Basic BPM for Healthcare


Healthcare professionals have no difficulty understanding what a Case is and what a Best Practice protocol is. Ask any healthcare worker what Case Managers do and the answer will be “Well, they manage Cases”.

A Case in healthcare is a Patient. Each patient has an Electronic Medical Record (EMR) or Electronic Health Record (EHR) or e-Chart and each and every intervention carried out at the Case must be documented. This gives a history, which is a reverse chronological listing of interventions with date/timestamps and electronic signatures, plus hyperlinks that allow data to be viewed, as it was, at the time it was collected, on the form versions that were in service at that time.

It is well established in healthcare that consistent use of Best Practice protocols leads to improved outcomes so its unlikely you will get arguments from staff members re the value of a methodology such as BPM (Business Process Management).

Except that few know/care what BPM is and it’s probably just as well because in a well-designed EMR/EHR/eChart application system core methodologies such as BPM should stay in the background.

(typical demo script)

Let’s take a look at a typical Case Manager’s workload for a day and how BPM helps improve staff productivity, improve throughput, decrease admin/clinical errors and improve compliance with internal and external rules and regulations, all of which leads to improved outcomes for the patient and for the healthcare facility itself.

We will start with a blank canvas upon which we can map a process template using drag-and-drop techniques. Process designers or facilitators deposit “steps” on the canvas and link the steps with directional arcs.  Each step has a routing parameter (who), an optional instruction (what), plus one or more forms that are needed to document performance of the step at run time and collect any required data.

The best way to build process templates is in real time, in front of a small group of stakeholders.  The process mapping environment allows immediate compilation and roll out of process templates so you can “piano play” your process in front of the stakeholders.  This beats holding a design meeting where you take notes, go away for a few days and then come back to review a paper process map.

Some of the steps you see in the demo are decision boxes that cause branching to sub-pathways along the process.  Other steps are system-level steps called key process points or KPPs where background software examines the state of a process instance and determines whether it is appropriate to proceed/not proceed.

An example of a KPP is a chart review where, if a rule set stipulates that seven (7) deliverables must be present and only six are present, the system will set up a roadblock. Case managers must remedy any chart deficiencies or seek supervisor override in order to move forward.

Best Practice workflows set the stage for the Orchestration (i.e. guidelines) of process instances and Governance (i.e. guardrails).

Once a process has been mapped, one click compiles the process and rolls it out.

Let’s now take a look at the Run Time environment where the focus shifts from building process templates to patient-specific instances of process templates.

When I stream a patient onto a process template, the patient acquires a private instance of that template.

In this demo, we will be looking at several patients being processed.  Each patient progresses independently along his/her private instance of a best practice template. It’s not uncommon for a patient to be on two process instances at a time, it’s possible in some situations to have one patient on two instances or more of the same best practice template.

Clearly, with multiple providers attending to the needs of multiple patients on different Best Practice instances, it is essential to have a Run Time environment that is able to match up patient needs with provider availability and provider skills, at different locations.  Many times, equipment is needed, accordingly, automated resource allocation facilities are needed to cover the full range of What, Who, Where, When and Why.

The user interface for a healthcare worker is surprisingly simplified – facts are this extends to any work, so the methodology used is not specific to healthcare and can apply to , say, job shop operations such as Helicopter Maintenance, Repair, Overhaul (MRO).

If you think about it, we all come in to work each day and attend to our fixed-time appointments.  In between appointments we work on our to-do lists.  That covers 100% of what everyone does each day, all day.

It follows that the ideal UI is a single screen with a traditional calendar and a to-do list.  Not all that different from Outlook, you might say, but with one huge difference which is background processing that provides orchestration and governance.

In the example, we see a new patient, Martin Frobisher, being streamed onto a best practice protocol.

Watch as I process steps and then visit the patient history.  In the demo, all steps are routed to me so that we avoid having to log out/log in under different user accounts at each step.

At a practical level, you will have noticed that as and when I commit steps, I do not have to tell anyone.  The system automatically loads the next-in-line step to the attention of providers who are a) available and b) have the requisite skills to perform specific steps.  The providers do not need to look up instructions.  These, where needed, are a property of each step.

The same holds true for forms. Any and all forms needed to document an intervention are at the step. Providers do not have to hunt for the right forms.

Case management is greatly simplified, all any provider has to do to bring himself/herself up to speed on a Case is to click on the Patient Hx.  And, any data collected at a step of an instance, carries forward along the instance, so no double keying is needed.

Things do not fall between the cracks because the moment one step is committed the next-in-line step posts.

There are no unwanted delays between the completion of one task and the start of the next, assuming case managers are diligent in processing steps as these post to their inTrays.

In the normal course of events, steps are routed to skill categories not individuals.  If an order for Day–Nurse posts, and there are five Day-Nurses on shift, the order will broadcast to all five.  The 1st to pick up the order ‘takes’ the order and locks it down. The order clears from the inTrays of the other four. If a person goes off shift without completing a step, the step goes back to the pool for re-allocation to, say, a night-shift replacement.

Orchestration of instances goes beyond resource allocation and data collection.  Decision support in the form of calculators, algorithms etc. can be built into forms. Custom widgets can be dragged and dropped onto a process template to provide special functionality.

The same holds true for Governance. Here the likely scenario is that a KPP step will have a skill code tag of “system” which means no human sees the step.  As with ordinary process steps, there are forms but the data on these forms comes from data recorded by providers.  A rule set at these forms evaluates to True of False and when the rule set evaluates to TRUE the gateway opens whereas an evaluation to False leaves the gateway closed.

Bottom line, we have a simple user interface that accommodates all manner of structured and ad hoc interventions, with Orchestration and Governance.

There is, however, one very important dimension to the BPM implementation that we have not discussed and that is interoperability.

In any large organization, no single software system handles all aspects of running operations.  The usual finding is multiple systems, each making an important contribution to operations. These systems need to talk to each other and BPM systems are no different.  Accordingly, it is essential that any BPM system you acquire have the ability to engage in multi-directional data exchange.  If your proposed BPM system does not have interoperability, then you need to look elsewhere for a solution.

If you would like to see an EMR/EHR in action, call Civerex at 800 529 5355 and we will walk you through a 15-20 minute GoToMeeting demo. If you like, you can take control of the mouse and build and run a demo of your choice to prove to yourself that no training is required to build simple process templates and make these operational.

About kwkeirstead@civerex.com

Management consultant and process control engineer (MSc EE) with a focus on bridging the gap between operations and strategy in the areas of critical infrastructure protection, connect-the-dots law enforcement investigations, healthcare services delivery, job shop manufacturing and b2b/b2c/b2d transactions. (C) 2010-2017 Karl Walter Keirstead, P. Eng. All rights reserved. The opinions expressed here are those of the author, and are not connected with Jay-Kell Technologies Inc, Civerex Systems Inc. (Canada), Civerex Systems Inc. (USA) or CvX Productions.
This entry was posted in Automated Resource Allocation, Business Process Management, Case Management, Compliance Control, Data Interoperability, Decision Making, Interoperability, Process Management, Productivity Improvement and tagged , , , , , , , , . Bookmark the permalink.

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