Month: November 2016

Patient Satisfaction: IoT Enabled patient pathway by Arnab Paul, @iArnabPaul

They may forget your name, but they may never forget how you made them feel… Maya Angelou


Patient satisfaction is not a clearly defined concept, although it is identified as an important quality outcome indicator to measure success of the services delivery system

Ever since the Institute of Medicine’s 2001 ‘Crossing the Quality Chasm’ report codified patientcenteredness as one of six health care quality aims, patient-centered care has gained footing within the landscape of health care reform. There is no consensus between the literatures on how to define the concept of patient satisfaction in healthcare. In Donabedian’s quality measurement model, patient satisfaction is defined as patient-reported outcome measure while the structures and processes of care can be measured by patient-reported experiences




Many of our Linkedin friends would concur that even if we run a million dollar enterprise and have a fairly good experience on dealing with stressful situations in our everyday business life but when it comes to visiting the hospital we get cold feet – because of the element of unforeseen and unexpectedness of the entire process that we have to undertake and on top of that we as a patient community do not have a collective voice and it makes matters worse.

I believe we have a tremendous potential as a nation provided that we as a provider and receiver of healthcare services are on the same page, though it is easier said than done.Patient who visits a hospital is looking for value on investment (VOI) and the Provider is looking for return on investment (ROI). Healthcare providers have their limitations, financial and otherwise — but at least they are doing their bit and performing reasonably well. Since they have fixed resources at their disposal – the only thing humanly possible for them is resource optimization.

In India, we have already missed the bus when it comes to patient satisfaction surveys unlike our western counterparts. For everything in life we need some kind of metrics, some tools to measure the clinical outcome and the patient satisfaction. So to make up for it may I suggest we incorporate Tech enabled, IoT optimized patient feedback mechanism.

Various Accreditation bodies like NABH, NABL, CAP, JCI and ISO are functioning in the healthcare domain but these are mostly voluntary, these accreditations are a reflection that the entity has undergone high quality of audit in its internal departments, but does it say anything about the patient satisfaction or patient engagement, the answer is a big NO. In India, one could safely bet that 90% of the patients visiting the hospitals do not have the foggiest notion of what do these accreditation means, entities need to think beyond certifications and accreditation, entities need to educate people, create more awareness among the stakeholders specially the patient community, they ought to let the world know that these organizations have the benchmark this will inspire confidence in the patient community.

So in a truly democratic healthcare system the patient ought to have a voice and a mechanism in place just to ensure that his voice his heard and above all accreditation agencies must also factor in the patient voice.

Few days back I got a very interesting email from someone who heads the ‎Clinical Transformation and Analytics, Clinical Technology and Patient Safety Innovations at a Super Speciality, New Delhi, she enquired about the tech solutions that could be put in place to enhance the patients positive experience,it so heartening to note that the providers are seriously interested in improving the patients experience and by and large I presume most of the providers do want to improve the patients experience.

So what is the solution, how do we propose to go about it, well unlike Press Ganey & HCAPHS, I don’t know of any organization in India working towards the goal of providing patient satisfaction survey. Press Ganey has stated that a minimum of 30 survey responses is necessary to draw meaningful conclusions from the data it receives and that it will not stand behind statistical analysis when less than 30 responses are received. The entities mentioned above are highly detailed paper based patient feedback mechanism, in this time and age we need to think digital, think ahead.

If we go digital & truly real time in the patient feedback mechanism it would greatly enhance the whole patient experience and maybe help to manage solve some of the issues in real time. Wouldn’t it be just great if we incorporate IoT’s in the patient feedback loop, we wouldn’t have to wait for 30 odd surveys to be analyzed we could just go ahead and fix the situation right away if it warrants an action. 

The article was first published in Mr. Arnab Paul’s LInkedIn pulse page, it has been re-published here with the author’s permission
Author

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[content title=”About Arnab Paul”]

Arnab Paul, CEO, Patient Planet

Globally-minded systems thinker, action-oriented and inspired toward optimizing health outcomes through innovation, creativity, cooperation. Passionate about facilitating the alignment among technology, people and processes to ultimately improve patient experience and the functioning of healthcare.

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Shift in US Healthcare by Srinath Venkat, @ConnectSrinath

The adoption of EHR is growing rapidly because of billions of dollars spent by the government to incentivize providers for EHR usage.
Also, there is a greater commitment by government to reduce the drug related adverse events in healthcare by recommending e-prescribing to the providers

Transformation in US Healthcare through EHR and Personalized Healthcare
Healthcare has undergone series of changes in last few decades. From passive, reactive, one size fits all approach, it has moved towards more customized, responsive, real-time care administration. Electronic Health Record (EHR) is systematized longitudinal collection of patient health data which gives the complete record of clinician-patient encounter. 

It also streamlines the clinical workflow, thereby improving the health outcomes through decision support, quality management and reporting of information across the continuum of care. There are various vendors who provide EHR services based on the care setting (Ambulatory, Hospital, Clinic or Physician office), and the major ones include EPIC, Cerner, McKesson, Allscripts and GE.
 

The Health Maintenance Organization (HMO), which provides managed care by giving access to providers in its network for self-financed and insured individuals, were first started in 1931 by Farmer’s Union of Oklahoma, where flat fee is collected irrespective of the services rendered. By 1951, it was estimated that 45% of the Americans were insured, and in 1965, Medicare which covers the older people above 65 years of age and younger people with disability was introduced. 

In 1996, Health Insurance Portability and Accountability Act (HIPAA) was introduced, which helps in protecting the healthcare information and reducing the healthcare administrative costs. In 2010, Patient Protection and Affordability Care Act (PPACA) was introduced which helped the people to purchase health insurance through Health Insurance Exchanges.
 

The Four Ps of Healthcare (Patient, Provider, Payer and Public) benefit from the EHR which helps in integration of healthcare information, reducing the duplication, avoiding redundancy, thereby reducing the administrative and treatment cost in healthcare. 

The Meaningful use of EHR is the usage of certified (Certification Commision for Healthcare Information Technology) health information systems and software for improving the health outcomes and reducing the cost. EHR has both provider and payer component. Doctors, Hospitals, Laboratories, Pharmacy and other ancillary services use provider systems, which includes, practice management, EHR, Revenue Cycle Management (RCM), Document management and E-prescribing. 

There is a shift in healthcare towards retail-like scenario leading the consumer driven healthcare, where the patient is well-informed and shops for different treatment options using web portals like Web MD. Remote medical practice, real-time data collection, information integration and transfer, and collaboration among providers using EHR, creates significant improvement in overall health outcomes and cost. 

The adoption of EHR is growing rapidly because of billions of dollars spent by the government to incentivise providers for EHR usage. Also, there is a greater commitment by government to reduce the drug related adverse events in healthcare by recommending e-prescribing to the providers. The shift from pay for volumes / pay per visit towards pay for performance / outcomes which is encouraged by creating Accountable Care Organizations (ACOs) is a motivational factor for meaningful use of EHR in healthcare.

The article was first published on Srinath Venkat’s LinkedIn Pulse page. The article has been republished here with the authors’ permission

Author

Srinath Venkat

Srinath Venkat is a Healthcare Management Professional with qualifications in Public Health, Healthcare Technology Assessment and Entrepreneurship in Emerging Market Economies. He has been in to research and consulting roles with leading healthcare research firms in activities like Market study, Go To Market strategy, Technology Mapping and Business Model evaluation. He is passionate about innovative business models, startup ecosystem and the evolving landscape.

Putting patients at the heart of IoT in India, By Arnab Paul, @iArnabPaul

Patients are the most important stakeholders in the healthcare ecosystem and that they should be empowered to make informed choices.


