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Population Health Management and Business Process Management

Posted on June 13, 2014 I Written By

Chuck Webster, MD, MSIE, MSIS has degrees in Accountancy, Industrial Engineering, Intelligent Systems, and Medicine (from the University of Chicago). He designed the first undergraduate program in medical informatics, was a software architect in a hospital MIS department, and also VP and CMIO for an EHR vendor for over a decade. Dr. Webster helped three healthcare organizations win the HIMSS Davies Award and is a judge for the annual Workflow Management Coalition Awards for Excellence in BPM and Workflow and Awards for Case Management. Chuck is a ceaseless evangelist for process-aware technologies in healthcare, including workflow management systems, Business Process Management, and dynamic and adaptive case management. Dr. Webster tweets from @wareFLO and maintains numerous websites, including EHR Workflow Management Systems (http://chuckwebster.com), Healthcare Business Process Management (http://HCBPM.com) and the People and Organizations improving Healthcare with Health Information Technology (http://EHRworkflow.com). Please join with Chuck to spread the message: Viva la workflow!

This is my fifth and final of five guest blog posts covering Health IT and EHR Workflow.

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 solicited by John Lynn for this week that he’s on vacation. Here was the outline:

If you missed one of my previous posts, I hope you’ll still check it out. Finally, thank you John, for allowing to me temporarily share your bully pulpit.


Patient Safety And Process-Aware Information Systems: Interruptions, Interruptions, Interruptions!

Posted on June 12, 2014 I Written By

Chuck Webster, MD, MSIE, MSIS has degrees in Accountancy, Industrial Engineering, Intelligent Systems, and Medicine (from the University of Chicago). He designed the first undergraduate program in medical informatics, was a software architect in a hospital MIS department, and also VP and CMIO for an EHR vendor for over a decade. Dr. Webster helped three healthcare organizations win the HIMSS Davies Award and is a judge for the annual Workflow Management Coalition Awards for Excellence in BPM and Workflow and Awards for Case Management. Chuck is a ceaseless evangelist for process-aware technologies in healthcare, including workflow management systems, Business Process Management, and dynamic and adaptive case management. Dr. Webster tweets from @wareFLO and maintains numerous websites, including EHR Workflow Management Systems (http://chuckwebster.com), Healthcare Business Process Management (http://HCBPM.com) and the People and Organizations improving Healthcare with Health Information Technology (http://EHRworkflow.com). Please join with Chuck to spread the message: Viva la workflow!

This is my fourth of five guest blog posts covering Health IT and EHR Workflow.

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.


Usable EHR Workflow Is Natural, Consistent, Relevant, Supportive and Flexible

Posted on June 11, 2014 I Written By

Chuck Webster, MD, MSIE, MSIS has degrees in Accountancy, Industrial Engineering, Intelligent Systems, and Medicine (from the University of Chicago). He designed the first undergraduate program in medical informatics, was a software architect in a hospital MIS department, and also VP and CMIO for an EHR vendor for over a decade. Dr. Webster helped three healthcare organizations win the HIMSS Davies Award and is a judge for the annual Workflow Management Coalition Awards for Excellence in BPM and Workflow and Awards for Case Management. Chuck is a ceaseless evangelist for process-aware technologies in healthcare, including workflow management systems, Business Process Management, and dynamic and adaptive case management. Dr. Webster tweets from @wareFLO and maintains numerous websites, including EHR Workflow Management Systems (http://chuckwebster.com), Healthcare Business Process Management (http://HCBPM.com) and the People and Organizations improving Healthcare with Health Information Technology (http://EHRworkflow.com). Please join with Chuck to spread the message: Viva la workflow!

This is my third of five guest blog posts covering Health IT and EHR Workflow.

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.

Tomorrow I’ll discuss workflow technology and patient safety.


