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Free Webinar "The Power of Process" on Workflow Automation, BPM and Healthcare I Interview New M*Modal Website(!) on Future of Language and Workflow in Healthcare #POWHIT at #HIMSS13: People & Organizations improving Workflow w/Health Information Technology Wordle Based on 40,000 Words in 500 Comments to NYT’s “Digital Shift on Health Data Swells Profits” "SR works well, but it is nothing without workflow integration" 10 clicks vs dock S.Y.S.T.E.M.: An EHR should… Save You Substantial Time, Effort, and Money Process Support and Knowledge Representation in Health Care: New Book! Fixing Our Health IT Mess: Are Business Models or Technology Models to Blame? Meeting Meaningful Use Measures Without Overhauling Your Workflow And Reducing Productivity Can Healthcare Really Have Both Consistent and Flexible Information Systems? "workflow engine ensures vital tasks are completed & accumulate useful context to direct clinicians to best choices" Twitter Reacts to New York Times’ “In Second Look, Few Savings From Digital Health Records”: An Informal Sentiment Analysis EHR is "horribly inefficient & productivity robbing method for capturing clinical info & presenting it back to clinicians" Natural Language Processing and Healthcare Workflow: Interview with M*Modal’s Chief Scientist Juergen Fritsch, Ph.D. Short Overview of the RFID Technology in Healthcare < complementary to workflow tech Activity-Based Working "provides employees with predetermined activity areas that allow them to conduct specific tasks" "Process simulation software is a natural complement to Lean Six Sigma" BPM models & executes Ecuadoran health insurance processes. Users design screens, content & behavior. Eliminate silos "medicine shld b standardized like business processes" vs "dangerously reductive" vs "focus on interpersonal interaction" BPM 101 < good short intro Intelligent Complex Event Processing with Artificial Neural Network < patient monitoring system example IBM: Using BPM Tools and Methodology in Healthcare Care process management: Using BPM tools and methodology in the healthcare environment Health IT and Patient Safety: Building Safer Systems for Better Care - Institute of Medicine 2012 Big data problems in healthcare call for BPM Facebook-like EMR (Part I) < need to combine activity stream with structured workflow EHRs breed digital discontent for docs "unintended consequences...a lot of unhappy doctors...electronic records actually slowed things down, and the doctors could see fewer patients" Workflow engine eliminates user dispatch requirements for routing: automated, rules based delivery of current exam w/relevant prior images and reports What makes a good process model? < full text Highly flexible & massively scalable workflow engine for dynamic healthcare IT intra- & extra-mural workflows Safety-Enhanced Design < HHS: user-centered design, SW QA, patient safety event reporting Why Lean Might Not Be the Best Solution to Healthcare Inefficiencies < need dynamically changing workflow Errors Occurring in Clinical Radiology Practice < communication loop and imagine chain are workflows Swiss Cheese and Patient Safety < "incomplete layers of protection allow errors to pass through" < layer = processes EHR Data Pre-processing Facilitating Process Mining: Application to Chronic Kidney Disease "meaningful use led to the growth of a small number of vendors and dependency/lock in with those vendors" < out of context, I know! EHR vendor copy "web based software that has a built in customized workflow engine" Managing the Life Cycle of Electronic Clinical Documents < problem that EHR workflow is "hard coded" Workflow Builder for medical imaging interoperability "pre-defined components and workflows, standard workflows can be customized using point and click functionality" Interactice Voice Response Visual Application Mapping "visual mapping for creating call flows" resembles workflow process definition editor Common BPM adoption patterns and best-practices across different industries < no healthcare but good overview efficiency, visibility, agility Petri Nets and Clinical Information Systems, Part II: A Closer Look at State Demystifying Speech Recognition < audio to phonemes to words to phrases to formatted text Chapter 31. Organizational Workflow and Its Impact on Quality (in healthcare) 2004 & 2006 EHR Workflow Management System Tutorials My blog post > Top Ten Reasons EHR-BPM Tech Is Not (Yet) Widely Deployed in Healthcare Workflow Tokens "imagine record as manila folder w/little wheels" < discusses clinical paper form workflow BPM Streamlines Health Care Appeals and Grievances by 30% Process Mining in Healthcare: Data Challenges when Answering Frequently Posed Questions Intelligent BPM < patient examination example 5 benefits of NLP for healthcare < conversation, coding, documentation, decisions, interoperability What is an iBPMS? < Hmm...what is an iEHR BPMS? Physicians are increasingly dismayed by meaningful use because the requirements are complicated, they slow work flows and the value is not always overt NLP & transcription: discusses workflow "minimize both risk and errors by executing three to four levels of proofreading and quality checks" Building a Large-scale Commercial Natural Language Generation System for an EMR Workflow management software...helps healthcare providers achieve efficient healthcare environments Cited! My “Process-aware EHR BPM Systems: Two Prototypes and a Conceptual Framework” User-Centered vs Activity-Centered Design: A Follow Up to “User-Centered EHR Design Considered Harmful” Future of Social in the Enterprise < relevant to social, groupware and workflow in healthcare Smart Infusion Pumps < dose error reduction system Healthcare workflow wins Workflow-as-a-service contest < mentions my blog User-Centered vs Activity-Centered Design: A Follow Up to “User-Centered EHR Design Considered Harmful” Lost in Menuspace: User Interactions With Complex Medical Devices "finite state diagrams permitted us to fully describe the inner workings of the infusion device before lab and field studies." 5 health IT insiders offer their takes on EHR usability < data entry, error, metrics, training, slows down docs "I think the market is the final test of usability" Process Thinking for Business Agility < fascinatingly relevant to EHR development "EMRs alone will never fix bottlenecks, improve workflow or build a better team. They are repositories for info" Ten Years Ago, Dallas HIMSS: Landmark Presentation on BPM EMR Workflow Groupware My comment: importance of workflow engines and process definitions to "knitting modules together in to usable EMR workflows" "Clinical Process Optimization" & "Activity Based Costing" Best Care at Lower Cost: Path to Continuously Learning Health Care in America < 450 pages mention "workflow" 20 times, never workflow technology or BPM The Trouble with EHRs - 26% report decrease in productivity Context-aware compliance checking < relevant to medical error & patient safety Why Lean & Agile Go Together < possible argument 4 process-aware EHR methinks Automated support for case management processes with declarative configurable specifications "Healthcare seems the natural domain for case management" Controlling business process instance flexibility via rules of planning < deontic logic: must, ought, etc. Large Scale Requirements Analysis as Heterogenous Engineering < relevant to meaningful use "Language-Aware Information System" < not many hits, but interesting parallel to "Process-Aware Information System" Why Workflow Analysis, Redesign Are Keys to Successful EMR Implementation and EMR Selection "Business process management software can help healthcare CIOs not only deal with data-related challenges, but also align data systems with operational needs, enabling productivity gains" Knowledge Intensive Business Processes < Modeling Approaches to Healthcare Processes (p 35) Gartner 2010 Bpms Magic Quadrant < not current or healthcare specific, still relevant to healthcare Modelling workflow processes for clinical information systems How to create EHR workflows that increase productivity "many EHR built-in workflows cannot be altered" < that's why need EHR workflow system Medical Lab Realizes 50% Productivity Improvement in Medical Billing with Adaptive Case Management Interesting slides about BPM, KPIs, and goals in healthcare context Ensemble Business Process Management (BPM) < link to healthcare case study (no mention BPM tho) Hospital delivers high quality patient care with a collaborative and interdisciplinary BPM system Chester County Hospital: A [BPM] Case Study Hospital users use BPM to create 120 process flows, 12 times more productive Tweeted graph "More docs believe EHRs decrease productivity! Fault in design or EHR use?" Select dictation process designed to promote physician workflow < front-end vs back-end workflow My comment on: Intelligence-Based EMR < business process management and natural language processing Putting Watson to Work in Healthcare < workflow under hood EHR Usability, Workflow & NLP at AMIA 2012: Presentations You Don’t Want to Miss! "speech & language understanding tech & clinical documentation workflow" < increasing confluence of NLP & workflow Enhancing Productivity of an Evolving Workforce < adaptive case management, relevant to health IT EMR Workflows – How Essential are They? < first two paragraphs obviously based on my EMR Workflow Management whitepaper Activity Theory: Hierarchical structure of activity < motive, activity, goal, action, operation, condition "Unconverted workflow" even after addition of NLP to generate ICD-10 codes Vendor: Speech recognition + NLP + ICD-10 + workflow orchestration + EHR Why the EMR Needs to be Viewed as a Medical Device < yes, like a medical device it should execute a process model ICD-10: Going back to basics - A Workflow Perspective "The workflow processes that are implemented from a technology perspective are fluid and subject to change" Healthcare Business Intelligence: Guide to Empowering Successful Data Reporting and Analytics Speech Technology to Drive EHR Adoption "once-and-done workflow" vs disruptive "queries from coders or CDI specialists" EMRs should "keep track of test results and alert doctors when the results have not been reviewed" Lean Simplified - Value Stream Mapping - Patient Scheduling < value-added (keep) vs non-value-added (eliminate) (1:03 in video) "Create your own voice assistant fast using a point-and-click web tool: NO CODING REQUIRED" Do You Believe Doctors Are Systems < debate touches on \\'processes\\' ONC EHR Eval Matrix < workflow, customize, alert unfinished, bypass, mult-task, clicks < describing BPM/ACM system Reorganizing for Optimal Workflow "visualize the layout and patient flow through clinical and operational design and modeling" Experts Raise Concerns About Safety of EHRs "Technology errors that disrupt a physician's workflow" < variety of relevant BPM tech Looming Policy Struggle for Meaningful Use < two interesting mentions of workflow re MU "recurring issue of concern for healthcare professionals is the steep EHR learning curve (often caused by their abysmal design) and the dip in healthcare facility productivity that a move to EHRs creates" 2-3 fewer patients seen each day w/EHRs compared to paper < need true EHR workflow systems Meaningful use versus customizable workflow < yet another argument for EHR BPM systems Lean Thinking in Healthcare < prevent delays of communication/handoff btwn roles & depts < needs BPM Clinician "I want a system that can be customized but that doesn't take an IT expert to do it. I want a system that meets meaningful use" Provider of hospital-wide interoperability and workflow engine recognized "empowers health care organizations to take a more holistic approach to workflow design" Tutorial on Activity-Based Costing of EHR < of implementation, not use, too bad! Activity-based costing for health care institutions < full text from proceedings paper >200,000 hits on Google for "activity based costing" surgery OR healthcare OR medicine OR clinical < big increase over only few years ago! Kashfi - 2010 - Applying a user centered design methodology in a clinical context. - Studies in health technology and informatics (Pariya Kashfi) - Academia.edu Acceptance of Speech Recognition by Physicians: Survey of Expectations, Experiences, and Social Influence < three mentions "workflow" "Surgical safety checklists are