The final frontier? – ACM, BPM, CPM, DMS, ECM

First we had CPM, then, somewhat in this order, DMS, BPM, ECM, and more recently, ACM.

What are these methodologies, what are their benefits, which ones do you need to manage your business, is there any overlap across the methodologies and how do you implement and integrate the methodologies?

• CPM (Critical Path Method) dates back to the 1950’s and is the methodology of choice for Project Management. It is used to plan, monitor and control the timing of events and costs associated with projects.
• DMS (Document Management Systems) have been around for approximately the same time and owned the imaging/storage/retrieval domain until ECM came along.
• BPM (Business Process Management) is the preferred methodology for planning, monitoring and control of structured activity.
• ECM (Enterprise Content Management) is an upgrade for DMS, at least for large scale document management initiatives.
• ACM (Adaptive Case Management) is the new kid on the block and is the methodology of choice for management of unstructured work.

It’s obvious that any organization that has a mix of unstructured and structured work needs ACM/BPM and since both methodologies draw on scarce resource pools it seems that a common run time environment is the way to go.

Since ACM implementations have a strong focus on unstructured work, it’s obvious there is a need to accommodate random arrival of documents that support this work, unlike form templates that can be anticipated and progressed along BPM process instances.

So, in respect of integration, we might as well try to have ACM/BPM/ECM working together seamlessly.

Practical Considerations for Patient Care

In respect of methodologies of choice for healthcare, the core focus must be the “case” given that decisions relating to patients require consultation of prior interventions for decision-making regarding current and future interventions. A case is nothing but a meta record or “bucket” that accommodates pretty much any object and allows viewing of recordings in reverse chronological order.

The term “case” pre-dates Adaptive Case Management in healthcare. The old term for “case” was “the chart”.

Curiously, after 50 years of trying to go paperless, we still see row upon row of filing cabinets with colored file folders at clinics/hospitals and some of the more” advanced” healthcare facilities seem preoccupied with scanning of legacy documents as they struggle to escape from paper.

The nice feature of the chart (assuming you could find it when you needed it) was that you could open up the file and see the chronology of services rendered for a patient. The problem was worrying about whether anything important had been removed which could influence decision-making.

Electronic charts make the chart available everywhere and, usually, what is in the chart can be viewed but not changed. However, the presentation of the material in some implementations is a step backwards from the chart where you could see data, as it was, at the time it was collected, on the form versions that were in use at the time the data was collected.

Wait a minute !

This sounds exactly like a requirement for ECM, so why not expand e-charts to include not only forms that can be filled in, plus scanned material, plus, while we are at it, spreadsheets, MS Word documents, and audio/video recordings?

There are many ECM software systems/services on the market.  Having to navigate a separate database clearly gives rise to increased complexity and increased security risks compared to having documents IN a patient EMR so it looks like the combination of methodologies for run time workflow management in a mixed structured/unstructured work environment is precisely ACM+BPM+ECM.

Practical Considerations for Discrete Manufacturing

For work that is mostly structured, it would seem advisable to look for software that integrates BPM+CPM+ECM, particularly for discrete manufacturing applications where JIT inventory management is being practiced.

Now, what are the chances that the next new methodology will have an acronym that starts with an “F”?

The Juggler

Too much to do, too many options,  how to prioritize?

If this sounds like your average workday, the reality is your organization has finite resources, and there always will be options, so how do you rationalize spending time on one initiative instead of another.

First, you need to inventory all of your assets – plant, equipment, human resources, products on the market, products coming on the market, changing regulations, industry trends, competitors.

All of these are related because when you put a focus on one, it diminishes your focus on the others.

We used to complain that we either had too much information , or too little, or it was in the wrong place.

Today, I would say we have too much information and it’s everywhere,  and on top of this, some of the information is bad and some of it is not.

Consider my Blog.  I have 100 + articles and I walk a tightrope each time I put out a new post (e.g. is it a duplicate of something already out there, does the advice go counter to what I have published in other blogs, are the topics interesting or boring, has the style of the posts changed over time for the better or worse?)