Interoperable Health IT and Business Process Management: The Spider In The Web

Posted on June 10, 2014 I Written By

Chuck Webster, MD, MSIE, MSIS has degrees in Accountancy, Industrial Engineering, Intelligent Systems, and Medicine (from the University of Chicago). He designed the first undergraduate program in medical informatics, was a software architect in a hospital MIS department, and also VP and CMIO for an EHR vendor for over a decade. Dr. Webster helped three healthcare organizations win the HIMSS Davies Award and is a judge for the annual Workflow Management Coalition Awards for Excellence in BPM and Workflow and Awards for Case Management. Chuck is a ceaseless evangelist for process-aware technologies in healthcare, including workflow management systems, Business Process Management, and dynamic and adaptive case management. Dr. Webster tweets from @wareFLO and maintains numerous websites, including EHR Workflow Management Systems (http://chuckwebster.com), Healthcare Business Process Management (http://HCBPM.com) and the People and Organizations improving Healthcare with Health Information Technology (http://EHRworkflow.com). Please join with Chuck to spread the message: Viva la workflow!

This is my second of five guest blog posts covering Health IT and EHR Workflow.

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!


Five Guest Blog Posts On EHR and HIT Workflow, Usability, Safety, Interoperability and Population Health

Posted on June 9, 2014 I Written By

Chuck Webster, MD, MSIE, MSIS has degrees in Accountancy, Industrial Engineering, Intelligent Systems, and Medicine (from the University of Chicago). He designed the first undergraduate program in medical informatics, was a software architect in a hospital MIS department, and also VP and CMIO for an EHR vendor for over a decade. Dr. Webster helped three healthcare organizations win the HIMSS Davies Award and is a judge for the annual Workflow Management Coalition Awards for Excellence in BPM and Workflow and Awards for Case Management. Chuck is a ceaseless evangelist for process-aware technologies in healthcare, including workflow management systems, Business Process Management, and dynamic and adaptive case management. Dr. Webster tweets from @wareFLO and maintains numerous websites, including EHR Workflow Management Systems (http://chuckwebster.com), Healthcare Business Process Management (http://HCBPM.com) and the People and Organizations improving Healthcare with Health Information Technology (http://EHRworkflow.com). Please join with Chuck to spread the message: Viva la workflow!

John Lynn is taking a well-deserved week off to attend a family function. He asked if I was interested in five EHR workflow guest blog posts, a blog post a day this week, on EMR and HIPAA. Of course I said: YES!

Here’s the outline for the week:

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, it’s 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).

So 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.


Next Week’s Topic – EHR Workflow

Posted on June 6, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Next week, it’s going to be a little different around here. Next week, I’m going to be spending the week at Zions National Park as part of a family reunion. We did this a couple years back and unless things have changed, I’ll be stuck completely off the grid with no wifi or even cell coverage (Although, I may slip into town one day to check my email). Should be quite the experience.

I’ve actually done this a few times before and you probably didn’t know it. I just schedule the posts to appear and no one even realized I was gone. In fact, when I’ve done it in the past, I’ve had some of my highest traffic days on the blog. Don’t ask me how that works.

Next week, I decided to do something a little bit different. When I first started blogging, I remember a blogger “turning over the keys” to his blog to another blogger for the week. I always thought that was a kind of cool idea. Usually the person who “drives” the blog for the week enjoys it, the readers get another perspective, and the blog keeps humming while I’m wrestling 4 children and 12 cousins in the wilderness.

That’s indeed what I’ve done. Next week, I’m passing the keys to the EMR and HIPAA blog over to Chuck Webster, MD. Most people know him better as @wareFLO. He’s also well known for his famous HIMSS hat cam which has now been transitioned to Google Glass. However, Chuck is most well known for his interest in love passion adoration addiction to EHR and Health IT workflow. See his blog for example.

If you say EHR, he thinks workflow. If you say HIE, he thinks workflow. If you say population health, he thinks workflow. If you say meaningful use, he thinks workflow. If you say revenue cycle management, he thinks workflow. If you say donuts, he thinks workflow (This seems appropriate on National Donut day).