seamlessly integrated into the system's workflow model" < can users edit workflow model? Model-Driven User Interface Generation and Adaptation in Process-Aware Information Systems < relevant to health IT EHR systems trending to mesh with physician work habits < EHR workflow management/BPM system featured Good example of NLP pipeline/workflow in EHR context "Software should fit itself into physician workflow rather than forcing physicians to change their workflow to match the software" AMIA 2012 Tutorials & Working Group Tutorials < lots of usability and workflow, BPM mention "gastroenterologists, ophthalmologists... do the same kind of thing over and over again. So they can design a software system that speeds up their workflow" Use of Interactive Voice Response Technology in Health Care (slides) Information Overload and Design and Implementation of Computerized Decision Support Discrete Event Simulation for Process Improvement: Emergency Department Flow (video) Clinical decision support: Converging toward an integrated architecture < implications for workflow Fire Up Workflow Engine to Improve Software Development < not healthcare-specific but accessible to healthIT professional Doctors Still Don't Love Smartphone Dictation. < 1-5% error rate requires post-editing workflow Case Management as a Service (CaaS) - Health Case Management < BPM & ACM My comment: meaningful use and the waterfall model of software development “perioperative workflow management system, provides users with clinical dashboards...and provides analytic tools for improving operating room workflow" Better Project Model than the "Waterfall” "The problem with requirements is that they are often wrong” < may be part of problem with meaningful use requirements... Collaborative care platform seen as first step toward shared electronic white board < tracks individual care goals; tracks tasks/steps and responsible party < BPM & ACM HITPC Meaningful Use Workgroup Subgroup #3: Care Coordination (see PowerPoint) Business Process Mapping (in Healthcare) < wish was combined with Business Process Management! "checklists create capacity & save money @ same time" + patient safety, IMO ideal 4 social, mobile, cloud BPM/ACM Mediating Between Representation and Action in Workflow Systems < relevant to mediating between physicians and EHR databases Trends Driving the Patient-Centered Medical Home "Emphasis on cost and productivity performance improvement" E-Prescribing toolkit improves workflow < nice diagrams! Traversing the many paths of workflow research: developing a conceptual framework of workflow terminology through a systematic literature review Modeling Clinical Pathways as Business Process Models using Business Process Modeling Notation Voice recognition can have dramatic impact on productivity < unable to move on until complete job correctly < relevant to healthcare workflow "Users can also implement non-programming clinical development processes and associated standard operating procedures within the workflow engine" "doing BPM" = modeling environment + draw / connect series of flows of human tasks & system tasks + executed in runtime environment < not healthcare-specific, but good overview Design Principles < some easier with process-aware tech, some you simply get My comment: EHR workflow systems could become opportunistic organisms that colonize health IT Business intelligence planning for health care EHR Market and Biology 101 “Hard problems, such as decision support, integrated workflow engines, and interoperability, are easier to tackle when starting from scratch" Rethinking knowledge work: A strategic approach < EHR "smart forms" & drug interactions, pages 6 & 8 BPM vendor announces next-generation product development and management solution for healthcare market The EHR Has No Clothes “absence of understanding of the typical tasks and workflow in a primary care office" Leading Healthcare Organizations Recognized by BPM Vendor for Innovations and Business Transformation Clinical NLP at 2012 NAACL Human Language Technology Conference < interesting workflow issues associated with NLP tools Report: Health Care Industry Struggles With Usability of Electronic Health Record Systems IBM Watson and Medical Records Text Analytics My comment on Dr. Mostashari's comment that, ideally, an EHR is not just a documentation system, its a "workflow engine" Usability in Healthcare: Overcoming the Mismatch Between Information Systems and Clinical Work BPM Predicts | The Verticals of Promise for the next 5 years < of 5 verticals listed #Healthcare is #1 New Process Mining Tool Debuts: Healthcare Opportunities Abound! My comment (need for process-aware info systems) on: Healthcare, Your Process is Your Product The user interface for EHRs should be uniform < common view with which I disagree Automatic Generation of Patient-Specific Medical Advice < NLP Healthcare Interface online Course < improve productivity & quality "*without* radically changing underlying tech" < difficult! Automatic Code Assignment to Medical Text Social translucence: an approach to designing systems that support social processes < relevant to clinical groupware Speech Recognition Streamlines Vermont Hospital's Workflow "more lines of dictation in less time with fewer people" "BPM platforms include graphical modeler where app’s pieces R configured, not coded" < EHR should too Creating Usable Electronic Health Records (EHRs): A User-Centered Design Best Practices Workshop "Cognocare an [adaptive case management] #ACM-based system for designing personalized oncology treatments" How To Ease EHR Frustration < "It takes twice as long to complete a patient's visit, and I see 75% of the patients now as compared to before EHR" Cooperative principle - Wikipedia, the free encyclopedia "five key CDS areas: order sets, multi-parameter alerting, nursing care plans, reference content, and drug information databases" Blog comment (not mine) re BPM & ACM functionality "not seen very many EHRs that have such capabilities" When Process Mining Meets Bioinformatics Everything You Always Wanted to Know About Planning (But Were Afraid to Ask) < relevant to all sort of areas in Health IT New Text Search Uncovers Disease Ties and Safety Data Hiding in Electronic Health Records | Observations, Scientific American Blog Network "EMRs are designed to archive information [not] optimal workflow efficiency" Clinical Groupware as Clinical Teamware for Pediatric and Primary Care Practice Health Systems Spending Billions 4 "Last Battle" "to reorder workflow the system has to reconfigured w/considerable time & expense" Frontiers of biomedical text mining: current progress (full text PDF) Intro to Clinical NLP Part 2: Demonstrations of Open Source Tools (PDF: 101 slides) How natural language processing and semantic search could revolutionize clinical decision support? Are EMRs Killing the Clinical Narrative? Healthcare "powerful workflow engine [uses] Windows Workflow Foundation #WWF Beyond Rules & Notifications: Workflow Tech Paves Way for Clinical Improvement (7 workflows) Workflow Management Systems for Mid-Size CROs - Applied Clinical Trials "EHR" vs "EMR"? Reference Concept Maps reveal similarities and differences between scientific and popular definitions Efficiency dashboard helps hospitals pinpoint savings opportunities Extreme Collaboration "Teams collaboratively designing face-to-face, exemplified by war room environments" < how can EHR leverage/make possible/not get in way of? EHR "application architectures and data models must accommodate more fluid workflows" AI enables dynamic process generation for Adaptive Case Management < relevant to EHR BPM HIE Technology: Workflow Factors & Patterns of Use "HIE-related workflow was modeled... site-to-site differences identified" "Workflow engines specialize in executing a business process, not just decisions made at a discrete point in time. The technology can assist greatly in clinical decision-making by not only presenting clinicians with alerts and reminders, like a rules engine, but also by encouraging teamwork in clinical decisions, assisting with the time management and task allocation in process delivery, stating changes in patient or operational conditions, and creating behind-the-scenes automation of process steps" EMR Workflow Management in Operating Room "structured processes, analyzing outcomes and the integration into existing office systems" Plans as Situated Action: An Activity Theory Approach to Workflow Systems < medical scheduling domain Support for Activity-Based Computing in a Personal Computing Operating System < process-centered, includes medical example Process Automation & HITECH Opportunity < Vendor "healthcare and pharmaceutical BPM workflows" My comment: Are "User" And "Process"-Centered EMR Design On A Collision Course? My blog comment: Patient-centered? Physician-centered? Neither! Both! Process-centered! Thesis-Antithesis-Synthesis! Defining BPM Again "BPM software provides control and visibility" < both lacking in many EHRs EHRs, BPM and Complex Event Processing/Event-Driven Architectures workflow engines have three functions: Verification of current status: Determine authority of users: Execute conditional script "challenge of clinical (EMRs) vs. operational (capacity, optimization, throughput) platforms" Improved EHR usability requires a new look at how these systems work "NIST offers some valuable ideas on a technical level, but it does not address the main reasons why many physicians still find EHRs unusable or less usable than they should be" My Comment on Disappearing EMR... "click minimization' ... Many quick, accurate, and enjoyable clicks can be vastly preferable to fewer slow, errorful, and painful clicks" E-Health Records: Are We Safe(r) Yet? "unintended consequences of not taking workflow into account." ProcesssMining.org: Home of ProM, the free open source process mining tool Process-Oriented Integration & Coordination of Healthcare Services across Organizational Boundaries Nearly 80% MD's still use paper chart! Some Maine Doctors Struggle with Conversion to Electronic Medical Records New generation of physicians: new EHR demands "physicians want to work with EHRs that they can modify to their individual preferences" < such as workflow Which EMRs Offer Workflow Management Systems? (Forum discussion) Crack (medical practice) workflow bottlenecks « tables 1 & 2 « classic process mining event logs Why Specialists Need Speciality-Specific EMRs That Understand More Than Their Specialty < ontology, workflow, care coordination Cognition & The Intrinsic User Experience « relevant to EHR usability Interruptions, Usability, and Pediatric and Primary Care EMR Workflow My comments on relevance of process mining to developing EHR & Health IT workflow ontologies Generalist vs Specialty-specific EHRs < workflow considerations AHRQ zeroes in on health IT workflow "health IT has often had disappointing results...need for greater attention to...modeling workflow" AHRQ hopes to help hospitals with health IT project workflow < clinical, not project, workflow Clinical Business Intelligence: One View « one vendor's one pager Why Many Clinicians Dislike Their EMRs "EMRs are not designed to make doctors' lives easier" Hold Onto Your Hats: BPM in Healthcare is Taking Off! HL7 to "open the feedback loop, particularly to those concerned with usability and workflow" Computerized records don't reduce healthcare costs: Social media reactions < where's my tweet? Using Knowledge in the World to Improve Patient Safety: Designing Affordances in Health Care Equipment to Specify a Sequential “Checklist” Electronic health record-based surveillance of diagnostic errors in primary care “Cheaper By The Dozen” Efficiency Gurus Meet EMR Workflow Systems–Usability Results Nurses get tasks, ask for info, enter EHR data using Speech recognition + NLP + two-way dialogue workflow system "…user-centered design…streamlining workflow, tremendous effort has been expended to ensure that the user experience is so intuitive, no training…is necessary" "To standardize things like user interface means hampering innovation and eliminating the possibility of growth and ongoing improvement of usability." HIMSS12 paper: Process Mining of Clinical Workflows for Quality and Process Improvement Free report: Needles in a haystack "mining data, conducting and integrating evidence-based research, and driving the behavior changes required for patient compliance." My comment on TIBCO blog