I used to have this nice binder to file all of my posts, but it filled up, and then I had two binders.  You can see where this was going.

What’s the solution?

It’s called a Mind Map and wow, have these come a long way.  First of all, you can start with a free one. Free is good.

OK, you don’t have a blog -  that was just an example.

But, you do have a corporation to run and you do have options and scarce resources, so my advice is get with the program and start using mind maps upstream from your strategic plan.

In fact, make your mind map your stay-resident application in the background for all of your strategic planning activity.

If you do this you won’t have to focus so much on your juggling skills.

Worried about taking the plunge?  Call me at 450 458 5601.  Five minutes on the phone and you will have a free, first-class mind map downloaded and installed on your PC, ready for you to start making more effective decisions.

The rest will be up to you.

Haste makes waste

Don’t be in a rush to select a BPMs product . . . .

First your client needs a consultant (internal or outsourced) to help them set up a mind map, then develop/improve the corporate strategy and then, only, do we get to where processes are needed and tools are needed to map these.

The term “processes” needs highlighting because there are two camps, one that buys into the notion that everything is a process (including ad hoc processes of one step), the other being unwilling to accept the transition from two steps to one as being a minor one that really does not require different thinking.

At the end of all of this when your client has a mind map, and a strategy and is about to select a mapping environment, its important to know what the mix of structured versus unstructured work is going to be for the organization (5/95, 95/5, or more likely a changing mix somewhere in between). For most of the scenarios you probably need ACM/BPM not BPM.

The next to final step along the road to success with ACM/BPM is to have seamless integration between your mapping environment and a run-time automated resource allocation, leveling and balancing environment where your best practices can guide the processing of instances of templates. There should be no need to write any code to compile your process maps.

If your processes are the least bit complex, you will not get sustainability by expecting staff to stare at process maps.

The auto resource environment, on the other hand, will post tasks to user Orders InTrays and remove concerns of what to do, when, how, where, and, at times, why.

With knowledge workers most of the posting is done by the knowledge worker (their to-do list) but for routine work, the auto resource environment does most of the heavy lifting.

The final step, following recording of transaction data at steps (structured or unstructured) involves, again, seamless linking to a data warehouse where your client can carry out data mining / data analysis, with a view of identifying ways and means of improving processes.

Coming soon to a place near you !

In healthcare, the long standing presumption has been that the patient has received an almost exclusive focus (i.e. fix this problem and the rest will take care of itself).

It’s easy to understand how that has worked in a Fee-For-Service model environment (e.g. order 5 tests and maybe you will discover issues that 4 tests might not have discovered).

Where we seem to be headed is toward a Performance Based Reimbursement (PBR) model, based on aggregate outcomes and the danger here is that the focus will shift to “measures”.

It will be tempting under PBR to avoid taking on problematic patient populations (i.e. often the very ones who most need help).

With large numbers of patients being serviced, the numbers probably average out but how do healthcare professionals operating under PBR get to where they feel their actions at the individual patient level consistently contribute to better aggregate outcomes?

Traditional case management has relied on mostly qualitative governance for decision making regarding discharge.  Given a diagnosed disease, the healthcare professional selects a modality from an inventory of modalities, gains access to pairs of goals/objectives, picks one or more of these, tracks progress toward attainment of goals/objectives and, then, when the time is right, initiates discharge protocols.

All of this is very subjective and could be supplemented with non-intuitive decision support mechanisms, one example of which is a generic Figure Of Merit Matrix that consolidates progress across all goals/objectives.

This model has been described at http://wp.me/pzzpB-iF

You can get a free copy of the spreadsheet that defines the “Adaptive Case Management Earned Value Matrix”  model and immediately start to use it across your entire patient population.

You can order it by e-mailing civerex@civerex.com or by phoning 450 458 5601.

Considerations for easy use of the model are a) ability to attach individual spreadsheet instances to each patient file for quick access when a particular patient has the focus in your EMR and b) ability to export diagnosis plus tracking of progress information toward the overall case objective for statistical/tabular analysis across different patient populations.