In a broader sense, the “patient pathway” is the route that a patient will take from their first contact with a healthcare provider or a member of staff, through referral, to the completion of their treatment. It also covers the period from entry into a hospital or a Treatment Centre, until the patient leaves.


In healthcare, there already exists whole gamut of technologies in various states of maturity – wearable devices that are perhaps not yet ready to be used as clinical-grade, beta-versions of monitoring devices, inventory tracking systems already being utilized in hospital operations, etc. The innovations we will see in the coming years will push these to new heights and give health system operations the opportunity to be leaders in adoption of the connected world empowered by the internet of things. Willingness to explore the opportunities presented by this world will be the differentiator between those who leverage the capabilities for optimization and those who stick to what’s been just good enough so far.

Internet of Things (IoT) refers to any physical object embedded with technology capable of exchanging data and is pegged to create a more efficient healthcare system in terms of time, energy and cost. One area where the technology could prove transformative is in healthcare. The potential of IoT to impact healthcare is wide ranging. We’ve already seen an increasing movement towards fitness tracking wearables over the last few years. Imagine a world where your vital signs were being constantly monitored and fed back to your healthcare professional.

Many of us who advocate LEAN in Healthcare, we know that lean stands for removing all that is not required, Simply, lean means creating more value for customers with fewer resources. A lean organization understands customer value and focuses its key processes to continuously increase it. The ultimate goal is to provide perfect value to the customer through a perfect value creation process that has zero waste. The core idea of lean involves determining the value of any given process by distinguishing value added steps from non-value-added steps, and eliminating waste so that ultimately every step adds value to the process. To maximize value and eliminate waste, leaders in health care, as in other organizations, must evaluate processes by accurately specifying the value desired by the user; identifying every step in the process (or “value stream,” in the language of lean) and eliminating non-value-added steps, and making value flow from beginning to end based on the pull — the expressed needs — of the customer/patient. When applied rigorously and throughout an entire organization, lean principles can have a dramatic affect on productivity, cost, and quality.

With the deployment of IoT in healthcare it would enhance the scope of monitoring patients response, since huge zettabytes of data are going to be generated from the many monitoring sensors, if we are somehow able to remove the noise and work on the intelligence derived from it, and if we could somehow wed the intelligent data derived from IoT with the LEAN/ SIX SIGMA tools it would greatly enhance the quality of the patient care pathway. We would be able to do a better job of mapping his entire journey and improve on the patient e care pathway.

IoT in itself wouldn’t be a big help unless the information that is obtained from the sensors and other embedded systems are not synced with data analytics.

These are exciting times for Healthcare Delivery system, after proper deployment of sensors and by the optimum use of other remote monitoring system, suffice to say monetizing the data generated by the IoT would be the principle driver for enterprises and small businesses alike in years to come.

The article was first published in Mr. Arnab Paul’s LInkedIn pulse page, it has been re-published here with the author’s permission
Author

[tab]
[content title=”About Arnab Paul”]

Arnab Paul, CEO, Patient Planet

Globally-minded systems thinker, action-oriented and inspired toward optimizing health outcomes through innovation, creativity, cooperation. Passionate about facilitating the alignment among technology, people and processes to ultimately improve patient experience and the functioning of healthcare.

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Medical Imaging Informatics Market by Swapna Supekar

Increase in number of diagnostic imaging procedures and high prevalence of chronic diseases spur the growth of medical imaging informatics market





Medical imaging informatics involves usage of digital technology to capture medical images, facilitating data analysis to record and correlate observations, and draws conclusions that play a vital role in the diagnosis of medical problems. The implementation of electronic health records (EHR) in the healthcare industry increases the demand for medical imaging to exchange medical images in the various departments of healthcare settings.

Increase in number of diagnostic imaging procedures and high prevalence of chronic diseases have raised the demand for various advanced diagnostic image processing and analysis software around the world. The healthcare industry focusses on developing procedures for early diagnosis due to rise in the number of chronic diseases, providing maximum growth potential for imaging procedures. 

For More Professional and Technical Industry Insights: 
https://www.alliedmarketresearch.com/medical-imaging-informatics-market

aAccording to the Organization for Economic Co-operation and Development (OECD), North America had an increasing number of imaging procedures for computed tomography (CT) and magnetic resonance imaging (MRI). For instance, in the U.S., 76 million and 81.2 million CT scans were performed in 2013 and 2014, respectively, representing an increase of around 7% from 2013 to 2014. Similarly, MRI scans of a total 1.78 million and 1.87 million were performed in 2012 and 2013, respectively, in Canada. 

Furthermore, Europe reported an increase in number of diagnostics imaging procedures. In Germany, positron emission tomography (PET) scans of a total 0.08 and 0.09 million were performed in the hospitals in 2012 and 2013, respectively. Thus, increase in the number of medical imaging procedures, rise in number of installations of medical imaging informatics, and high prevalence of chronic diseases worldwide are expected to propel the growth of the market.

Developed regions such as North America and Europe together accounted for the highest share in 2015 and is expected to maintain their leading position from 2016 to 2022, due to increase in demand for medical informatics technology, high adoption rate of technological advanced healthcare IT systems, well-established healthcare infrastructure, and presence of leading players such as Dell Inc., General Electric Company, Siemens AG, and others.

However, Asia-Pacific is anticipated to grow fastest during the forecast period, owing to large patient pools who require medical imaging procedures for the diagnosis of diseases. Moreover, increase in healthcare expenditure in the region and improving healthcare infrastructure are expected to support the growth of the market.n

The article has been published with the Author’s permission
Author
Swapna Supekar

Swapna Supekar, is a keynote senior consultant on digital marketing at Allied Market Research. She has been recognized for developing a robust social network strategy for the company. Swapna has written several whitepapers, case studies, and articles. She is a visiting faculty member at various educational institutions and has expertise in life sciences and medical devices.

Challenges and Promise of #IoT in Healthcare by Arnab Paul, @iArnabPaul

A critical path to improving healthcare efficiency is to shift focus from acute care to early intervention. Remote patient monitoring technologies would be just a small cog in the wheel of Connected health


The ‘internet’ of people changed the world well there’s a new internet emerging and it’s poised to change the world again this new internet is not just about connecting people it’s about connecting things and so it’s named the Internet of Things.


Ok so connecting things to the internet big deal right well it kind of is and here’s why because things can start to share their experiences with other things, you take things and then you add the ability to sense and communicate and touch and control and there you get an opportunity for things to interact and collaborate with other things so think of it like this, we as human beings, we interact and contribute and collaborate with other people in our own environment through our five senses we are seeing and smelling and in touch and taste and hearing, right well imagine things with the ability to sense and to touch and then add the than ability to communicate and that’s where the internet of people and the internet of things intersect. I believe like the internet revolution, IoT opportunity is transformative. 

However there are few challenges   Some of the challenges that I can think of is like the interoperability issues of different software programs we do have an issue of  Heterogeneity of sensors and networks also last mile gap in delivering quality of service & Security with regard to  Privacy and Governance.

Broadly Challenges could be categorized under

Integration:  Gadgets & Devices
The diversity of devices in the networks is another obstacle for the successful implementation of IoT in healthcare.  The problem lies in the fact that the device manufacturers do not have an agreed-upon set of communication protocols and standards. The lack of uniformity among the connected medical devices also significantly reduces the opportunities of scaling the use of IoT in healthcare.

Security: Data Transmissions at risk
The main concern for regulatory bodies and users alike is, of course, the security of personal health information that is stored and transmitted by the connected devices. Strict access controls are required to ensure compliance with healthcare regulations.