post: BPM and Healthcare — Why Has It Taken So Long? US/HealthIT Not-Invented-Hereism but process mining is game changer Elusive Usability of EHRs < workflow mentioned but not emphasized Using Agent-based Simulation To Simulate Emergency Departments Simulation-Based Modeling Framework To Deal With Clinical Pathways Why Doesn’t Healthcare Embrace Simulation And Modeling? EHRs: 6 factors in physician satisfaction ‹ touch-typing? Electronic Health Record Workflow Management Systems EHR Initiative Launched to Empower Drug Safety and Medication Adherence - New York Times Blog comment: "not seeing forest (high-level flows & permissions) 4 trees (chunks of data & transactions)" « argument 4 EHR BPM/case management systems Video interview: Process Mining of Clinical Workflows for Quality and Process Improvement < HIMSS12 poster Dutch blog (in English) Master Thesis on EHR selection "embedded workflow engine and clinical intelligence enables us to proactively manage processes and analyze outcomes to drive safer and more efficient healthcare" BPM sighting "Healthcare Process Management workflow engine...proactively manage and streamline processes including patient plans of care...analytical tools to...additional improvement" NIST seeks vendors' EHRs to study usability EHR Business Process Management: From Process Mining to Process Improvement to Process Usability “Workforce Analytics for Healthcare” Software Aims to Enhance Business & Clinical Intelligence < dashboard, ad-hoc reports, real-time visibility/alerts Data Requirements FAQ: How to Extract Data for Process Mining? « hospital example discussed Webcast: Is [EHR] Usability More Valuable Than Oil? < "EHR ontology from usage data...evidence-based design" < process mining & semantic BPM Certification Board for Professionals in Patient Safety "Mitigating Risk Through Systems Thinking and Design and Human Factors Analysis" BPM vendors "event-driven technology is unique in its ability to see, understand, and automatically respond to real-time events (and non-events, like when a scheduled medication or test is missed)" Productivity Focused EHRs: Outlasting Government Incentives No, the FDA is not assaulting mobile technology Are EHRs being used to stifle physicians? < no, but usability an issue < commenter: user designer Wonder when we'll see on TV > "If you or a loved one has suffered an injury due to an EHR…speak with an experienced attorney about your legal rights" "three over-arching concepts: access, integration, and user-centered design…streamlining workflow…to ensure that the user experience is so intuitive, no training…is necessary" EMR Shortfalls < need “data in motion...driving healthcare decisions as events occur so that outcomes can be optimized” AKA BPM + CEP SimChart, an educational simulated electronic health record (EHR) system Healthcare Use of Workflow Engine Tech w/Emphasis on Data Analysis & Decision Support Human Factors Inculturation through Education for EHR Hazard Ahead - Medical Alarms & Patient Safety "unintended consequences of the use of medical devices and alarms" New IOM Report on HIT and Patient Safety: Safer Systems, Better Care What Matters Most about Usability & Design for Clinicians "common terms related to human factors and usability and how these relate to technology design" Practical Application of Control Theory to Improve Capacity in a Clinical Setting "predict department occupancy and avoid patient overflow" Finding the Right Workflow Using an Ambulatory EHR Do EHR Investments Lead to Lower Staffing Levels? "Hospitals with a greater number of EHR applications in use do not appear to realize significant gains in labor efficiency" < my opinion? need true process automation One hour video: Heavily-Used Interfaces: Designing for Efficiency < relevant to EMR EHR usability EMR: Efficiency Mauled Repeatedly < E.M.R. Get it? Go Big (Data) or Go Home "an EHR is only as valuable as the data captured within it" Startups Aim To Help Patients Search Medical Adverse Event Reports Call to Prioritize Patient Safety "adverse event reporting systems are 'bolt-on' additions… do not result from a thorough analysis of how work is done… not designed to capture near-misses" IBM YouTube Video: BPM for Healthcare Providers in Treatment Decision-making - YouTube < mentions EHRs & complex event processing BPM & Medical Devices "monitors literally hundreds of thousands of events on a daily basis from medical monitoring equipment and it senses response patterns and issues alerts" Digital World - A HIMSS Perspective < mobile technology, interruptions, workflow "Improve usability by creating more intuitive interfaces and designing flexible EHR systems that...streamline workflows and improve quality" Call for Papers | BPM 2012 < includes Process-enhanced groupware, case handling systems, complex event processing, ontologies and semantic process models Introduction to Industrial Engineering < includes: define processes, identify inefficiencies, process improvement Intuitive vs. Intuitable EMRs, EHRs, and Clinical Groupware: Do We Need Smarter Users or Smarter User Interfaces? Developing a Process Quality Improvement Questionnaire – A Case Study on Writing Discharge Letters Compliance Oriented Process Management Using the Example of Clinical Trials Context, Retrospection, and Prospection in Healthcare Process Definitions On the Modeling of Healthcare Workflows Using Recursive ECATNets "Since the implementation of the EHR system, each doctor sees one less patient each day...loss of $1.5 million each year" < EHRs need dramatically more usable workflow! EMR Adoption Model < should compare other maturity models: software, BPM, usability, care coordination "software that allows hospitals to efficiently and effectively plan and manage patient workloads" $250,000 Janssen Connected Care Challenge "improve the coordination of care as patients are discharged after surgery or other inpatient stays" < cross organizational workflows Automated Workflow Engine | Power Your [Medical] Practice < "workflow engine" increasingly mentioned in Health IT National Institute of Mental Health uses BPM "to automate and streamline operations, improve user support, and reduce costs" "Healthcare providers contend with the seemingly conflicting goals of cutting costs while simultaneously improving the quality of care" < BPM to rescue, will see more and more 2012 New Year's Resolution "Improve usability by creating more intuitive interfaces and designing flexible EHR systems that enable customization" EHR Workflow Mining: EHR Workflow Inc. Sentinel Events Alert on HIT "Not only must the technology or device be designed to be safe, it must also be operated safely within a safe workflow process" "aspects of a modern system that are absent from most EMR systems today: 1. Easy-to-create forms and workflow" Refining Process Models through the Analysis of Informal Work Practice < relevant to understanding EHR workflow What is a Business Process? "activity or set of activities that will accomplish a specific organizational goal" < therefore a Clinical Process = "activity or set of activities that will accomplish a specific clinical goal" MATH (Modeling & Analysis Toolsuite 4 Healthcare) "software of an information system actually embodies a model of workflow" < practically central tenet of BPM < why I advocate EHR BPMSs XDW: Workflow Automation Among Multiple Care-Providing Institutions < Human readable roles, tasks, participants Business Rules Manifesto < would be interested to rewrite as "Clinical Rules Manifesto" re Clinical Decision Support Borneo Post: "checklists have been so effective at minimizing human error that WHO reinstated use of checklists in medical workflow" 7 Ways KPIs Can Make Your Process Worse < applies in spades to clinical intelligence KPIs Decomposing Process Mining Problems Using Passages < not specifically about healthcare, but relevant to process complexity 6 Ways to Use Business Intelligence Software [in healthcare] < process mining relevant to all 6 Blog comment: W/right "BPM/Rules application it'd be possible 2 cut out a lot of time& cost of getting a diagnosis & prescription" EHR's "newest release will increase physician software usability as much as five times when compared to previous releases" < 5 times more efficient? Effective? User satisfaction? EHR templates: Time-saver or patient safety risk? < good discussion template-related medical error liability Models for Using Predictions to Facilitate Hospital Patient Flow Ideal Heme-Onc Patient Care and Flow < improved workflow saved money, increased patient satisfaction Use of Information Technology in Patient Safety Initiatives < human-factors, patient safety initiatives, ethics Improving Flow at Emergency Rooms Using Activity-Based Costing, Lean and Simulation < reduced cycle time & waiting time Using Simulation Based Optimization To Structure And Manage Ambulatory Clinics Seven Hospital Flows and the Eight Events on the Patient Highway Systems Modeling and Simulation for Reducing Medication Errors < quality, workflow, patient safety, reducing errors Spurring Innovation in Healthcare Delivery: "hospitals now must focus on driving costs out of clinical processes" When it comes to EHRs and HIT "When workflow is interrupted by technology, people get really crazy" "workflow tool guides provider through follow-up tasks and ensures final discharge status determinations made in compliant manner" Modeling Business Objectives for Business Process Management < healthcare is one of two examples AHRQ Health IT Toolkit for Workflow Assessment "standardize and simplify your processes" "EHR which offers a customizable interface designed to mimic and improve upon existing workflows can cut down on the time needed to diagnose and suggest treatments" Performance Management Patient Flow "Flexible, configurable workflow and views to reflect organizational processes" "In 2012 I predict we’re going to hear story after story about the lack of usability with EHR software. The complaints will start to pile up" < w/o effect Enhancing Usability in EMR Screen Design "Screen design is an important issue in usability for the EMR" Diagnosing the Symptomatic ED - Simulation the Tool of Choice Healthcare has alot of artificial demand "'failure demand': …demand caused by the failure to do something or to do something right for the customer" Free Workflow "templates": Patient check-in, Office visit, E-prescribing, Appointment scheduling, Laboratory orders, Referral generation, Office discharge Non-collaborative to Endocollaborative to Omnicollaborative BPM < healthcare needs to move toward "endo-" & "omni-" Who's Responsible [for Medical Error while using an EHR] "cut and dried" < I don't think so, not from "systems" view Healthcare CIO on 2011: EMR EHR Vendors…added features for certification resulting in…lack of usability & workflow integration…Providers radically changed workflow…resulting in turnover & frustration EHRs Need to Grow Up "must accommodate more fluid workflows that can change daily or weekly based on the demands of new participants" Usability and Success < a framework for EMRs EHRs: functional, reliable, usable, meaningful, pleasurable Children's Healthcare of Atlanta Workflow Management System "browser-based "drag-&-drop" workflow designer…faster & less expensive to develop custom workflows" A Process Mining Project < underlying tech relevant to improving EMR EHR workflow & usability " skills-based routing and queuing enables a virtual workflow that closely maps to and improves the physical workflow healthcare providers are currently engaged in today. This allows for easier adoption" EMR Workflow Systems vs. EHR Workflow Management Systems Clinic uses analytics to manage patients' pain Common Error of Overloading Mobile Apps with Features < a problem in common with EMRs and EHRs Clinicians Can Be Eager Adopters! “report identified workflow as the overwhelming problem in almost all facets of EHR usage” Automated Workflow for Increased Efficiency and Reduced Frustration Gauging Maturity of your BPM Strategy (part 2): no BPM, ad hoc, opportunistic, systematic, managed, optimized BPM offers healthy prognosis for improving electronic health records Are you satisfied with your EHR system? 