Needless to say, next week Chuck is going to be taking you through a series of blog posts covering EHR and Healthcare IT workflow. I’ve seen the preview and there are some real valuable nuggets that he’ll share. I particularly like the posts he’s planning for later in the week.

How’s that for a preview? Of course, if you hate EHR workflow, then I’ll be back with my regularly scheduled programming the week after. I look forward to hearing what you all think about Chuck’s posts. If you like the idea, maybe we’ll do it again in the future. Either way, I hope you’ll welcome Chuck next week and give him the same honest feedback, support, critiques, and suggestions in the comments that you give me.

This Geek Girl’s Singing: HIMSS 14 Social Media Finale

Posted on March 14, 2014 I Written By

Mandi Bishop is a hardcore health data geek with a Master's in English and a passion for big data analytics, which she brings to her role as Dell Health’s Analytics Solutions Lead. She fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.

As one of the inaugural crop of HIMSS Social Media Ambassadors, a second-generation native Floridian, and a former Orlando resident, it is my sworn duty to summarize, recap, and perhaps satirize the last group of Blog Carnival posts, to metaphorically sing the HIMSS opera finale. And you folks submitted some doozies! I’m very grateful to the HIMSS (@HIMSS) and SHIFT Communications (@SHIFTComm) team for providing me with links to all entries. Y’all have been BUSY!

A man after my own heart, and a frequent #HITsm participant who weathers harsh criticism with witty aplomb: Dan Haley’s (from athenahealth, @DanHaley5) piece on 3 Takeaways From HIMSS – Policy And Otherwise caught my attention with the line, “Regulators are from Mars…” He stole my favorite blog entry prize with the line: “Orlando is magical when you are a kid. Kids don’t attend HIMSS.”

First-time attendee Jeffrey Ting (from Systems Made Simple) outlined his experiences with some of my favorite topics in his piece, HIMSS Reflections By A First-Time Attendee: HIEs and interoperability. I agree with him: the Interoperability Showcase’s “Health Story” exhibit was one of the best presentations of the whole conference.

Dr. Geeta Nayyar’s perspective as a board member of HIMSS and CMIO for PatientPoint gave her a unique vantage point for her post, HIMSS 14: A Truly Inspiring Event. Take note, HIMSS conference planners – your monumental efforts were recognized, as was the monumental spirit of the closing keynote speaker, Erik Weihenmayer.

HIMSS Twitter recaps permeated the blogosphere, with my favorite being the inimitable Chuck Webster’s (@wareflo) HIMSS14 Turned It Up To 11 On And Off-Line!. Chuck also periodically provided trend analysis results of year-over-year #HIMSS hashtag traffic for each period of the conference, complete with memes for particular shapes: Loch Ness monster humped-back, familiar faces of frequent tweeters.

Health IT guru Brian Ahier’s (@ahier) wrapped up the “Best In Show” of HIMSS Blog Carnival , complete with Slideshare visuals awarding Ed Parks of Athenahealth “Best Presentation” and providing an excellent summation of must-read posts.

Interoperability was one of the most prevalent themes of HIMSS, and a plethora of posts discussing the healthcare industry’s progress on the path to Dr. Doug Fridsma’s (@Fridsma) High Jump Of Interoperability (Semantic-Level) were submitted to the Blog Carnival. Notable standouts included: Shifting to a Culture of Interoperability by Rick Swanson from Deloitte, and Dr. Summarlan Kahlon’s (of Relay Health), Diagnosis: A Productive HIMSS 2014, which posited that, “this year’s conference was the first one which convinced me that real, seamless patient-level interoperability is beginning to happen at scale.”

And who could forget about patient engagement, the belle of the HIMSS ball? Telehealth encounters, mobile health apps and implications, patient portals, and the Connected Patient Gallery dominated the social media conversation. Carolyn Fishman from DICOM Grid called it, HIMSS 2014: The Year of the Patient, and discussed trepidation patients feel about portal technologies infringing on face-time.