Analytics : Data insights
Even though the process of collecting and aggregating data comes with complications, healthcare IoT is responsible for accumulating massive amounts of valuable data it can be used to benefit the patients, however deriving the insights from immense amounts of data is problematic without sophisticated analytics programs and data professionals.

A critical path to improving healthcare efficiency is to shift focus from acute care to early intervention. Remote patient monitoring technologies would be just a small cog in the wheel of Connected health. Health and fitness monitoring will precede patient monitoring as the driver for IoT solutions in healthcare. IoT in healthcare holds great promise for the coming generations because it could just transform the quality of life of the aging population. IoT could feel a bit intrusive  at times for the current generations, but looking at the trends it would help the millennials and the aging populations both get really helpful insight about the status of their health and act upon them.

The article was first published in Mr. Arnab Paul’s LinkedIn Pulse post. The article is reproduced here with the authors permission.  

Author

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[content title=”About Arnab Paul”]

Arnab Paul, CEO, Patient Planet

Globally-minded systems thinker, action-oriented and inspired toward optimizing health outcomes through innovation, creativity, cooperation. Passionate about facilitating the alignment among technology, people and processes to ultimately improve patient experience and the functioning of healthcare.

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3 P’s framework – Product Motivation by Prashantha Sawhney

This article is the last in the series related to 3 P’s framework to be successful. We finally focus on Product as it relates to the “why” and “what” work needs to be done.

Traditionally most people talk about products focusing on Feature – Function – Benefit methodology which has worked well for the past 40 years since it was introduced by IBM in 1976. With changes in times as well as proliferation of products, to differentiate their products, people also started to focus on USP (Unique Selling Proposition), RoI (Return on Investment), Efficiency savings, increased Effectiveness,  reduced TC (Total Cost of Ownership) etc. These are logical things which appeal to the mind, however many times we still are not able to decide on a specific product given this multitude of facts and figures.


This is where the Golden Circle from Simon Sinek comes in handy.  Focus is on moving from the Why to the What. It helps us understand the right way to reach our potential customers/partners and drives to deeper meaning on the very existence of the product.



The focus is now no longer just on the functionality that the product offers or how it achieves certain business objectives. With the clarity on why the product is needed, and with people who believe in the product, that brings in a good motivation for all involved parties and leads to eventual success.



PS: If you haven’t watched his TED video (in the top 3 most watched videos on TED) – please do take some time to watch it and get inspired.

Do share your feedback/ views on other approaches you may have followed to be successful.

The article was first published in Mr. Prashantha Sawhney’s LinkedIn Pulse post. The article is reproduced here with the authors permission. The views shared by the author are shared in his personal capacity

Author
Prashantha Sawhney

Results-driven engineering professional with ~17 years of experience in leading high performance product teams

Healthcare IoT Strategy for Entrants & Incumbents by Arnab Paul, @iArnabPaul

The long-predicted IoT revolution in healthcare is already underway, as new use cases continue to emerge to address the urgent need for affordable, accessible care


We are still running around, jumping in the puddle of data mining and other data insights when we are hit by this new wave called ‘Internet of Things” . Typically in the healthcare system the  patients dont really care what sensors will record and transmit and to whom and to where and whether it follows the standard protocol, what they really care about is whether they will be able to get well soon and how this IoT is going to help him have a better quality of life and how soon that would happen.  

Similarly the providers dont care about the tons of data that will be accessible to him, he would be more eager to know the intelligent real time information that would help him diagnose any ailment. However, at the moment, the health monitors, wearables remain largely outside typical care channels. 

One common IoT-enabled wellness monitor, for example, creates, transmits, analyzes, and stores data—but in a database not linked to, and incompatible with, traditional health records.  However useful, the information is unavailable or even unknown to doctors unless patients volunteer it—and, indeed, physically bring it to a visit. There is a gridlock in the flow of information at the aggregate stage. 

Alleviating that gridlock—and integrating prevention and wellness monitors with existing electronic health-records systems—is key to taking full advantage of IoT-enabled devices’ capabilities and keeping people healthier longer. Established health care IT companies, will no doubt find these new business models threatening, considering the new entrants eager to join the fight for customer value.  It is critical that IoT Companies deliberately identify how IoT technology fits into their existing products and strategies, and enables the delivery of transformational innovation. 

Simply using the IoT to enable innovation is unlikely to create sustainable advantage.  Companies should identify areas of high unmet needs and clearly articulate the value they will deliver for their customers. Development should begin with a specific use case in mind and a clear vision of how each stage in the Information cycle will contribute to addressing customer needs. Strategy to access capabilities through in-house development, acquiring companies, or partnering will be necessary. 

In all cases, whether entrant or incumbent, the IoT strategy should be built from an understanding of which care settings and which gridlock the entity seeks to alleviate.  From there, choices as to whether to focus on the setting or the stage of the gridlock will determine the appropriate business model. 

The long-predicted IoT revolution in healthcare is already underway, as new use cases continue to emerge to address the urgent need for affordable, accessible care. 

The article was first published in Mr. Arnab Paul’s LinkedIn Pulse post. The article is reproduced here with the authors permission.  

Author

[tab]
[content title=”About Arnab Paul”]

Arnab Paul, CEO, Patient Planet

Globally-minded systems thinker, action-oriented and inspired toward optimizing health outcomes through innovation, creativity, cooperation. Passionate about facilitating the alignment among technology, people and processes to ultimately improve patient experience and the functioning of healthcare.

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Pragmatic #Interoperability by Dr. Charles Webster, @wareflo

“Pragmatic interoperability (PI) is the compatibility between the intended versus the actual effect of message exchange”

This article has been re-published with the authors permission. The article was first published by Dr. Charles Webster on his blog here