44% “No” Small businesses not benefited from traditional workflow systems…However smartphones/tablets offer productivity improvement in customer satisfaction & revenue/employee Dynamic workload balancing, automated shared workflow, and quality assurance, quality improvement software solutions for radiology, cardiology, pathology, dermatology, and ophthalmology New healthcare tablet "Designed for the way your work flows... purpose-built for ease-of-use by the injured, aging and ailing – as well as your staff" < interesting angle! EHR Alerts, Evidence, and Usability "Ant colony optimization" - Google Search < hmm, wonder if can be used to optimize EMR EHR workflow? Process Mining - Pallas Athena “process-oriented approach…provides process visibility into what is otherwise often a mystery” Efficient and Moral Market-driven EMR and EHR Usability Innovation Future of Physician Workflow: Mobile Technology Improves Physician Productivity “traditional PC-Based EHR vendors turning to…intuitive easy-to-use tap-and-go interfaces” NSF: Advancing Health Services through System Modeling Research “applying tools & techniques of industrial & systems engineering to improve healthcare delivery system” Workflow engine "intelligently orchestrates patient care across communities based on condition, episode and population health" BPM and Healthcare "BPM can be the instrument for collecting and analyzing the data that allows the six sigma to determine root cause" Process Mining in the Large: Preprocessing, Discovery & Diagnostics < medical examples mentioned IEEE Process Mining Manifesto > 75 authors, > 50 organizations < authoritative, timely, well-written, several healthcare references Slides 15-16 Hospital workflow management system < workflow engine, definitions, editor Complex Event [Processing] Analytics: From Real-time Business Intelligence Services to Healthcare Applications BPM/Adaptive Case Management LinkedIn discussion “In patient care, also, each set of activities should have a clear definition what the goals are” Usability 101: Applied Methods & Insights < "measuring the effectiveness, efficiency & satisfaction of user experience with an EHR" Promoting Usability With A Novel Healthcare Usability Maturity Model Health Everyware: Making Mobile Health Beautiful & Useful < Define "usability" & describe benefits for mobile device application development Selecting an EMR for Your Practice: Evaluating Usability< 9 principles, 7 steps Artificial Intelligence Command & Control System “continuously optimizes operational schedules available resources taking into account real-time variability of procedures & changing inpatient & emergency room demands” IT support for healthcare processes - premises, challenges, perspectives "distinguish between organizational processes and the medical treatment process" BPM: Healthcare Industry's Prescription for Serving Patients Better "BPM can help hospitals cope with these new realities of healthcare" User Interface Derivation from Business Processes: A Model-Driven Approach < relevant to generating EHR UIs from process models "Natural Step toward EMR...flexible business process management (BPM) automation...whole process is prompted, routed & tracked" Amish Guide to Intelligent Web Design < Exercise: Read as “Amish Guild to Intelligent EMR & EHR Design” EHRs & Healthcare Productivity Paradox < links to 40 web resources < not listed, but hey, makes me objective, right? Conference: Multi-Agent Organization “Multi-Agent Systems is a computational paradigm for modelling intelligent distributed systems” < relevant to healthcare business process management How open-source BPM system helps healthcare companies to improve their processes Clinical Groupware: A Definition Global Event List for Health Innovation < curated list of conferences directly or indirectly related to wireless health How to Reduce Waste with Process Mining < hidden activities, idle times, duplication & variation < just think if embedded in EMR EHR… Breaking Down Info Silos in Health Care < Workflow engine (business process management)… provides ‘process interoperability’ crossing system boundaries… coupled to analytics to monitor KPIs Expert Team Decision-Making & Problem Solving: Development & Learning < relevant to EMR EHR groupware & workflow systems Who Will Police EMRs and EHRs? < EHR bites man stories? Extracting/Inserting Meaningful Use Concepts into TURF Model < EMR EHR usability: user, function, task, representation Usability, Workflow & Patient-Centered Cognitive Support in improving HIT < work ontology, keystroke models, workflow modeling Cognitive Engineering Approach to Visualizing Clinical Data “Cognitive science methods…promise to meaningfully inform & formulate design” Estimating Task Execution Time in EHRs Using Keystroke-Level Model < keystroke level event data < add process mining! Workflow Considerations of Computerized Asthma Management System in Pediatric Emergency Dept “workflow oriented, sustainable approach in challenging environment” Care-Coordination Capability Maturity Model: Understanding HIT Adoption < interesting to compare to BPM maturity model Analyzing Medical Processes “detecting defects in human-intensive processes used to administer healthcare” Automated Discovery of Workflow Models from Hospital Data Evaluating the effectiveness of clinical alerts: A signal detection approach Cognitive Architecture for Simulating Bodies and Minds < virtual patient simulation, mental & physiological Context-Aware Drug-Drug Interaction Alerts < addresses alert fatigue, patient safety Intro to Agent Based Modeling (ABM) for Health Sciences When Medical Errors Happen, Executives Shouldn’t Hide < lessons for EHRs & patient safety? Clinical workflow engine “advantages of an automatic gear box…Changing gears is unnecessary we stay at wheel & decide where to drive” National Patient Safety Foundation < definitions of patient safety and healthcare error Cognitive Complexity and Error in Critical Care "a contextual understanding of how errors tend to occur" NIST: Make EHRs More User-Friendly < Usability-driven development, expert review afterwards, user testing Reducing Unintended Consequences of EHRs < workflow/process frequent mention, usability no mention Size Matters “Larger a practice is – the more physicians, exam rooms & patients – the more likely it is to adopt an EMR” Beloved Doctor Benched for Not Being Proficient with EMR “Do we want good computer operators or excellent doctors?” Chief Experience Officer Joins HIMSS EHR Usability Task Force “beyond feature/function to create intuitive user workflows to facilitate ease of use” Workshop HCI (Human-Computer Interaction) for Medicine & Health Care "optimization of processes & operational sequences is of increasing interest" EHR Safety Event of the Month "The system doesn’t let us edit notes, no matter what’s wrong with them" 2011 AMIA EHR Usability Symposium < agenda plus links to slides < state of EMR usability art EHR "fast, flexible design that adapts automatically to a physician's workflow and sets the benchmark for ease of use, speed and flexibility" < workflow engine? workflow engine to enable the intelligent automation of health-care systems and processes World Usability Day > Customer Journey Maps: Breakthroughs to Improving Patient Experience < usability EHR Workflow Toolkit for Physician Practices < great stuff, but no workflow engine/process definitions Streamline Health to Provide Business Process Management Solutions to Leading Texas-Based Pediatric Hospital - SmartBrief "planned sequence of events... could be executed by an EHR's workflow engine" < clinical trial context "flexible, fast, scalable imaging workflow engine that dramatically improves medical imaging workflow based on customer defined instructions" Complete Alarm Summit Summary Notes "list of priority issues...related to clinical technology alarms" 2011 National Clinical Alarms Survey: Perceptions, Issues, Improvements & Priorities of Healthcare Professionals Smart Objects as Building Blocks for Internet of Things < "aware" appears 55 times: activity- policy- process- context- safety- Exploring context-awareness for ubiquitous computing in healthcare domain < location-aware + big buttons Using Time-&-Motion Method to Study Clinical Work Processes & Workflow "‘checklist’ STAMP (Suggested Time And Motion Procedures)" Cloud-Based "workflow management system…on-site medical record retrieval and review through an intuitive and easy-to-implement online interface" Verifiable Workflow Management Systems and Applications to Healthcare < formal process model verification < patient safety Workshop on Agents Applied in Healthcare "agents fit well w/ usual characteristics of problems found in health care" Configurable Process Models: Experiences From A Medical & An Administrative Case Study Approximate Compliance Checking for Annotated Process Models "Compliance management is of increasing importance in…healthcare" How EHRs, meaningful use & quality reporting lead to workflow redesigns that improve patient care quality & value MIE 2011 Abstract: Usability Evaluation of Health Information Systems: Towards In-Situ Analysis of Complex Healthcare Systems and Environments Workflow Dilemmas in Lab Results Follow-up < Medical Informatics in Europe 2011 Automating Workflow "Agents are messengers that are placed directly into the patient note. Agents are ‘intelligent’" < user-editable, event-driven Will IT And Clinicians Ever Get Along? "getting a clinical champion during the design phase of your project" EHR Data Pre-processing Facilitating Process Mining: Application to Chronic Kidney Disease Costs & Implications of EHR System Downtime on Physician Practices < $2500/hour cost of downtime for five physician practice GE Healthcare Workflow Technology < visualize, simulate, predict bottlenecks to improve throughput Systems Engineering Perspective on Human-Centered Design of Health Information Systems Metadata-Driven Software Systems in Biomedicine: Designing Systems that Adapt to Changing Knowledge < includes BPM/workflow system discussion Actual mention of "workflow engine" in article about EMRs "custom building a system with screen painters, workflow engines & report writers..." Healthcare Workflow Blog: "workflow editors, engines & other workflow technology tools in healthcare" ONC: EMR EHR users "look forward to the day when the technology works for them instead of them working for the technology" EMR Workflow Management: The Workflow of Workflow "many people—providers & vendors—confuse workflow with workflow management & EMR workflow systems with EMR workflow management systems" EHR Usability with Nursing Students, Int. J.Nursing Education "usability assessment... EHR documentation knowledge & skill using patient case scenario" Speech Recognition Tool Comes Up 'Speechless' "broken process where editing & review is not happening…'supervised tool'" Responsibility-driven Design and Development of Process-aware Security Policies < relevant to process-aware EMRs EHRs Real-Time Detection of Process Change using Process Mining < relevant to improving process-aware EMRs EHRs "As the functionality in different EMR products becomes more ubiquitous and standardized, usability becomes a much more important determinant of successful use" Workflow Management Systems for Healthcare Processes, Encyclopedia of Healthcare Information Systems Minimum Viable Product "allows collecting max amount of validated learning about customers w/ least effort" < usability role for marketing 50,000 hits in Google for "by physicians for physicians" EMR OR EHR > design, usability, user-centered EMR implementation: efficiency vs. incentives < productivity, costs, efficiency, increasing patient visits, improving patient care, free time to grow business One-Touch Workflows for Healthcare "Workflow Composer transform labor intense, manual workflows into custom, one-touch buttons" Medical Device Alarms Summit, Oct. 4-5, 2011 < human factors, workflow, cognition, attention, EHR as a potential “secondary notification system” Primary Care Physicians' Experience with EMRs: Barriers to Implementation < typing, menus, buttons disrupt patient interviews $42 Million Gift Aims at Improving Bedside Manner < improving physician usability EMR Usability & Struggle to Improve Physician Adoption "single, inflexible workflow…drop-down menus, check boxes & other pre-defined selections" David Blumenthal lauds incrementalism at forum on EHRs "admitted that electronic records can increase workloads & slow doctors down" Patient-Physician Communication LEVEL: Let patient look at EHR, Eye contact, Value EMR as tool, Explain what Ur doing, Log off & say so Turkmenistan Health and Medical Industry Ministry to introduce e-workflow system across country EHR Usability & Business Analytics < proposes that natural language processing is solution to EMR usability problem Putting the “U” in EHR Usability℠: The Federal Health IT Five Year Strategic Plan Physicians "‘We want iPads!’ Challenge w/iPad [is] applications… If an application isn’t designed to interact with that screen size… it raises all kinds of issues” Should Government Standardize EHR Usability? "missing ingredient in EMR software is expertise not standardization" When Computers Come Between Doctors and Patients - NYTimes.com Public-private coalition announces EHR adverse event reports site Amazon Website Redesign; Easier for Tablet Use "less cluttered, more white space & fewer buttons" < relevant 2 EMRs EHRs 2 Finding the Meaning in Meaningful Use — NEJM "Success in improving care with EHRs may be related to the types of EHRs that are used" EHR Vendors Give Keyboard-Hating Docs Pen Alternative - Healthcare - Electronic Medical Records - Informationweek "Cloud-Based Workflow [Medical Record] Systems... turn inefficient processes into centralized, Web-based workflows that increase project transparency and dramatically reduce time and cost" NLP to the rescue! "pointing and clicking my way through and I said this is crazy I can’t do this, I'll never be able to see patients" The Real Reasons Behind [LOW] Electronic Health Records Adoption "driving tech adoption through monetary reimbursement only is grossly short-sighted" Breaking Usability Rules: UX Case Study < maybe EMRs EHRs should break more usability rules than less: esp. rule #1 Badly Designed Electronic Medical Records Can Kill You “Information is not the scarce resource. Attention is” Usability Expert Jakob Nielsen Would Like EMRs / EHRs with Big Targets, Less Functionality and Better Workflow Management "many of the objectives included in Stage I of the meaningful use guidelines can be handled by mobile services Mayo Clinic Conference on Systems Engineering and Operations Research in Health Care "ACOs will need new analytic, clinical workflow, administrative & communication functions to…reduce costs & improve care" Healthcare IT News AMIA Symposium: Human Factors, Modeling and Workflow "workflow systems…computational modeling and simulation as tools to represent workflow processes within HIT" Consumer Health Technologies Need to be Simple: poor usability "remains biggest obstacle" Bending the Cost Curve "tools & actionable intelligence so knowledge can be dropped into real workflow environment" $29M: Hawaii Health Systems to deploy Soarian [EMR EHR workflow management BPM system] across hospitals Tragic Errors: Usability and Electronic Health Records Researchers Offer Way To Classify Health IT-Related Medical Errors - iHealthBeat Electronic medical records reengineered physician workflow, bringing average wait times down from 17.8 days to 4.2 days Major Award for Process-Aware EMR / EHR BPM Workflow System: Congratulations and Thank You! Leveraging Social BPM For Enterprise Transformation < insights for clinical groupware here JAMA: Health IT larger role to play in patient safety "promise remains largely unfulfilled" "To manage genetic data in labs … BPM (business process management) software … work directly with process owners...visualize process" Book preface (PDF) for Process Mining: Discovery, Conformance & Enhancement of Business Processes < relevant to Health IT Does Your EHR Increase or Decrease Workload and Productivity? BPIC’11 First International Business Process Intelligence Challenge: based on event log from Dutch hospital Four Challenges for Process Mining in Healthcare: Heterogeneity, Multi-disciplinarity, Change, Data Collection Workshop PDF: Guiding Patients in Hospital, mHealth open source workflow management system, models clinical processes Small Practice EHR Lessons: Efficiency "small family practice physicians treat... 30 patients/day... 16 minutes/patient" New Book - Process Mining: Discovery, Conformance and Enhancement of Business Processes < not healthcare specific but highly relevant Turning the tide: Providers and patients win when health IT reflects workflow | Government Health IT Hospital Uses Business Intelligence Solution to Save Time and Gain Insight from Data "Efficient workflow & standard methods for measuring workflow are critical to improved delivery of healthcare" Transforming the Radiological Interpretation Process "Point-and-click, template-driven EHR systems that are time-intensive & cumbersome for the physician" EMR / EHR Usability - Standardization vs Usability & Innovation | Theo Mandel's Usability Blog "We Fell In Love with Workflow" insurance to billing, lab results to physicians, medication orders to pharmacy EMR Scribes "UIs of these systems still too awkward... to perform necessary tasks quickly & efficiently" Mobile BPM -> "With healthcare increasingly delivered outside traditional hospital setting, IT mobility is key" NIST Guide to the Processes Approach for Improving the Usability of Electronic Health Records Health Info Tech Raises Patient Safety Issues: workflow, interoperability, usability "innovative & adaptable workflow engine & associated user interface... workflow is as smart as it is easy to use" EHRs & Medical Decision-Making: info overload, time pressure, multi-tasking, EMRs not aligned Student project: "Effective EMR training is org. by role & workflow, not by features & functions" JAMIA: Long-term EHR usability depends on design Paper: Moving From Traditional Software Engineering to Componentware LanguageMate Starling Tour | LanguageMate.com: touchscreen, workflow management, KPIs Object-Oriented Tech for Collaborative Apps in Healthcare "healthcare-based workflow management systems" Many Physicians Have Mobile Devices; Some Are 'Super Mobile' Users - iHealthBeat AlphaMed Tech: case studies medical practice workflow, throughput, revenue, productivity EMRs, ICD-10 Pave the Way to Business Intelligence | EMR and HIPAA BPM-Approach to Adverse Event Management: Pegasystems HEALTHINF 2012 International Conference on Health Informatics Medicine and Technology [part of HCPLive]: Implementing an EHR for the Small Practice Data Capture And Workflow Management Technique: patent Work Group on Improving Usability of EHRs - iHealthBeat: vendor responsibility to better align EMRs with clinical workflow IBM Business Process Manager Healthcare Pack Dynamic Clinical Pathways - Adaptive Case Management for Medical Professionals: social BPM, full text book chapter REVIVING HOUSE CALLS: Asheville doctor turns medical practice into mobile business | The Asheville Citizen-Times | citizen-times.com Pfizer Launches Clinical Trial Tapping Mobile Phones, Web - iHealthBeat: tapping phones! 13th AI Medicine Conf - Care Planning: Time-annotated Clinical Guidelines to Task Networks eLearning: Workflow Management EMR Systems & the Primary Care Physician Are Healthcare Institutions Using BPM w/ Fiscal & EHR/EMR Software? EHRs Should be Designed with Clinicians in Mind "If Apple decided to create a [EMR/EHR] / no more effort than our existing written workflow / not slow us down..." Are pediatricians prepared to go paperless? lost money, saw fewer the patients, took typing courses, decreased patient face time Microsoft Medical Media Lab: Visual Workflow construction & manipulation...give healthcare workers tools to automate workflows w/smart workflow builders Automating Infection Control w/ Business Process Management at Chester County Hospital Cracking the Code of Successful EHR Design "Traditional EHRs consistently fail to help physicians make more money, do less work or deliver better care" Unforeseen Complication of Electronic Medical Records "I turned my back to him to type" IT in Process Control: goals, models, observability, controllability (p 8) Usability: the extent to which a product can be used by specified users to achieve specified goals with effectiveness, efficiency and satisfaction in a specified context of use Why Does Healthcare Have the lowest BPM/Business Process Management maturity? BPM To Streamline Soldier Rehabilitation: process for registering, diagnosing & rehabilitating injured soldiers...more efficient Government and EHR Design "labyrinth of interconnected screens & links define health IT user experience" Documenting Distracts from Doctoring "EHRs...distract from patient care...drop productivity/income by 30%" Do Electronic Medical Records Make Physicians More Productive? Empirical Analysis and Design Implications: workflow, usability Heatlh IT Innovation Awards "integration of BPM into a clinical setting via the EMR...improved efficiency, consistency and outcomes" Do EMRs Deliver On Their Paperless Promise? "You need to implement workflow automation system to truly deliver" Adaptive Medical Workflow Using BPEL Process and Ontological Knowledge Base Processing Mining in Healthcare: A Case Study Soarian, Meaningful Use: workflow engine prompts caregivers to complete appropriate process steps at the appropriate time & patient CHI Conf: Designing Flexible EMR Systems for Recording and Summarizing Doctor-Patient Interactions: EHR, mobile, usability How Design Can Drive Down Healthcare Costs: "pretty clunky systems" vs "things that are delightful to use" Inadequacy of Off-the-Shelf Business Process Management and Workflow Automation Systems for Patient Care Incorporating HIT Into Workflow Redesign: "workflow engine" (p 83) only tool out 100 not categorized! No mention BPM Health System Redesign: "Any intervention that can safely and effectively be performed by a non-physician, should not be performed by a physician" How Far Does the Aviation-Health Care Comparison Go? - Health Blog - WSJ mHealth: Think outside the system: need "better, faster, simpler tools that completely begin to match the human workflow process" Which EHR company should I choose? "Count how many clicks it takes to complete each task" Really? Is one three sec click better than two one sec clicks? Ontological Knowledge Framework for Adaptive Medical Workflow: BPM, execute on-the-fly context-aware workflows EHR Alerts Don't Improve Abnormal Test Result Follow Ups: alerts: displays tracking processes, redesign clinical workflow, policies for notification Medical Handoffs | In Practice: Better techniques may improve doctors' handoff of patients - Los Angeles Times Electronic records a pain - BostonHerald.com "avoid is becoming a data-entry clerk instead of a physician" Pharmacy workflow management system minimizes waste Process Mining for Usability Tests - Flux Capacitor: relevant to improving EMR usability Healthcare company increased AR processing by 37% with BPM Whitepaper: BPM in Healthcare (India) "Process automation has been viewed w/skepticism in the healthcare industry" True! Hays Medical Center Uses Open Source Businesss Process Management System Business Process Management Success at BlueCross BlueShield of Tennessee Complexity of EMRs discourages new users, doctors tell HHS panel "10 minutes to navigate drop-down menus to order a routine mammogram" Implementation of workflow engine technology to deliver basic clinical decision support functionality 2003: "Over the next decade we have the opportunity to harness the power of the workflow engine to provide care for the sick" Process Mining: Discovery, Conformance and Enhancement of Business Processes < includes healthcare examples Course - Healthcare Workflow Process Analysis and Redesign: nothing about workflow engines & process definitions tho! WfMC Handbook on Social BPM "Business Process Management and Workflow are, by their very nature, social activities" Leveraging the Soarian Workflow Engine, how to use IT tools implement & enhance clinical workflows Artificial intelligence and capturing quality information into your EHR BPM-based Care Management Solution Features Workflow Integration with Clinical Guidelines Essentials of Clinical Workflow Analysis: begs for application of workflow automation/BPM Works like a ChARM? Great EMR tagline: "Your workflow, only better" has EHR WfMS/BPM-like task management features Modeling Business Processes: A Petri Net-Oriented Approach (Cooperative Information Systems series):Amazon:Books Understanding Requirements for Computer-Aided Healthcare Workflows: Experiences Challenges: see table of healthcare workflows Customizing the EMR to Improve Usability and Clinical Care "daunting, multiple-click and screen-intensive process that impedes clinical care" Graphical solution adapts EHR workflow to practice and physician. Similar to BPM process definition editor? Understanding How We Care for Patients: Information Needs & Best Practices for Capturing Clinical Workflow