For filmmakers: Invisible Tripod, what next?

I talked today to a rep at Kenyon Labs re their “invisible tripods”.

Take a look at the web site . . .

http://www.ken-lab.com/

but be prepared for weeks of sleepless nights if you decide to save up and buy one of their gyros.

It LOOKS like this proven invention (binoculars on ships etc) really could act as an “invisible tripod”. Would that be cool or what?

Really, really, really neat stuff if it works the way they say.

Does anyone have one of these such that performance can be confirmed?

If your camera plus add-ons weighs less than 8 lbs the model to get is KS-6, above 8 lbs it would be the KS-8. Bottom line, I think most AC130/160 owners could do with KS-6. These gyros are NOT that expensive.

Consider the prospects of being able to walk around an actor or a site with no jiggles, following actors up/down stairs, filming from a moving car – this opens up new horizons.

I have to go to Meriden, CT in a couple of weeks and I might be able to fit in a visit to the Kenyon Labs factory which is apparently not far from Meriden.

Sadly, Kenyon Labs has bought back all of their public shares so no chance to invest.

Why did I not hear about these folks earlier?

Thanks to members of DvxUsers for pointing them out.

The Compleate HR Manager

I remember this time when I had a young working mother in my department who had to be home by 1600 hrs and so I told her, no problem, just start at 0730 hrs and finish at 1530 hrs.

This worked for a while until one day I had a visit from the HR Manager who told me I was not allowed to do this.

I asked him to show me the procedure that governed starting hours and then ceremoniously removed the offending procedure, ripped it up and then announced that I no longer had a procedure that said I could no longer do this.  HR did not speak to me for a number of months.

In 1990 when my wife and I decided that we had enough of working for Fortune 500 companies and started up our own business, we had a problem with dog-sitting for our German Shepherd, Aimie. We ended up having to keep her at the office.

The thing about Aimie was she either liked you or she did not like you.  If she did not like you, even a sideward glance would provoke a deep growl.  You could come back in three years and the response would be unchanged.

People would ask “Does she bite?” and the answer was “Not if she likes you”. This usually led to “But, how do I know if she likes me?” followed by “You’ll know!”

To make a long story short, back in those days we figured that with a small group of people one of the most important things was to have harmony across the organization so the usual routine following interviews would be “How did you like so-and-so?”, followed by “And, how did you like so-and-so?”

Then, the final question would be “And, how did Aimie relate to the candidate?”

For legal reasons, we will not, even today, admit to any role that Aimie might have played in our hiring processes, but we did find out after a while that this type of screening was not regarded as appropriate.

Aimie lived to the age of 13 1/2. We still think of her almost daily and miss her terribly.

Medicare and Medicaid Programs: Electronic Health Record Incentive Program-Stage 2

The comment period for “Electronic Health Record Incentive Program-Stage 2″ closes Monday.

If you have not yet read CMS-2012-0022-0001, now is  the time.

Civerex displays an active interest in evolving EHR technology and I am reproducing below a copy of our comment #81005bf1  to regulations.gov where we predict the outcome of a forced move away from patient centric to statistical reporting of abstract aggregate measures.

Here below is an extraction of the text of our commentary:

We did a search on “performance” across the Stage 2 NPRM and our comment is that whereas FFS allowed a focus on patient care under the false belief that “more is better”, we predict that any shift to Performance Based Reimbursement is going to abstract this focus to aggregate measures which will not be perceived as “hands on” controllable. 

 Civerex has developed an “earned value” model (on spreadsheet) that allows healthcare providers to track progress toward meeting individual patient objectives, thereby providing a foundation for aggregate measures. 

 The use of a model of this type would allow healthcare professionals to feel that they have control over the measures they will be required to report on (i.e. managing individual patients efficiently will lead naturally to better aggregate outcomes).

 We are willing to contribute this algorithm for general use so long as there is a credit line showing Civerex as the developers of the algorithm. 

 See a writeup on “Adaptive Case Management Earned Value Matrix  Model” at

http://wp.me/pzzpB-iF

 

We are hoping they will take us up on our offer.