Healthcare is awash in data. We build messages. We send them. We parse them. We look up their meaning using nomenclatures, classifications, and terminologies. But health IT often fails to systematically do useful things with this encoded, sent, parsed, and looked-up data. We lack a sound theoretical foundation to our thinking about how to use healthcare data to communicate and coordinate human and machine action. I argue that this missing theory of interoperability is Pragmatic Interoperability.
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Issues of pragmatic interoperability manifest themselves as issues about coordination among EHR workflows (with and among other health IT systems). Pragmatic Interoperability is the science behind the practical engineering nuts and bolts in my previous 7000-word, five-part series, Achieving Task and Workflow Interoperability in Healthcare.
I will further argue that the most mature technology for implementing pragmatic interoperability today is workflow technology. Workflow technology encompasses a number of related technologies, from workflow engines, task and workflow management systems, business process management (BPM), and other process-aware information systems such as case management, interface engines, and customer relationship management systems. “Process-aware” means there is an explicit representation of work or workflow and engine executing or automatically consulting this representation of work during automated accomplishment or facilitation of work or workflow.
In many ways, the healthcare workflow, workflow technology, and workflow interoperability stars are aligning. There’s a great fit between BPM (Business Process Management) and FHIR (Fast Healthcare Interoperability Resources) when it comes Achieving Task and Workflow Interoperability in Healthcare. FHIR provides access to EHR data. BPM orchestrates tasks and workflows across EHRs and other health IT systems, potentially in different healthcare organizations. FHIR (and non-FHIR) EHR API (Application Programming Interfaces) initiatives will play an important role in ushering into healthcare the kind of process-aware BPM-style interoperable workflow it so desperate needs.
The key to achieving task-workflow pragmatic interoperability is representing clinical and administrative task and workflow states and events, and making them accessible via APIs. This is the necessary layer between data interoperability (syntactic and semantic, to be discussed below) and task- and workflow-oriented pragmatic interoperability. The next interoperability layer up from data interoperability consists of workflow engines orchestrating choreographies of workflow conversation among EHRs, and between EHRs and other health IT systems. Intelligent, transparent, flexible, workflow-managing process orchestration engines in the cloud will supply healthcare interoperability’s missing workflow layer.
Current healthcare interoperability rests on a two-legged stool. One leg is Syntactic Interoperability. One leg is Semantic Interoperability. (More on those below.) Plug-and-play syntactic and semantic interoperability is the holy grail of EHR interoperability. We hear less about the next level up: pragmatic interoperability (the linguistic science behind task and workflow interoperability).
Pragmatic Interoperability is the third leg missing from the healthcare interoperability stool. This five-part series describes pragmatics (a subfield within linguistics), its relevance to healthcare interoperability, and how to leverage process-aware workflow technologies, such as Business Process Management, to achieve task-workflow pragmatic interoperability. We need to add the crucial third leg of the healthcare interoperability stool.
Linguistics is made up of a number of subfields. You may think of them as a pipeline or series of layers from compression and rarefaction of sound waves to purposeful communication and coordinated action. The output from syntax is the input to semantics. The output from semantics is the input to pragmatics. In the pragmatics layer we do things with words to change the world to achieve goals. It’s actually way more complicated that how I make it seem. There are feedback loops. Linguists argue about where to draw the lines between syntax, semantics, and pragmatics. But this simplified model will serve the purpose of this series about pragmatic interoperability in healthcare.
Syntax and semantics are terms borrowed from linguistics, specifically, the study of signs. A sign is something, such as an ICD-10 code, that can be interpreted to have meaning, such as a medical diagnosis. Syntax is about relations among signs, for example relations among fields in an HL7 message or characters in an ICD-10 code. Syntactic interoperability deals with the structure of healthcare data (reminiscent of sentence diagrams in high school English class). It is necessary for transmitting healthcare data in a message from one system to another. Syntactic interoperability is the ability of one EHR (for example) to parse (in the high school English class sentence diagram sense) the structure of a clinical message received from another EHR or health IT system (if you are a programmer think: counting HL7’s “|”s and “^”s, AKA “pipes” and “hats”)
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Semantics is about the relation of signs to what they mean or denote in the world, such as a diagnosis, etiology, anatomic site, and so on. Semantic interoperability deals with the meaning of data. It is necessary for sharing meaning between transmitting and receiving systems. Semantic interoperability is the ability for that message to mean the same thing to the target EHR as it does to the source EHR or health IT system (think controlled vocabularies such as RxNorm, LOINC, and SNOMED).
Syntactic and semantic interoperability are not enough. They are just tactical tools. Pragmatics is about how we use syntax and semantics as a tool to accomplish goals. Semantics is about literal meaning. Pragmatics is about non-literal meaning. I will discuss pragmatics, in depth, in Part 4 of this series, but will introduce the idea of pragmatic interoperability below.
To review: Syntactic interoperability parses sent data structures; semantic interoperability preserves meaning across sending and receiving systems; pragmatic interoperability does something useful with the outputs of the former. It would not be grandiose to say a theory of healthcare pragmatic interoperability is a theory of healthcare interoperability, since syntax interoperability serves semantic interoperability, and semantic interoperability serves pragmatic interoperability.
Let’s start with a straightforward definition of pragmatic interoperability.
Pragmatic interoperability (PI) is the compatibility between the intended versus the actual effect of message exchange.” (Towards Pragmatic Interoperability in the New Enterprise — A Survey of Approaches)
Compatibility between intended effect versus actual effect of message exchange…
When you speak to me, you are trying to do something, to change the world in some way. Even if you do not explicitly tell me to do something, I grasp your intended meaning and likely help you do whatever you are trying to do. I consider the context of your utterance, your likely workflow (your goal, remaining tasks and their order, and which uncompleted tasks I might help you complete), and help if I can.
If you ask me if I know the time for the next scheduled surgery, I ignore your literal question (to which my overly literal answer would have been “Yes”), and respond to your intended meaning (”2:30″). I act in a pragmatic interoperable manner. The intended effect of you question is to find out the scheduled time (so that you can show up on time, so that you can complete your residency, so you can … and so on). The actual effect is you find out the time. Since intended and actual effects match, we achieve pragmatic interoperability.
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Key to modern conceptions of pragmatics is that human communication is not just encoding a message in my brain, sending it to you over a potentially noisy channel, and then you decoding that message. This is a naive model human communication. Among linguists an inferential model of communication replaced the simplistic encode/send/decode model of communication.
What do I mean by inferential? Speakers imply (suggest indirectly) and addressees infer (deduce from evidence and reasoning rather than from explicit statement). Consider an extreme example. Suppose everyday at 6PM an on-call physician sends a text message to a partner that everything is under control. Whenever no text message is sent, they both understand the partner needs to come in to help out. Since no overt message was sent, there is nothing to decode. Nonetheless, the address successfully infers the “speaker’s” intended meaning. This was an extreme example. For the rest of this series I will assume some overt token, a message, is exchanged. But the literal content of the message is insufficient to achieve pragmatic interoperability. Non-literal meaning must be inferred from shared background knowledge. The most important shared background knowledge to achieve healthcare interoperability is knowledge about tasks, workflows, plans, and goals, all of which are explicitly represented and automated by workflow technology.
Healthcare interoperability must incorporate more inference-based communication. The key technology to allow this to happen will be workflow technology. Workflow technology relies on explicit models of work and workflow. When these models (such as shared care plans) are shared, this is the context that make task and workflow interoperability possible. Shared context between sender and receiver make possible inferences necessary to achieve pragmatic interoperability. Current shared care plan-based health IT applications rely on humans to be the workflow engines, to react to changes in state and to trigger workflows. Increasingly this will be accomplished, or facilitated by software-based workflow engines.
A reasonable objection is that, designed right, all communication among health IT systems can be based on literal meaning (semantics) and not have to rely on non-literal meaning (pragmatics). I disagree. There is always some implicit message context that is not captured in the message itself. In some instances, perhaps it can be ignored. But in general, health IT needs to perform a better job taking into account the clinical context of sent and received messages. In this series, I will specifically focus on task, workflow, plan, and goal context, because we have an available tool to manage this context: workflow technology.
The earlier offered definition of pragmatic interoperability is deceptively simple, but nonetheless powerful. First of all, it makes intuitive sense. Clinicians can understand it, as in, do what I mean, not what I say, sort of way. Second, it can apply to relatively simple scenarios and to relatively complicated scenarios. “Effect” can refer to something as simple as sending someone (perhaps in another healthcare organization) a task to complete. Compatibility between intended and actual can be as simple as checking to make sure the task moves through its task life cycle (pending, started, resigned, started, escalated, complete and so on) to “complete” by a certain time or date. On the other hand, “effect” can refer to complex constellations of tasks, workflows, and mental states, as in, “I accept responsibility for completing all tasks in this assigned workflow, promise to complete them within one week, and inform you when they are complete.”
This series is about the science behind task and workflow interoperability, recently outlined in my recent 7000-word, five-part series Achieving Task and Workflow Interoperability In Healthcare. That series was about practical engineering. So if you are looking for a practical guidebook, go there. Here I am talking about theories supporting why I believe process-aware technology is key to achieving task and workflow interoperability.
Science is about understanding the world. Engineering is about solving problems. Scientific theories are abstract, tentative, and eschew practical consequences. Engineering is concrete, decisive, and about practical consequences. However, as Kurt Lewin, the famous organizational psychologist famously said: “There is nothing as practical as a good theory.” Have no fear, though; mine will be a gentle introduction to linguistics and pragmatics.
Stay tuned for (or proceed to… if there’s nothing there, it hasn’t been published yet) Task, Workflow, and Interoperability Definitions: Pragmatic Interoperability Part 2.
Read the Blog Posts on Pragmatic Interoperability by the Author
Here is an outline of this five-part series on workflow, linguistics, and healthcare interoperability.
  1. Task-Workflow Interoperability Benefits and Next Steps: Pragmatic Interoperability Part 5
Author

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Dr. Charles Webster

HIMSS14, HIMSS15, and HIMSS16 Social Media Ambassador! If you’ve got a healthcare workflow story, I want to tell it, blog it, tweet it, interview you, etc. Dr. Webster is a ceaseless evangelist for process-aware technologies in healthcare, including Workflow Management Systems, Business Process Management, and dynamic and adaptive case management.