Business Process Management: A Comprehensive Survey Hajo Reijers, Head of BPM Research at Perceptive SW, on Healthcare Business Process Management Quest Diagnostics and Appian Partner to Bring Business Process Management to HIMSS13 Clinical & Business Intelligence, Meet Process Mining (Submitted to #HIMSS13 Blog Carnival) My Rejected Presentation Proposal: Process-Aware Information Systems Come to Healthcare The Next Five Years: The EHR Network Effect Study quantifies practice boost from physicians delegating tasks < PS Greater span of control made possible by task management software Why Companies Should Develop Event Models < not healthcare specific, but good overview Top 6 Most Unruly Meaningful Use Workflows "We rejected a number of the EHR platforms simply because ... deviations from our current lab workflows were just too great" Meaningful Use survey of 684 physicians < big work & time issues In Second Look, Few Savings From Digital Health Records - New York Times Meaningful Use, Workflow Burdens, and the “Broken Iron Triangle” Software Development Anti-Pattern Personalising situated workflow systems for pervasive healthcare applications Use of RFID in Healthcare: Benefits and Barriers < "where" just one of who, what, why, when, where & how Secure social media to share image, discuss tough problem: malleable directory of professional colleagues "By wrong EHR I mean one that ...kill[s] a physician’s workflow, that cause a doctor 2 not want 2 be a doctor" Cockpit Checklists: Concepts, Design & Use "sequential framework to meet internal and external cockpit operational requirements" "EHR implementation a 'painful,' time-consuming process... the practice learning a new workflow" Enabling Collaborative Workflows: Shaping the Future of Mobile Healthcare An Assessment of the Most Forward-Looking Collaborative Workflow Applications Impacting Healthcare EHR transition means fewer patients per day for some docs The future of work is social: An interview with a BPM CEO < relevant to EHRs, PHRs & care coordination My comment: data-based vs workflow-based EHRs, mobile, cloud, social and data gravity 2006 EHR WfMS Tutorial Slides 36-41: EMR EHR Usability Principles and Workflow: Relevance Process mining five most performed care processes of a urology department My comment: Workflow-as-a-Service & cloud BPM; MeaningfulUse & SMART EHR apps; effectiveness, efficiency & usability Using communication and collaboration tools to improve patient care and clinical workflow Workflow of an Emergency Room and why Mobility is the solution BPMS, Monitoring and Business Intelligence < vendor blog Human Error < Reason (2000) What are the biggest issues with EMR today? < Number one issue is workflow, top'o the list Business Processes – Attempts to Find a Definition Example swiss cheese holes lining up > two layers: ICU nurse doesn't follow standard protocol, oncology nurse distracted Task-Centered User Interface Design A Great Workshop about Diagnostic Error: A Multidisciplinary Exploration "20 percent of the tasks within an EHR drive 80 percent of daily use for nearly all roles" "An EMR with embedded workflow engine and decision support logic will eventually become the gold standard in healthcare" Nice NLP pipeline (workflow) < sentence detector, tokenizer, part-of-speech tagger, chunker, named entity recognition, event extractor EHR vendor adds visual workflow tools giving end-users significant flexibility to configure their workflows Process-Centered Design "a business application's user interface is a business process" "built-in workflow engine enables HIM managers to create electronic workqueues for coding staff, automating manual handoffs" Petri Nets and Clinical Information Systems, Part III: Modeling Concepts and Tips Why Everything You Know About EHR Design Is Probably Wrong < Oh, the humanity! My two cents: EHR workflow management systems Intelligent Business Operations < much of this applies to Intelligent EHRs too! Wiki as a Participatory Tool for Patients in Clinical Guideline Development My conversation about BPM, components and EHRs on EHRscience.com Meaningful use shld not be viewed as a checklist "but rather as steps that are part of any practice’s given workflow" Predicting the Results of Applying Workflow Management in a Healthcare Context New Book Includes My Chapter About Natural Language Processing, Business Process Management, and Adaptive Case Management in Healthcare "What are the biggest issues with EMR today? 1. Workflow..." Procedural vs. Declarative < in BPMS vs BRMS processes vs rules context Routine vs knowledge work < flowcharts vs checklists < relevant to EHR design Application and Simplification of BPM Techniques for Personal Process Management < relevant to simplified EHR workflow representation Nice table contrasting structured, unstructured, narrative & hybrid data in HIM context My new blog post: Nuance’s 2012 Understanding Healthcare Challenge: Natural Language Processing Meets Clinical Language Understanding "Physicians are on the front line of recognizing a clinical need for which even a workflow solution might potentially result in a better patient outcome" BPMN vs ACM < docs = 'archtype' Comparative User Experiences of Health IT Products: How User Experiences Would Be Reported and Used Toward a theory-driven taxonomy of groupware < forming (orientation), storming (conflict), norming (cohesion), performing (task performance), and adjourning Successful automation? "Forced automation w/financial carrot is what meaningful use incentive program is all about" BPMN vs. Patient Treatment Plans | Collaborative Planning & Social Business Activity (vs User) Centered Design < benefits and disadvantages of both "Workflow technology offers the potential to unlock the true value of healthcare IT" Meaningful use EHR certification criteria for 2014 "providers to be forced to use a given workflow/form/template to achieve MU that is not consistent with optimal workflow/usability" page 152 < this is the problem Workflow engine sighting! Major EHR vendor adding workflow engine functionality! < comment on my blog "fully integrated information and workflow management systems for healthcare organizations" Inflexible, Big-Box EHRs Endanger the QI/Lean Movement < argument for process-aware Process vs Data Quadrant: Document, Task, Case, Workflow Management Business Process Management (BPM) Market Shares, Strategies, and Forecasts, Worldwide, 2012-2018 < good overview description BPM EMR Usability and NLP "NLP today fits into the workflow of EMRs" BPM Could Save Your Life "API level access means that your product can fit within the end users existing workflows" Facilitating Team Design: How Designers Mirror What New Product Teams Do < team cognition Towards a non-workflow theory of business processes Integrating social software with BPM Experience < relevant to EHRs as "teamware" Meaningful Use (relevant to) > Large-Scale Requirements Analysis Revisited: The Need for Understanding of the Political Ecology of Requirements Engineering Cloud computing’s future is social | BPM News < relevant to care coordination Coupling Clinical Decision Support System with Computerized Prescriber Order Entry and their Dynamic Plugging in the Medical Workflow System "Hospitals are increasingly adopting ERP...and workflow management systems" Chapter 3: Enabling Flexibility in Process-Aware Information Systems < several healthcare examples "Physicians value their workflow...scribing, order entry & navigating from screen 2 screen...Start w/strong workflow" CHIME "natural language processing & workflow of providers" at heart of future of meaningful use Shifting bottleneck heuristic "good example of a service industry that may use this technique is a hospital" New Thoughts on EHR Design "'extreme' physicians..."designed their own workflows" < why need EHR workflow systems Quick Health Apps Development using BPM Centric-PaaS Partners Healthcare uses Ensemble BPM system to integrate internal and external EMR Workshop on BPM in Healthcare < 2007 pre-proceedings, two case studies BPM suite powers integrated health management system and personalized health portal EHRs may limit productivity < 30-50% productivity hit < current workflow systems are indequate, need more process tech Developers beware < Workflow-in-the-cloud lets people who don’t have coding background create workflows < highly relevant 2 healthcare Decreased productivity due to doctors fighting to do things way they want rather than following system prompts < Really? No Long Way to Go for EMR Usability "must truly improve the clinical workflow" Building Watson: Beyond Jeopardy < workflow: Filter, Base, Transfer Learning, Merge, Elite, Evidence Diffusion, Multi-answers Video: Using Process Mining to Improve Business Processes and Systems < not healthcare specific, but highly relevant Towards a System Support of Collaborative Knowledge Work < relevant to EHR & care coordination Top 10 EHR adoption challenges "Workflows must change" < yes, but how much? Should adapt to user workflow first, then gradually change History of process automation < see diagram page 93 (big file) My EHR Workflow Management Systems Features & Functions Survey < free to use! Transitioning to ICD-10 < one heck of a multisystem data flow diagram, workflow will need to change Free chapter about free open source Activiti BPM system Improving patient experience through EMR and health IT "opportunities to build new workflows that do enhance the efforts of people in terms of both timely and accurate information" DUDE: Mapping Business Process Models to Dialogue Systems < not healthcare specific, tho Nuance mentioned Turning nuance of medicine into rigidly defined processes: false precision, not true insight We Have To Wean Doctors Off Paper. But How? < user-centered workflow From Transaction-Based EHR to Intelligence-Based EHR < describing an EHR BPM system "simple mobile interface that walks doctors through their charting in an intuitive way" < "intraoperability" < workflow-driven screen flow (relevant to health IT) Enterprise Social Networks < connection, collaboration, optimization, transformation < ad-hoc to process-optimized (Finite State Machines) A Logical Choice for Medical Device Software < for EHRs too via BPM technology < patient safety Brain-machine interface-driven BPM will optimize execution of complex tasks > BPM+Healthcare :) Finite State Machines (FSM) < nice tutorial! EHR vendors, are you listening? "Wanted: well-designed, adaptable templates" < issue is workflow, not templates Artificial intelligence workflow engine manages complex processes across [healthcare] enterprise tailored to user preference Specialists look for tailored EHR solutions < nine mentions of customizable "workflow" in short article Limits of BPMN < nice overview business process management notation Could You Do Me a Favor? “Electronic Medical Record Workflow Management: The Workflow of Workflow” "create BPMN diagrams using speech recognition technology" < could be used by health IT Iron Triangle Software Development < applies to EHRs: meaningful use, deadlines, usability, stability, support, cost Workflow engine sighting! In EHR vendor community forum. Been predicting this. Cloud a "vector" carrying BPM into healthcare "Activity based costing is painfully difficult to implement – essentially someone has to stand around with a stopwatch and do 'time and motion' studies ... requires process maps for each activity that will be assessed" < need BPM and process mining Activity-based costing as a cure-all for health care? < right, won't scale, unless integrated into EHR BPM systems Introduction to Plan Recognition < relevance to EHRs recognizing user plans from speech, text & actions U-Compare: share and compare text mining tools with UIMA < NLP, workflow management, bioinformatics context Slides: Apache UIMA and Mayo cTAKES UIMA and how it is used in the clinical domain < workflow management system Business Process Management (BPM) Market Shares, Strategies, and Forecasts, Worldwide, 2011 to 2017 < not healthcare specific CDC Physician Workflow Study: Doctors Happy with EHR Systems < Workflow? In what sense was this a "workflow" survey? Video Interview and 10 Questions for Nuance’s Dr. Nick on Clinical Language Understanding < some