Healthcare is going through an unprecedented change. Some of the change is forced by external regulatory mandates and some by rising costs and a sense that if we don’t do something soon, out-of-c0ntrol costs will force even more change from the outside. It would be easy to call this a crisis moment, though crisis implies impending collapse. Rather than collapse, the more likely outcome without any detour off the current path is greater impact to the people who pay the heavy costs for the system as it is.
Healthcare BPM lag
By and large, the healthcare industry hasn’t followed the process management path that other industries adopted a while back. There are exceptions but most would agree that platforms and process weren’t adopted as quickly as in other industries. There are several reasons for this.
- A fractured and complex supply chain as patients, payers, and providers all pursue their own agenda
- Because of the first point, there’s been no collaboration and no ownership of the outcome from an end-to-end view
- In many cases, the government or the employer are the buyer, adding another layer to an opaque business landscape
Discharge and Project RED
BPM practices adapted to healthcare have shown enormous benefits. Project Red is a great example led by Boston University. As a result of the early returns, 250 hospitals are applying reengineering principles to the very sticky problem of patient discharge and its impact on hospital readmissions. Add to the mix the Affordable Care Act’s provision to monitor stats on readmission and penalize hospitals for readmissions deemed avoidable.
National level notice is one thing, but penalties? Now people are paying attention. Interestingly, when people start to analyze the discharge process against traditional process improvement methods, one of the first observations is that the seeds of discharge success are sown at admission. The not-so-surprising conclusion? Only an end-to-end view of a patient’s entire stay and aftercare is useful for improving readmission statistics.
Project RED is a prototype of the improves that can be made in healthcare though the application of business process management. How many other highly common healthcare processes are also broken and could benefit from this now-proven approach? I think we can agree that the list is long.
Social solutions?
Part of any deep dive on discharge quickly points out that the successful discharge of a patient is heavily dependent on what I’ll call the extended patient care community. From the moment the patient becomes a candidate for discharge, the involvement by hospital staff, the primary care doctor, pharmacists, physical therapists, and the patient’s family is shown to be a big part of success. But how do so many people in different “systems” communicate and coordinate? There are great opportunities for social solutions that break down system walls and allow for real-time, contextual communication between the parties.
Mobile solutions?
[youtube http://youtu.be/F1p3ugA55T8&w=320&h=205]
Every nurse, doctor or discharge advocate that is tied to a computer terminal to do their job has been removed from directly caring for patients. Our reengineering of healthcare process has to be done with a heavy focus on making process simple, role-based, and above all, mobile. So once, we’ve gotten the healthcare professional away from the fixed coputer, what if every nurse or doctor passing a room could automatically receive updates on the patients within simply because of their location? If that sounds futuristic, it isn’t. Software is already performing this function.
If you want to learn more about how to reduce re-admissions, better manage patient workflow, or prepare for ICD-10 with your partners in a safe testing environment visit our booth at HIMSS which will feature demos on these topics and the ever-popular Team TIBCO cycling challenge.
In the short term I’d focus on areas of change. This is where value moeebcs apparent to end users. Change is one of those most feared’ of things. If the end users know what they are supposed to be doing when the change arrives then there will be less anxiety and less chance of them getting it wrong.Improving existing documentation can be a challenge. In this case look for areas where the documentation is in such a poor state so as to be unusable. Where the end user community is unanimous that the current state is not fit for purpose and is hindering their ability to perform. Existing documentation will have owners and authors that, rightly or wrongly, will be proud of their contribution. Bringing in a new approach may not sit well and the last thing you need is to make enemies early on.Areas of unstructured work (existing processes where no documentation exists) can also be considered where there is obvious pain caused by many hands doing things differently. Avoid these areas if there are no obvious problems. Documenting processes that everyone already knows wont appear to bring value in the short term.
“BPM and Healthcare — Why Has It Taken So Long?” That *is* an obvious question!
From:
http://chuckwebster.com/2009/11/ehr-workflow/well-understood-consistently-executed-adaptively-resilient-and-systematically-improvable-pediatric-primary-care-emrworkflow
An Obvious Question
An obvious question occurs. If there is such a great “fit” between what EMRs need and what workflow systems and business process management do, why hasn’t it happened yet? I myself have been puzzled by this. I think there is an element of NIHism (Not Invented Here-ism). The United States is a remarkable generator of new information technologies, from the large high tech companies to the university spin-offs to inventors who start in a garage. Much workflow research took place, and many commercial BPM products were created, outside the US (as I noted previously).
However, EMR workflow management systems are not prevalent in Europe either (the Soarian system, initially developed in Germany, being the sole exception of which I am aware). So I have another theory, which I will hold for a later post.
Nonetheless, workflow management systems and business process management technology is diffusing into the healthcare industry at an increasing rate. Some day most pediatric and primary care (and other general-purpose and specialty-specific) EMRs will be EMR workflow systems, although by then I expect the phrase “workflow system” to disappear. It will be the non-workflow system EMRs that will require qualification, much as we use “analog watch” or “silent movie” today (so-called retronyms) to distinguish them from their modern descendants.
And in a related comment:
http://chuckwebster.com/2009/07/ehr-workflow/white-paper-emr-workflow-usability-and-productivity-in-pediatric-and-primary-care#comment-247
“I don’t think this is an issue of technology diffusion from university to industry, but rather from abroad to the US. For example, none of the first seven International Conferences on Business Process Management occurred in the US. All were held in Europe (Eindhoven, The Netherlands; Potsdam, Germany; Nancy, France; Vienna, Austria; Milan, Italy; Ulm, Germany) except for 2007 (Brisbane, Australia). If anything, I think it is the academic types who are playing an important role in making this progress abroad known to a small but growing US audience.”
So…
What is to be done? …to make your question obvious to more than just you and me? Well, I think you are doing it: asking it in a public and accessible manner. But I think there is another angle as well.
The last letter in BPM stands for “management”. You can’t manage what you can’t understand or even see. Process mining is a hot topic in BPM and incredibly relevant to managing healthcare’s spaghetti processes. By analogy to invention of the X-ray over a hundred years ago, and what that did for diagnostic medicine, healthcare event logs (especially EHR) and process mining provide X-rays of healthcare processes that help see, understand and manage.
As process mining comes from the BPM world (though can be used with non-BPM systems too, such as EHRs); as clinical business intelligence becomes even hotter; as process mining is true business “intelligence”, process mining healthcare workflows cannot but increase visibility of BPM-related technologies: workflow engines, executable process models, visual workflow editors, business activity monitoring, complex-event processing, etc. etc.).
I presented a paper on this topic a several weeks ago at the Society for Health Systems’ Healthcare Process Improvement Conference preceding #HIMSS12 in Las Vegas.
http://ehrworkflow.com/HSPI2012/ehr-bpm-process-mining-webster-2012-shs-conf.pdf
EHR usability problems preventing EHR adoption are fundamentally about EHR and HIT workflow usability. Lucky for healthcare, companies such as TIBCO have workflow solutions for healthcare’s workflow problems, and perceptive writers such as you are spreading the word: BPM.