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Workflow, Usability, Safety & #Interoperability Perspectives by Dr.Charles Webster, @wareflo – Part5 #AMIA2016

Population Health Management and Business Process Management: Part – 5
“Workflow is a series of tasks, consuming resources, achieving goals.”

This article has been re-published with the authors permission. The article was first published by Dr. Charles Webster on his blog here

Way back in 2009 I penned a research paper with a long and complicated title that could also have been, simply, Population Health Management and Business Process Management. In 2010 I presented it at MedInfo10 in Cape Town, Africa. Check out my travelogue!


Since then, some of what I wrote has become reality, and much of the rest is on the way. Before I dive into the weeds, let me set the stage. The Affordable Care Act added tens of millions of new patients to an already creaky and dysfunctional healthcare and health IT system. Accountable Care Organizations were conceived as virtual enterprises to be paid to manage the clinical outcome and costs of care of specific populations of individuals. Population Health Management has become the dominant conceptual framework for proceeding.
 

I looked at a bunch of definitions of population health management and created the following as a synthesis: “Proactive management of clinical and financial risks of a defined patient group to improve clinical outcomes and reduce cost via targeted, coordinated engagement of providers and patients across all care settings.”
 
You can see obvious places in this definition to apply trendy SMAC tech — social, mobile, analytics, and cloud — social, patient settings; mobile, provider and patient settings; analytics, cost and outcomes; cloud, across settings. But here I want to focus on the “targeted, coordinated.” Increasingly, it is self-developed and vendor-supplied care coordination platforms that target and coordinate, filling a gap between EHRs and day-to-day provider and patient workflows.


The best technology on which, from which, to create care coordination platforms is workflow technology, AKA business process management and adaptive/dynamic case management software. In fact, when I drill down on most sophisticated, scalable population health management and care coordination solutions, I usually find a combination of a couple things. Either the health IT organization or vendor is, in essence, reinventing the workflow tech wheel, or they embed or build on third-party BPM technology.
 

Let me direct you to my section Patient Class Event Hierarchy Intermediates Patient Event Stream and Automated Workflow in that MedInfo10 paper. First of all you have to target the right patients for intervention. Increasingly, ideas from Complex Event Processing are used to quickly and appropriately react to patient events. A Patient Class Event Hierarchy is a decision tree mediating between low-level events (patient state changes) and higher-level concepts clinical concepts such as “on-protocol,” “compliant”, “measured”, and “controlled.”
 

Examples include patients who aren’t on protocol but should be, aren’t being measured but should be, or whose clinical values are not controlled. Execution of appropriate automatic policy-based workflows (in effect, intervention plans) moves patients from off-protocol to on-protocol, non-compliance to compliance, unmeasured to measured, and from uncontrolled to controlled state categories.
 

Population health management and care coordination products and services may use different categories, terminology, etc. But they all tend to focus on sensing and reacting to untoward changes in patient state. But simply detecting these changes is insufficient. These systems need to cause actions. 
And these actions need to be monitored, managed, and improved, all of which are classic sterling qualities of business process management software systems and suites.
 

I’m reminded of several tweets about Accountable Care Organization IT systems I display during presentations. One summarizes an article about ACOs. The other paraphrases an ACO expert speaking at a conference. The former says ACOs must tie together many disparate IT systems. The later says ACOs boil down to lists: actionable lists of items delivered to the right person at the right time. If you put these requirements together with system-wide care pathways delivered safely and conveniently to the point of care, you get my three previous blog posts on interoperability, usability, and safety.
 

I’ll close here with my seven advantages of BPM-based care coordination technology. It…

  • More granularly distinguishes workflow steps
  • Captures more meaningful time-stamped task data
  • More actively influences point-of-care workflow
  • Helps model and understand workflow
  • Better coordinates patient care task handoffs
  • Monitors patient care task execution in real-time
  • Systematically improves workflow effectiveness & efficiency

Distinguishing among workflow steps is important to collecting data about which steps provide value to providers and patients, as well as time-stamps necessary to estimate true costs. Further, since these steps are executed, or at least monitored, at the point-of-care, there’s more opportunity to facilitate and influence at the point-of-care. Modeling workflow contributes to understanding workflow, in my view an intrinsically valuable state of affairs. These workflow models can represent and compensate for interruptions to necessary care task handoffs. During workflow execution, “enactment” in BPM parlance, workflow state is made transparently visible. Finally, workflow data “exhaust” (particularly times-stamped evidence-based process maps) can be used to systematically find bottlenecks and plug care gaps.

In light of the fit between complex event processing detecting changes in patient state, and BPM’s automated, managed workflow at the point-of-care, I see no alternative to what I predicted in 2010. Regardless of whether it’s rebranded as care or healthcare process management, business process management is the most mature, practical, and scalable way to create the care coordination and population health management IT systems required by Accountable Care Organizations and the Affordable Care Act. A bit dramatically, I’d even say business process management’s royal road to healthcare runs through care coordination.

This was my fifth and final blog post in this series on healthcare and workflow technology


Additional Blog Posts by the Author
  1. Five Guest Blog Posts On EHR & HIT Workflow, Usability, Safety, Interoperability and Population Health
  2. Interoperable Health IT and Business Process Management: The Spider In The Web
  3. Usable EHR Workflow Is Natural, Consistent, Relevant, Supportive and Flexible
  4. Patient Safety And Process-Aware Information Systems: Interruptions, Interruptions, Interruptions!
  5. Population Health Management and Business Process Management
Author

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[content title=”About Dr. Charles Webster”]

Dr. Charles Webster

HIMSS14, HIMSS15, and HIMSS16 Social Media Ambassador! If you’ve got a healthcare workflow story, I want to tell it, blog it, tweet it, interview you, etc. Dr. Webster is a ceaseless evangelist for process-aware technologies in healthcare, including Workflow Management Systems, Business Process Management, and dynamic and adaptive case management.

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Workflow, Usability, Safety & #Interoperability Perspectives by Dr.Charles Webster, @wareflo – Part4 #AMIA2016

Patient Safety And Process-Aware Information Systems: Interruptions, Interruptions, Interruptions! : Part – 4
“Workflow is a series of tasks, consuming resources, achieving goals.”

This article has been re-published with the authors permission. The article was first published by Dr. Charles Webster on his blog here

When you took a drivers education class, do you remember the importance of mental “awareness” to traffic safety? Continually monitor your environment, your car, and yourself. As in traffic flow, healthcare is full of work flow, and awareness of workflow is the key to patient safety.


First of all, the very act of creating a model of work to be done forces designers and users to very carefully think about and work through workflow “happy paths” and what to do when they’re fallen off. A happy path is a sequence of events that’s intended to happen, and, if all goes well, actually does happen most of the time. 

Departures from the Happy Path are called “exceptions” in computer programming parlance. Exceptions are “thrown”, “caught”, and “handled.” At the level of computer programming, an exception may occur when data is requested from a network resource, but the network is down. At the level of workflow, an exception might be a patient no-show, an abnormal lab value, or suddenly being called away by an emergency or higher priority circumstance.
 