discussion of NLP and workflow Human Workers, Managed by an Algorithm < form of social BPM Computer-assisted coding promises to ease pain of ICD-10 transition "Workflow is a tricky question" "domain-specific languages let users define business rules, help ensure applications do what they're supposed to" < argue EHR WfMS/BPMs are these Soarian Workflow Engine Congestive Heart Failure workflow - YouTube Sociotechnical Aspects of Healthcare Computing (slides) Research in Human-Computer Interaction for Clinical Decision Support (video) Intro to Statistical Text Mining for Health Services Researchers (video) Meaningful Use More Like Meaningless Tasks "more non-productive work for physicians and little, or no, improvement in quality of care for patients" JABBAH: Java Application for translation between BPM and Hierarchical Planning Domains < relevant to EHR workflow systems Mutual insurer to use BPM to modernize operations and drive higher quality customer service My comment: the analogy between EHR data entry and playing a piano Business Process Management in Healthcare Closing the Loop by Mining Careflows (39 slides, Wil van der Aalst) Medical Bill Review Platform “customizable workflow modeling, a business decision rules engine, data analytics" EHRs improve hand offs, care coordination in post-acute settings "need a better process [for] communications flow" What is the value of process maturity models? < reminds me of discussions we *should* be having about EHR & usability maturity models Clinical Decision-Support Systems: A Systematic Review " …integrate into workflow…into workflow tools… w/workflow-oriented quality improvement programs" Using EHRs to Improve Quality & Efficiency: Hospital "Software developers must continue to work to develop systems that fit into clinicians’ workflow, minimizing administrative work & automating tasks as much as possible" Event Processing Tutorial (2011, AAAI, 130 slides) < no healthcare examples, but good overview... Business Process Environment Supporting Collaborative Planning < relevant to “collaborative" EHRs Process Mining: a new trend in BPM and BI? < Medical X-ray analogy very popular Health IT Orthodoxy Worth Rethinking < “health IT orthodoxy (set of tightly-held, common beliefs) that has shown a few cracks" Use of Simulation Approaches in the Study of Clinician Workflow Coordination Theory: A Ten-Year Retrospective < relevant to healthcare today! Study: EHR Quality Measurement In Infancy "physician…'click-tree hell'…navig8 multiple menus to perform simple actions" How Complexity Science Could Help Fix Health Care < workgroup competition, routing My comment: Your EMR is Lonely w/o Process < spot on, EHRs need BPM EHR design: A mold in need of breaking < call for tech from other industries < BPM HIT in Era of Care Delivery Reform "EHR systems generally do not facilitate integrated, team-oriented, cost-conscious care" #HIMSS Ambulatory EMR Adoption Model: Stages 0 (paper) through 7 (HIE capable, sharing of data between the EMR and community based EHR, business and clinical intelligence) My comments about usability and workflow on: ONC/NIST Workshop on Creating Usable EHRs (EHR Design Talk with Dr. Rick) Clinical decision support example in jBPM5 < (slide 16) ad-hoc sub-process; measure BP, HR; blood test, analyze, interpret Drools Flow “healthcare context to model nursing task, medication, notifications" My comment: "Workflow systems are just the process-aware tip-of-the-iceberg for BPM-style technology diffusing into healthcare" My comment: Healthcare is ‘wasting’ away < healthcare needs BPM and related tech to control cost and reduce waste Escaping the EHR Trap: The Future of Health IT "The IT foundation required for healthcare [includes] formalization of health care workflows" What Could You Do With an Extra 43 Minutes Every Day? “decrease unnecessary process friction” with EHRs? Football Plays and EHR Workflow Exactly! EHR has Specialty- & user-specific usability, emphasize customizability, but ensure interoperability Defining Various (Care) Pathway Terms Benefits of Computer Assisted Coding < interaction w/EHR could use BPM What is User-Centered Design < iterative "Develop screen flow & navigation" more easily & quickly done w/workflow tech! Process-Aware Information Systems < described in clinical intelligence and EHR workflow system context The Case Against User Interface Consistency < relevant to EHRs Video: BPM use in hospital at 1:45-3:20 My Virtual Graduate Degree in Computational Linguistics and Natural Language Processing < connections to BPM, really! EMRs require better user-centered design < well, no, need process-centered design Why do Most EMRs Cause Disappointments? | EMR Blog – EHR, Practice Management and Medical Billing What is EMR Software’s Effect on Productivity? BPM-ACM: from structured to unstructured processes < relevant to EHR workflow PDR and the iHealth Alliance Announce New Drug Safety Certification for EHRs - MarketWatch Does Your EMR’s Form Follow Function, or Does Its Function Follow Form? Doctors love-hate relationship w/ EHRs "too many steps to complete a task" < need workflow engines, process definitions Semantic process mining for the verification of medical recommendations Effect of Clinical Decision-Support Systems "improved identification of characteristics of the environment and workflow into which a CDSS is deployed" CONFlexFlow: Integrating Flexible Clinical Pathways into Clinical Decision Support Systems using Context and Rules Population Health Management needs to "rework tech, capture & manage more patient-related data & improve clinical workflow automation" Building Synergy: BPM in Healthcare – The Future is Now Healthcare "powerful workflow engine [uses] Windows Workflow Foundation (WWF)" My comment on: BPM and Healthcare - BPM from a Business Point of View Natural language processing: an introduction < "tutorial targets the medical informatics generalist" BPM and Geisinger Health System (PDF: 25 slides) Human-Automation Interaction < PDF full text chapter review: Sheridan & Parasuraman < PS Sheridan was my graduate advisors graduate advisor! An Introduction to Clinical Natural Language Processing (PDF: 104 slides) What can Natural Language Processing do for Clinical Decision Support? NIH Workshop: Natural Language Processing / Clinical Decision Support: State of the Art, Future Directions Healthcare software: Thoughts on usability < triggered by Windows 8 Metro Computerized Prescriber Order Entry and their Dynamic Plugging in the Medical Workflow System Automated Generation of Patient-tailored Electronic Care Pathways by Translating Computer-interpretable Guidelines into Hierarchical Task Networks Generalized Process Structure Grammars (GPSG) for Flexible Representations of Work < Fascinating! BPM meets Linguistics < knowledge representation < relevant to representing clinical workflow! Activity-Based Costing, EHRs and BPM (in A Conversation About EMRs, Workflow, Usability, and Productivity) Samples of Healthcare Dashboards "A traditional EMR has structured template-driven forms with complicated, inflexible, time-consuming, distracting (from the patient) drop-down menus, check boxes, radio buttons that require massive change to physician workflow" Work-Centered Support Systems "work management support aiding the metacognitive activities entailed in prioritizing and managing multiple intertwined work activities (such as requirements for attention shift and remembering the number and state of tasks in process)" NIST Health IT Usability Collaboration Site Process Mining explained by EHR Workflow Mining < Aah! Nice to see link to my presentation! ICD-10 implementation for payers: The BPM angle - Community Blog Work-Centered Design: A Cognitive Engineering Approach to System Design < relevant to designing EHR BPM workflow management systems Richard Veryard on Architecture: Intelligent Business Operations Healthcare BPM-Workflow < Vendor: "simulating the way you now process clinical and back-office documents...Workflows are easy to design, test, and implement" “Workflow’s Unique Contribution to Healthcare”: Let’s Make These Quotes from 1996 Come True Before 2016 TIBCO iProcess™ Engine (used in Siemens Soarian EHR BPM system) "Workflow engines in healthcare aren’t heard of too often...pushes alerts for activities to be completed...interacts with connected infrastructure to perform actions and events based on a set of programmable rules" < vendor Primary Care and Public Health: Exploring Integration to Improve Population Health < see role for coordination tech including BPM Doctors are drowning in too much data, not enough appropriate information Beyond Meaningful Use: Productivity Part 3 "nothing in most current EHRs...making sure doctors are optimally utilized" Geek Wisdom: “Interoperability” Must Include Process Collaboration "Process interoperability coordinates work processes" Conference has designs on smarter healthcare "wildly different workflow…highly variable workflow… most docs think most EHRs suck" Business intelligence use cases for health care organizations Intelligent Patient Management "modeling of patient flow in hospital and the healthcare system in general, the modeling of healthcare interventions, and the management of patient care, the allocation of resources, healthcare expenditure and performance" Lightweight Approach for Designing Enterprise Architectures Using BPMN: An Application in Hospitals SOA & BPM Help Power “Hospital of the Future” EHR Deployment Can Rattle Hospital Revenues " mismatch that occurred between processes as mapped out for the EHR and what actually happened in the clinics " User-Centered EHR Design Considered Harmful (Try Process-Centered Instead) Activity-Centered Design "understanding your users as people is far less important than understanding them as participants in activities " My comment: Specialty-specific EHRs vs General EHR « the need for cross-specialty communication "“Transforming Health Care: The Role of Health IT” has one glaring and stupefying omission -- nowhere in the report does it address productivity." NIST Releases Guidelines for EHR Usability Evaluation - User Centric, Inc. Task Switching < relevant to EHR-mediated workflow interruption Clinical Intelligence "operates at three levels, namely, patient-level, practice-level, and system-wide" < vendor copy Cross Enterprise Workflow - IHE Wiki "manage and track the tasks related to patient-centric workflows as the systems hosting workflow management applications coordinate their activities for the health professionals and patients they support" Applying BPM for Improved Patient Care Go home, Healthcare "deluge of information that will require complex BPM systems to pick out relevant information and trigger timely alerts" Perfecting the Art of the User-Friendly EMR "if you've seen one workflow, you've seen one workflow" Healthcare providers are using BPM for comprehensive case management that improves treatment outcomes, increases staff collaboration and productivity and delivers innovative yet cost-effective new services. emr workflow - Google Search An overview on the history and concept of care pathways as complex interventions What Do Clinicians Find Frustrating? "31%…make work processes take longer…25%…frustration with new health IT systems that lack user-friendly interfaces" Learning from Accident and Error: Avoiding the Hazards of Workload, Stress, and Routine Interruptions in the Emergency Department Cognitive balanced model: a conceptual scheme of diagnostic decision making BPM and healthcare — Why has it taken so long? #Healthcare #BPM #ProjectRED | BPM For Real Giving Office-Based Physicians Electronic Access To Patients’ Prior Imaging And Lab Results Did Not Deter Ordering Of Tests « did not reduce costs « need process and cost systems to systematically improve Conducting an EHR workflow analysis can improve efficiency and safety « works best with EHR BPM tech MSIE Thesis: Applying Principles of Process Mining to Finnish Healthcare Natural Language Processing Takes Center Stage In EHRs NLP "can help physicians enter structured data into computers more easily" < excellent overview "Plan to extend major EHR BPM WfMS from hospital into medical offices: workflow-enabled task management" Final NIST: Technical Evaluation, Testing, and Validation of the Usability of Electronic Health Records < 112 pages, workflow mentioned 5 times in passing Evidence-Based Health Care Incentives Simulation Tutorial On The