). Other industries are a half-generation ahead of health IT in adopting workflow management systems, business process management and adaptive case management systems. It is a natural and desirable progression of software application architectures: taking data out of applications into databases, user interfaces out of applications into operating systems, and, now, taking workflow out of applications into process-aware workflow orchestration systems. Health IT will not be an exception to this general pattern. However, as a community, of workflowistas, health IT and BPM professionals, we can accelerate the change needed to get to task interoperability and workflow interoperability. The key will be entrepreneurs (and intrapreneurs) seeing and grasping the opportunity. There's a lot of money to be made (or saved) in displacing (or compensating for) workflow-oblivious legacy health IT infrastructure.

By the way, there is no small role for health IT social media to palaver, kibitz, and egg on these healthcare workflow entrepreneurs and intrapreneurs. 

See also: 

Part 2: A look at what healthcare task interoperability means

Part 1: Achieving task and workflow interoperability in healthcare