Developing a model of work, variously called workflow/process definition or work plan forces workflow designers and workflow users to communicate at a level of abstraction that is much more natural and productive than either computer code or screen mockups.
 

Once a workflow model is created, it can be automatically analyzed for completeness and consistency. Similar to how a compiler can detect problems in code before it’s released, problems in workflow can be prevented. This sort of formal analysis is in its infancy, and is perhaps most advanced in healthcare in the design of medical devices.
 

When workflow engines execute models of work, work is performed. If this work would have otherwise necessarily been accomplished by humans, user workload is reduced. Recent research estimates a 7 percent increase in patient mortality for every additional patient increase in nurse workload. Decreasing workload should reduce patient mortality by a similar amount.
 

Another area of workflow technology that can increase patient safety is process mining. Process mining is similar, by analogy, to data mining, but the patterns it extracts from time stamped data are workflow models. These “process maps” are evidence-based representations of what really happens during use of an EHR or health IT system. 

Process maps can be quite different, and more eye opening, than process maps generated by asking participants questions about their workflows. Process maps can show what happens that shouldn’t, what doesn’t happen than should, and time-delays due to workflow bottlenecks. They are ideal tools to understand what happened during analysis of what may have caused a possibly system-precipitated medical error.
 

Yet another area of particular relevance of workflow tech to patient safety is the fascinating relationship between clinical pathways, guidelines, etc. and workflow and process definitions executed by workflow tech’s workflow engines. Clinical decision support, bringing the best, evidence-based medical knowledge to the point-of-care, must be seamless with clinical workflow. Otherwise, alert fatigue greatly reduces realization of the potential.
 

There’s considerable research into how to leverage and combine representations of clinical knowledge with clinical workflow. However, you really need a workflow system to take advantage of this intricate relationship. Hardcoded, workflow-oblivious systems? There’s no way to tweak alerts to workflow context: the who, what, why, when, where, and how of what the clinical is doing. Clinical decision support will not achieve wide spread success and acceptance until it can be intelligently customized and managed, during real-time clinical workflow execution. This, again, requires workflow tech at the point-of-care.
 

I’ve saved workflow tech’s most important contribution to patient safety until last: Interruptions.
 

An interruption–is there anything more dreaded than, just when you are beginning to experience optimal mental flow, a higher priority task interrupts your concentration. This is ironic, since so much of work-a-day ambulatory medicine is essentially interrupt-driven (to borrow from computer terminology). Unexpected higher priority tasks and emergencies *should* interrupt lower priority scheduled tasks. Though at the end of the day, ideally, you’ve accomplished all your tasks.
 

In one research study, over 50% of all healthcare errors were due to slips and lapses, such as not executing an intended action. In other words, good clinical intentions derailed by interruptions.
 

Workflow management systems provide environmental cues to remind clinical staff to resume interrupted tasks. They represent “stacks” of tasks so the entire care team works together to make sure that interrupted tasks are eventually and appropriately resumed. Workflow management technology can bring to clinical care many of the innovations we admire in the aviation domain, including well-defined steps, checklists, and workflow tools.

Stay tuned for my fifth, and final, guest blog post, in which I tackle Population Health Management with Business Process Management.

Additional Blog Posts by the Author
  1. Five Guest Blog Posts On EHR & HIT Workflow, Usability, Safety, Interoperability and Population Health
  2. Interoperable Health IT and Business Process Management: The Spider In The Web
  3. Usable EHR Workflow Is Natural, Consistent, Relevant, Supportive and Flexible
  4. Patient Safety And Process-Aware Information Systems: Interruptions, Interruptions, Interruptions!
  5. Population Health Management and Business Process Management
Author

[tab]
[content title=”About Dr. Charles Webster”]

Dr. Charles Webster

HIMSS14, HIMSS15, and HIMSS16 Social Media Ambassador! If you’ve got a healthcare workflow story, I want to tell it, blog it, tweet it, interview you, etc. Dr. Webster is a ceaseless evangelist for process-aware technologies in healthcare, including Workflow Management Systems, Business Process Management, and dynamic and adaptive case management.

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Workflow, Usability, Safety & #Interoperability Perspectives by Dr.Charles Webster, @wareflo – Part3 #AMIA2016

Usable EHR Workflow Is Natural, Consistent, Relevant, Supportive and Flexible : Part – 3
“Workflow is a series of tasks, consuming resources, achieving goals.”

This article has been re-published with the authors permission. The article was first published by Dr. Charles Webster on his blog here

Workflow technology has a reputation, fortunately out of date, for trying to get rid of humans all together. Early on it was used for Straight-Through-Processing in which human stockbrokers were bypassed so stock trades happened in seconds instead of days. Business Process Management (BPM) can still do this. It can automate the logic and workflow that’d normally require a human to download something, check on a value and based on that value do something else useful, such as putting an item in a To-Do list. By automating low-level routine workflows, humans are freed to do more useful things that even workflow automation can’t automate.


But much of healthcare workflow requires human intervention. It is here that modern workflow technology really shines, by becoming an intelligent assistant proactively cooperating with human users to make their jobs easier. A decade ago, at MedInfo04 in San Francisco, I listed the five workflow usability principles that beg for workflow tech at the point-of-care.

Consider these major dimensions of workflow usability: naturalness, consistency, relevance, supportiveness, and flexibility. Workflow management concepts provide a useful bridge from usability concepts applied to single users to usability applied to users in teams. Each concept, realized correctly, contributes to shorter cycle time (encounter length) and increased throughput (patient volume).

Naturalness is the degree to which an application’s behavior matches task structure. In the case of workflow management, multiple task structures stretch across multiple EHR users in multiple roles. A patient visit to a medical practice office involves multiple interactions among patients, nurses, technicians, and physicians. Task analysis must therefore span all of these users and roles. Creation of a patient encounter process definition is an example of this kind of task analysis, and results in a machine executable (by the BPM workflow engine) representation of task structure.

Consistency is the degree to which an application reinforces and relies on user expectations. Process definitions enforce (and therefore reinforce) consistency of EHR user interactions with each other with respect to task goals and context. Over time, team members rely on this consistency to achieve highly automated and interleaved behavior. Consistent repetition leads to increased speed and accuracy.

Relevance is the degree to which extraneous input and output, which may confuse a user, is eliminated. Too much information can be as bad as not enough. Here, process definitions rely on EHR user roles (related sets of activities, responsibilities, and skills) to select appropriate screens, screen contents, and interaction behavior.

Supportiveness is the degree to which enough information is provided to a user to accomplish tasks. An application can support users by contributing to the shared mental model of system state that allows users to coordinate their activities with respect to each other. For example, since a EMR  workflow system represents and updates task status and responsibility in real time, this data can drive a display that gives all EHR users the big picture of who is waiting for what, for how long, and who is responsible.

Flexibility is the degree to which an application can accommodate user requirements, competencies, and preferences. This obviously relates back to each of the previous usability principles. Unnatural, inconsistent, irrelevant, and unsupportive behaviors (from the perspective of a specific user, task, and context) need to be flexibly changed to become natural, consistent, relevant, and supportive. Plus, different EHR users may require different BPM process definitions, or shared process definitions that can be parameterized to behave differently in different user task-contexts.

The ideal EHR/EMR should make the simple easy and fast, and the complex possible and practical. Then, the majority/minority rule applies. A majority of the time processing is simple, easy, and fast (generating the greatest output for the least input, thereby greatly increasing productivity). In the remaining minority of the time, the productivity increase may be less, but at least there are no showstoppers.

So, to summarize my five principles of workflow usability…


Workflow tech can more naturally match the task structure of a physician’s office through execution of workflow definitions. It can more consistently reinforce user expectations. Over time this leads to highly automated and interleaved team behavior. On a screen-by-screen basis, users encounter more relevant data and order entry options. 