Quantified-self wearable-tech offered engagement opportunities, as well. Having won one such gadget herself, Jennifer Dennard (@SmyrnaGirl) gave props to organizations like Patientco and Nuance for their use (and planned use) of wearable tech in support of employee wellness programs, and posited on the applications of such tech in the monitoring and treatment of chronic disease in her piece, Watching for Wearables at HIMSS14.

Finally, if you’re able to read Lisa Reichard’s (from Billians Health Data) @billians) highlights piece,Top 10 Tales and Takeaways, without busting out into Beatles tunes, you probably wouldn’t have had nearly as much fun as she and I did at HISTalkapalooza, dancing to Ross Martin’s smooth parodies. You also probably don’t have your co-workers frantically purchasing noise-canceling headphones.

I did say I’d be singing to bring HIMSS to a virtual close.

Can’t wait to get back to the metaphorical microphone for HIMSS 2015 in Chicago!

EHR and Football

Posted on September 7, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Some might think that this is going a little off topic, and that my mind is already looking forward to a big start to the NFL season this weekend and college football in full swing. I certainly won’t deny my love of some good football. I’m not sure why it’s so fun to watch, but it is. I have so many good memories watching football. Seems I’m not alone since I saw a tweet that said “An interesting commentary on the country. 4 million watched the Democratic Convention. 21.81 million watched NFL Football.”

With that said, I’m all about comparing EHR to other things we see in life as a way of learning and improving. I think analogies like this can be really valuable ways to see EHR in a different light.

I first started thinking about EHR and football when I saw this tweet from Charles Webster, MD:

Here’s a section of his blog post about EHR and football:

Medical office staff members interact in ways that are similar to a football team. For example, they have an offensive line whose responsibility it is to efficiently, effectively, and flexibly move an encounter from waiting room to checkout. There’s a quarterback who calls plays. Sometimes it’s the physician who directs staff to administer a vaccination or auditory test; sometimes the plays are called automatically based on the reason for the patient’s visit, such as “well child” versus “ear ache.”

Tasks are “passed” among team members, such as a nurse gathering vitals and checking medications and allergies before passing the assessment and treatment tasks to the physician. “Dropping the ball” results in inefficiency that slows the encounter and ineffectiveness that affects patient care and physician revenue.

The defensive line may be less obvious, but it consists of threats to the accomplishment of efficient, effective, flexible workflow. It is the offensive line’s responsibility to protect this workflow. For example, the phone nurse blocks defensive line interruptions that would otherwise distract the physician from maximizing use of the most important and constrained resource in the practice, his or her time. Anyone (or anything) who contributes to the hassle factor of practicing medicine is part of the defensive line.

You should check out his full article where he asks a bunch of interesting questions as well.

I think the best comparison to football comes when you consider who’s the leader of the team. In football, it’s essential to have strong leadership to be able to coordinate and inspire everyone on the team to do their job. I’ve seen many times where clinics have very poor leadership. Much like a football team, this leads to a lot of problems and issues.

In football they often talk about being “assignment sound.” That means that each player on the field has a specific assignment and they need to perform that assignment. They shouldn’t vary from it, because when they do they leave their other teammates in a bad position. Many medical practices implement an EHR with no plan in mind at all. It’s hard to be assignment sound when you don’t even know your assignment. Of course, this goes back to having good leadership as well.

Another problem in football is not only having a good plan, but inspiring the team to execute the plan. We’ve seen over and over again where the coach loses the football team. The team no longer listens to the coach, so no matter how much planning he does it doesn’t matter since he can’t inspire his team to execute it. EHR implementations can learn a lot from this idea. Your EHR implementation needs to have a well thought out plan, but it also needs a “coach” that can inspire the team to execute that EHR implementation strategy. It’s not enough to have a plan if your team isn’t going to support it.

I’m sure there are other good comparisons of EHR to football. Maybe we could even talk about the big business of football and how that compares to the big business of healthcare. One difference between football and EHR is that in football there’s only one winner. In EHR, everyone can win.