Workflow tech can track pending tasks–which patients are waiting where, how long, for what, and who is responsible–and this data can be used to support a continually updated shared mental model among users. 

Finally, to the degree to which an EHR or health IT system is not natural, consistent, relevant, and supportive, the underlying flexibility of the workflow engine and process definitions can be used to mold workflow system behavior until it becomes natural, consistent, relevant, and supportive.

In the next blog post in the series, I’ll discuss workflow technology and patient safety.

Additional Blog Posts by the Author
  1. Five Guest Blog Posts On EHR & HIT Workflow, Usability, Safety, Interoperability and Population Health
  2. Interoperable Health IT and Business Process Management: The Spider In The Web
  3. Usable EHR Workflow Is Natural, Consistent, Relevant, Supportive and Flexible
  4. Patient Safety And Process-Aware Information Systems: Interruptions, Interruptions, Interruptions!
  5. Population Health Management and Business Process Management
Author

[tab]
[content title=”About Dr. Charles Webster”]

Dr. Charles Webster

HIMSS14, HIMSS15, and HIMSS16 Social Media Ambassador! If you’ve got a healthcare workflow story, I want to tell it, blog it, tweet it, interview you, etc. Dr. Webster is a ceaseless evangelist for process-aware technologies in healthcare, including Workflow Management Systems, Business Process Management, and dynamic and adaptive case management.

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Workflow, Usability, Safety & #Interoperability Perspectives by Dr.Charles Webster, @wareflo – Part2 #AMIA2016

Interoperable Health IT and Business Process Management: The Spider In The Web: Part – 2
“Workflow is a series of tasks, consuming resources, achieving goals.”

This article has been re-published with the authors permission. The article was first published by Dr. Charles Webster on his blog here

Just in time for the 2016 AMIA Symposium, I’m delighted that Manish Sharma, the force behind @HCITExperts, is republishing my five-part series on workflow technology in healthcare. Thank you Manish!

Dr. Charles Webster

If you pay any attention at all to interoperability discussion in healthcare and health IT, I’m sure you’ve heard of syntactic vs. semantic interoperability. Syntax and semantics are ideas from linguistics.


Syntax is the structure of a message. Semantics is its meaning. Think HL7’s pipes and hats (the characters “|” and “^” used as separators) vs. codes referring to drugs and lab results (the stuff between pipes and hats).

What you hardly every hear about is pragmatic interoperability, sometimes called workflow interoperability. We need not just syntactic and semantic interop, but pragmatic workflow interop too. In fact, interoperability based on workflow technology can strategically compensate for deficiencies in syntactic and semantic interoperability. By workflow technology, I mean Business Process Management (BPM).
 
Why do I highlight BPM’s relevance to health information interoperability? Take a look at this quote from Business Process Management: A Comprehensive Survey:
 

“WFM/BPM systems are often the “spider in the web” connecting different technologies. For example, the BPM system invokes applications to execute particular tasks, stores process-related information in a database, and integrates different legacy and web-based systems…. Business processes need to be executed in a partly uncontrollable environment where people and organizations may deviate and software components and communication infrastructures may malfunction. Therefore, the BPM system needs to be able to deal with failures and missing data.”

“Partly uncontrollable environment where people and organizations may deviate and software components and communication infrastructures may malfunction”? 

Sound familiar? That’s right. It should sound a lot like health IT.

What’s the solution? 
A “spider in the web” connecting different technologies… invoking applications to execute particular tasks, storing process-related information in a database, and integrates different legacy and web-based systems. Dealing with failures and missing data. Yes, healthcare needs a spider in the complicated web of complicate information systems that is today’s health information management infrastructure. Business process management is that spider in a technological web.

Let me show you now how BPM makes pragmatic interoperability possible.

I’ll start with another quote:

Pragmatic interoperability (PI) is the compatibility between the intended versus the actual effect of message exchange.”

That’s a surprisingly simple definition for what you may have feared would be a tediously arcane topic. Pragmatic interoperability is simply whether the message you send achieves the goal you intended. That’s why it’s “pragmatic” interoperability. Linguistics pragmatics is the study of how we use language to achieve goals.

“Pragmatic interoperability is concerned with ensuring that the exchanged messages cause their intended effect. Often, the intended effect is achieved by sending and receiving multiple messages in specific order, defined in an interaction protocol.”

So, how does workflow technology tie into pragmatic interoperability? The key phrases linking workflow and pragmatics are “intended effect” and “specific order”.

A sequence of actions and messages — send a request to a specialist, track request status, ask about request status, receive result and do the right thing with it — that’s the “specific order” of conversation required to ensure the “intended effect” (the result). Interactions among EHR workflow systems, explicitly defined internal and cross-EHR workflows, hierarchies of automated and human handlers, and rules and schedules for escalation and expiration are necessary to achieve seamless coordination among EHR workflow systems. 

In other words, we need workflow management system technology to enable self-repairing conversations among EHR and other health IT systems. This is pragmatic interoperability. By the way, some early workflow systems were explicitly based on speech act theory, an area of pragmatics.

That’s my call to use workflow technology, especially Business Process Management, to help solve our healthcare information interoperability problems. Syntactic and semantic interoperability aren’t enough. Cool looking “marketectures” dissecting healthcare interoperability issues aren’t enough. Even APIs (Application Programming Interfaces) aren’t enough. Something has to combine all this stuff, in a scalable and flexible ways (by which I mean, not “hardcoded”) into usable workflows.

Which brings me to usability, tomorrow’s guest blog post topic.

Tune in! 

Additional Blog Posts by the Author
  1. Five Guest Blog Posts On EHR & HIT Workflow, Usability, Safety, Interoperability and Population Health
  2. Interoperable Health IT and Business Process Management: The Spider In The Web
  3. Usable EHR Workflow Is Natural, Consistent, Relevant, Supportive and Flexible
  4. Patient Safety And Process-Aware Information Systems: Interruptions, Interruptions, Interruptions!
  5. Population Health Management and Business Process Management
Author

[tab]
[content title=”About Dr. Charles Webster”]

Dr. Charles Webster

HIMSS14, HIMSS15, and HIMSS16 Social Media Ambassador! If you’ve got a healthcare workflow story, I want to tell it, blog it, tweet it, interview you, etc. Dr. Webster is a ceaseless evangelist for process-aware technologies in healthcare, including Workflow Management Systems, Business Process Management, and dynamic and adaptive case management.

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ICD to SNOMED CT Mapping: Observations and Inferences by Dr. SB Bhattacharyya, @sbbhattacharya


The Concepts presented in this article are as proposed by Dr. SB Bhattacharyya and presented in the HCITExpert Blog with permission from Dr. SBB – sbbhattacharyya@gmail.com

The Concept related to CSets are proposed by Dr. SB Bhattacharyya and presented in the HCITExpert Blog with permission from Dr. SBB.

Author

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[content title=”About Dr. S B Bhattacharyya”]

Dr. S B Bhattacharyya

Digital Health Influencer, Medical Doctor with experience in the healthcare industry in the fields of clinical practice, hospital administration, and medical informatics with particular focus on clinical data analytics.

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Workflow, Usability, Safety & #Interoperability Perspectives by Dr.Charles Webster, @wareflo – Part1 #AMIA2016

BPM-based Population Health Management & Care Coordination: Part – 1

“Workflow is a series of tasks, consuming resources, achieving goals.”

This article has been re-published with the authors permission. The article was first published by Dr. Charles Webster on his blog here

Just in time for the 2016 AMIA Symposium, I’m delighted that Manish Sharma, the force behind @HCITExperts, is republishing my five-part series on workflow technology in healthcare. Thank you Manish!

– by Dr. Charles Webster

I blog and tweet a lot about healthcare workflow and workflow technology, but in this first post I’ll try to synthesize and simplify. In later posts I drive into the weeds. Here, I’ll define workflow, describe workflow technology, its relevance to healthcare and health IT, and try not to steal my own thunder from the rest of the week.


I’ve looked at literally hundreds of definitions of workflow, all the way from a “series of tasks” to definitions that’d sprawl across several presentation slides. The one I’ve settled on is this:
“Workflow is a series of tasks, consuming resources, achieving goals.”
Short enough to tweet, which is why I like it, but long enough to address two important concepts: resources (costs) and goals (benefits).
What is workflow technology?
Workflow technology uses models of work to automate processes and support human workflows. These models can be understood, edited, improved, and even created, by humans who are not, themselves, programmers. These models can be executed, monitored, and even systematically improved by computer programs, variously called workflow management systems, business process management suites, and, for ad hoc workflows, case management systems.
Workflow tech, like health IT itself, is a vast and varied continent. As an industry, worldwide, it’s probably less than a tenth size of health IT, but it’s also growing at two or three times the rate. And, as both industries grow, they increasingly overlap. Health IT increasingly represents workflows and executes them with workflow engines. Workflow tech vendors increasingly aim at healthcare to sell a wide variety of workflow solutions, from embeddable workflow engines to sprawling business process management suites. Workflow vendors strenuously compete and debate on finer points of philosophy about how best automate and support work. Many of these finer points are directly relevant to workflow problems plaguing healthcare and health IT.
Why is workflow tech important to health IT?
Because it can do what is missing, but sorely needed, in traditional health IT, including electronic health records (EHRs). Most EHRs and health IT systems essentially hard-code workflow. By “hard code” I mean that any series of tasks is implicitly represented by Java and C# and MUMPS if-then and case statements. Changes to workflow require changes to underlying code. This requires programmers who understand Java and C# and MUMPS. Changes cause errors. I’m reminded of the old joke, how many programmers does it take to change a light bulb? Just one, but in the morning the stove and the toilet are broken. Traditional health IT relies on frozen representations of workflow that are opaque, fragile, and difficult to manage across information system and organizational boundaries.
Well, OK, I’ll steal my own thunder just a little bit. Process-aware tech, in comparison to hardcoded workflows, is an architectural paradigm shift for health IT. It has far reaching implications for interoperability, usability, safety, and population health.
BPM systems are ideal candidates to tie together disparate systems and technologies. Users experience more usable workflows because workflows are represented so humans can understand and change then. Process-aware information systems are safer for many reasons, but particularly because they can represent and compensate for the interruptions that cause so many medical errors. Finally, BPM platforms are the right platforms to tie together accountable care organization IT systems and to drive specific, appropriate, timely action to provider and patient point-of-care.
The rest of my blog posts in this weeklong series will elaborate on these themes. I’ll address why so many EHRs and health IT systems are so unusable, un-interoperable, and sometimes even dangerous. I’ll argue that modern workflow technology can help rescue healthcare and health IT from these problems.
Additional Blog Posts by the Author
  1. Five Guest Blog Posts On EHR & HIT Workflow, Usability, Safety, Interoperability and Population Health
  2. Interoperable Health IT and Business Process Management: The Spider In The Web
  3. Usable EHR Workflow Is Natural, Consistent, Relevant, Supportive and Flexible
  4. Patient Safety And Process-Aware Information Systems: Interruptions, Interruptions, Interruptions!
  5. Population Health Management and Business Process Management
Author

[tab]
[content title=”About Dr. Charles Webster”]

Dr. Charles Webster

HIMSS14, HIMSS15, and HIMSS16 Social Media Ambassador! If you’ve got a healthcare workflow story, I want to tell it, blog it, tweet it, interview you, etc. Dr. Webster is a ceaseless evangelist for process-aware technologies in healthcare, including Workflow Management Systems, Business Process Management, and dynamic and adaptive case management.

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Healthcare #IoT, what the future holds by Arnab Paul, @iArnabPaul

Things in healthcare, its popularity is undeniably on the rise in other industries


The world is continuously growing and changing. Various advancements have also occurred when it comes to the technology used in rendering healthcare services. Thus, there is no doubt that the healthcare industry has improved in the last decade but what are some of those improvements.  

The technology has also played a big role in patient registration and data monitoring. Before, people need to go seek a doctor and visit them personally for a consultation but now, it is very much possible for them to consult a doctor in the convenience of their own homes by allowing them to talk with their doctor through a video chat, as Telehealth has been introduced. 

Apart from that, there are also technologies that allow a healthcare provider to monitor their patients in their own mobile phones. It’s not only that for they are also now capable of sending and receiving patient’s information in their mobile phones as well. All of these have been made possible, as wireless connectivity exists. 

Devices that can help monitor one’s health of the one wearing it have also been highly available in the market.  As a matter of fact, there are even sensors that are capable of collecting data that would of course help their doctor be informed in case there is something abnormal with their patients. This allows them to provide the right medication and treatment to their patients fast. On the other hand, although great improvements have been made in the healthcare industry, one can still expect that a brighter future awaits in the next years or decades.  

Within five years, the majority of clinically relevant data will be collected outside of clinical settings. It has been said that healthcare in the future would become more personal. Thus, one can expect that personalized medicines or medicines that have been created specifically for an individual would be available. The way doctors diagnoses their patient’s disease and provides treatment to them would also be changed as data would become more accessible in the future, combined with the use of more hi-tech devices. As more people are being conscious of their health, one can expect that more tools and equipment would be available in the future.

Internet of Things

in the IoT paradigm everything in the world is considered as a smart object, and allows them to communicate each other through the internet technologies by physically or virtually. IoT allows people and things to be connected Anytime, Anyplace, with anything and anyone, by using ideally in any path/network and any service.Internet of Things could be the driver for health care’s new visage and revolutionize patient care transcendentally. Few ways how IoT can be used in healthcare industry  

1) Remote patient monitoring

Remote patient monitoring (RPM) uses digital technologies to collect medical and other forms of health data from one individual in one location and electronically transmit this information to the health care providers. RPM can help reduce the number of hospital readmissions and lengths of stay in the hospitals. 

2) Clinical care

Hospitalised patients whose physiological status requires close attention can be constantly monitored using IoT driven, non-invasive monitoring. Sensors are used to collect such information and using cloud to analyse data and then send this analysed data to caregivers. It replaces the need for the doctor to visit the patient during regular intervals for check up. This will also help to improve the quality of care through constant monitoring.

3) Device monitoring

An IoT connected device metal device can notify when there is a problem with a device.  This will prevent the device from shutting down and avoid patient rescheduling.

4) Outpatient Monitoring

This IoT solution enables doctors to capture health parameters and advice patients remotely. The patient’s hospital visit is therefore limited and needs to visit only on need basis. This solution helps hospitals manage hospital beds and consequently increase revenues while at the same time delighting customers.  

Although, IoT implementations will likely raise concerns around data privacy and security. While most of today’s devices use secure methods to communication information to the cloud, they could still be vulnerable to hackers. 

While we have yet to see a huge number of adopters of the Internet of Things in healthcare, its popularity is undeniably on the rise in other industries.

The article was first published in Mr. Arnab Paul’s LinkedIn Pulse post. The article is reproduced here with the authors permission. 

Author

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Arnab Paul, CEO, Patient Planet

Globally-minded systems thinker, action-oriented and inspired toward optimizing health outcomes through innovation, creativity, cooperation. Passionate about facilitating the alignment among technology, people and processes to ultimately improve patient experience and the functioning of healthcare.

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