Simulation Of Healthcare Systems Application Of Discrete-Event Simulation To An Outpatient Healthcare Clinic < relevant to optimizing EHRs The Cognitive Psychology of EHR/EMR Usability and Workflow Using a BPM System to Automate and Manage Process Improvement "BPM engine can perform key tasks and interact with the clinician to decrease the manual requirements of a process" The Cognitive Science Behind EMR Usability Checklists How the Experts Would Fix Health Care "productivity drop 30 percent across the board while we first deploy" EHR Workflow Mining « Paper/Video EHR Business Process Management: From Process Mining to Process Improvement to Process Usability Usability 101 workshoppers conduct research methods for improving EHRs EHR BPM system "the workflow engine, the rules engine, the analytics — will be incredibly important to you in the years ahead" New EHR Overlay Uses Voice Recognition Technology Similar to Apple’s Siri "can greatly speed workflow" Workflow engine sighting "cloud-based computing...vendor-independent clinical software...workflow engine...perfect match" 20 Software Engineering "Man-Years" Deliver Unparalleled EHR #Usability Labor Efficiency not Strongly Correlated w/ Adding EHR "more likely to contribute...CPOE, physician documentation & RFID" EHRs Make Doctors Accountable & Some Don't Like That "EHRs be audited to examine how long to [wide variety user activities listed]" Language Technology and the Clinical Narrative User Unfriendly "clinicians have been right all along: many EHR user interfaces are awkward and non-intuitive, and they hinder more than they help" BPM ECM Vendor Adds Process Mining: workflow visualization pinpoints bottlenecks & improves processes « vendor does a lot of healthcare business Conference track: Event-Driven Healthcare: TIBCO's Vision: Using Event Driven Healthcare to Enable Coordinated Care < BPM vendor sponsors healthcare track CCHIT "Innovation is good…even the best of EHRs today have their flaws. Innovation, however, carries varying degrees of risk" What is the value of process mining? Medical analogy "organizational MRI…external symptoms…picture of internal situation" Opinion: FDA Regulation of Mobile Health Apps Would Be 'Death Blow' 5 Ways to realize ROI from EHR "see more patients…workflow [needs to] match that of a practicing therapist or physician” < need editable process definitions executed by BPM workflow engine My comment on "The Coming Storm in #Healthcare #BPM #EMR" < would almost 1000 links be useful? "international medical imaging software company [adopts] configurable dashboards, reports & powerful workflow engine" Workflow usability! "EHR makes every aspect of the work involved with patient care take MUCH longer than it did before. It simply takes a long time to click a template multiple times, switch between screens multiple times. In my opinion the EHR reduces productivity" Improving Electronic Health Records Retrieval Using Contexts Linking EHR to Virtual Clinical Simulations "virtual hospital's pediatric and mental health units" Engineering a Demand for Safety & Quality with Human Factors Adding the "e" to Patient Safety: Building an eHealth Safety Program "EHRs improve patient safety, but may also introduce risks" Promoting Usability With A Novel Healthcare Usability Maturity Model "self-assessment tool scores maturity levels" Evolution from Transaction-Oriented to Intelligence-Oriented EHRs "clinical decision support and workflow management are key to drive data presentation based on the context of provider type and care setting in conjunction with sophisticated analytics" < sounds like BPM! LEAN Strategies & Rapid Response Workflow Improve Patient Safety < "innovative use of healthcare information technology (HIT) and Business Process Management (BPM) software to automate the process of care" Context-Aware EHRs (relevant to) "Context is any information that can be used to characterize the situation of an entity. An entity is a person, place, or object that is considered relevant to the interaction between a user and an application, including the user and applications themselves" Podcast: Applying BPM to Improve Patient Care: Interview with a Director of "Care Process Management" (AKA BPM) Health Care Lacks Software Innovation for Apple iPad: Report Mobile Not Leading to Care Transformation “Significant software innovation will be required to realize the vision for anytime, anywhere clinical computing” Business Intelligence/Clinical Intelligence sales brochure < nicely done, three legible dashboards Complete book text online: Patient Safety and Quality: An Evidence-Based Handbook for Nurses Changing Patient Workflow can Make Using an EMR Fun "downside to my new workflow is that I’ve got to hold everything in memory between the time my patient leaves my office and when she is ready in the exam roo " Why Design is Crucial to Effective EHRs "If the EHR is built on an archaic platform, it presents some design constraints, or idea constraints" < YES! need process-aware platform! AMA launches health IT tutorials for physicians "roles, responsibilities, workflows, consistent processes, team and individual goals" Healthcare’s Analytics "We need a system capable of naturally exploiting the coming data’s volume and diversity, using methods that learn at-scale and directly from observational data" 2nd Int. Conf. on Business Intelligence and Technology < includes: BPM, intelligence, mining, modeling and simulation "'Needs for usability certification' means...workflow reorganization, this software is really hard to use" Slide 18: "Small Office, BigStaff: Amount of support staff required to run a physician practice is a sign of the extreme inefficiencies in the healthcare marketplace" Enabling YAWL (BPMS) to Handle Dynamic Operating Room Management Conformance Checking of Executed Clinical Guidelines in Presence of Basic Medical Knowledge Linear Integer Programming for the Home Health Care Problem Representative EHR vendor comments on workflow "Who does what, when in the typical patient encounter" Healthcare workflow automation vendor "Workflow is simply the process of completing a series of tasks. A workflow can be very simple and include one person, or it could be a complex and dynamic series of processes among many people, groups or departments" Healthcare Simulation Software < discrete-event simulation driven 3D animation < compelling video Patient Flow Simulation, Improve layout and patient flow in healthcare 5th Int Workshop on Process-oriented Information Systems in Healthcare (ProHealth’12) + 4th Int Workshop on Knowledge Representation for Health Care (KRH4C'12) HR Behaviour Simulation "agents simulate HR performing allocated work from workflow management system… medical treatment process case study " "Widespread adoption of an EMR (or multiple compatible EMRs) that is intuitive and easy to use, that empowers the end user and patients, and that actually helps to make the healthcare system more efficient would be a good thing" ...but... Big data targets the health care industry - Health IT Pulse "Far too many EHR designs force us to play linear tic-tac-toe" < love Donald Norman "gulf of interpretation" Things That Make Us Smart reference Relevant to EHR BPM > Semantic BPM "Process ontology: Identifies all the artifacts that describe a process..." AMA "Workflow means the pattern of actions that physicians and staff follow to perform repetitive tasks" 5 Ways to Make Your EMR More User-Friendly "system should be consistent with how users complete tasks…'button grammar'" Healthcare Is Next Frontier for Big Data.< low frequency weak signals & patterns across time What is Usability? "The extent to which a product can be used by specified users to achieve specified goals with effectiveness, efficiency, and satisfaction in a specified context of use" Semantic BPM Tutorial < 2008, Milan, 135 slides Adapting Office Workflows to the EMR "I’ve got to hold everything in memory between the time my patient leaves my office and when she is ready in the exam room, during which I may have seen another patient" EMR Software: Today’s Medical Care Efficiency & Trends For the Future < obvious SEO content farm material, but more edgy than most! Team Creative Processes: Importance of Complementary & Shared Mental Models < complementary "knowledge structures held by team members that have unique role-specific task-relevant content" relevant to EHR BPM systems EHR Implementation 201 - Workflow & Redesign "The electronic health record acts as a catalyst for office workflow" Speed and Efficiency versus Cost and Customization "The way medical practices work varies from office to office, speciality to specialty and in some cases, doctor to doctor within a practice" 2 Day Workshop: Intro to Health Systems Engineering: Industrial Engineering Tools Applied to Healthcare 7 Objections Against Process Mining refers 2 "super flexible healthcare process, where every patient follows a different path" How University Hospitals Birmingham transformed its HR [w/BPM, IBM Lombardi specifically] EHR BPM: Process Mining to Process Improvement to Process Usability Allocating Limited Inpatient Bed Capacity < dynamic programming model + PDF preso + my alma mater = wow! Aviation Crew Resource Management: Flight Plan To Patient Safety < error troika: prevent, trap, mitigate errors Application of Human Factors Engineering to Health Care “weak aspects of cognition” (short term memory, attention to details, vigilance, multitasking etc.) Improving Emergency Department Patient Service By Enhancing Staff Workflows Improving Process with Integrated Design < simulation and BPM in childrens hospital Improving Pediatric ED Patient Throughput & Operational Performance < Length of Stay down 10%, Left-Without-Being-Seen cut in half AMA urges greater focus on ambulatory care safety < EHR focus Healthcare Process Support: Achievements, Challenges, Current Research < excellent, intersection of medical informatics & BPM Hospital billboards are claiming short wait times in emergency rooms < I saw lots thru Miami Clinical platform "assembles and maintains all of the workflow rules, call schedules, and contact preferences for every physician" High Reliability Healthcare: Applying Crew Resource Management to High-Performing Teams < aviation to healthcare Obtaining Thresholds for Effectiveness of Process Mining < precision, recall, retrieval mined models < relevant to comparing healthcare models Guiding Patients in the Hospital "generate personalized guidance messages for patients (given workflow execution patterns)" Are EHRs safe? No. < just better than alternatives Clinical Alerting Software Platform "User customizable rules, alerts, and display workflows without writing source code" < will see this more and more! Common sense EHR vendor definition "Workflow can be seen as the chronological hand-off of responsibility in a practice which starts when a client appointment is first made" 2011 Winner Global Awards for Excellence in BPM & Workflow: Riyadh Military Hospital, Saudi Arabia Industrial Engineer: Health Systems column "We Love Patient Logistics" < shoot, behind paywall, any IIE members care to summarize? Radiology Protocol Tool Recorder (RAPTOR) "optimizes advanced medical imaging protocol assignment workflow" Doctors' shift to electronic records brings short-term pain "longer work hours, lower productivity, reduced revenue and higher labor costs" < need "process usability" Real Time Performance Feedback is a Necessity in Today's Hospitals < won't be possible without process-aware EHRs The Savings Illusion — Why Clinical Quality Improvement Fails to Deliver Bottom-Line Results Healthcare RTLS BI (real-time location system business intelligence) dashboards/reports visualize trends, perform benchmarking & optimize performance Process Mining: Desire Lines or Cow Paths? < relevant to understand what EMR EHR users really do Radiology information system: a workflow-based approach "Each component corresponded to one task in the process and could be assembled by the workflow management system" Invoked Computing < devices should observe us and learn to do what we want to accomplish < EMR EHR equivalent? Health IT as Opportunity to Optimize Workflow "The less congruent an HIT system is with a physician's workflow, the less likely the physician is to use it" Well Understood, Consistently Executed, Adaptively Resilient, and Systematically Improvable Pediatric and Primary Care EMR Workflow EHR Upgrades More Likely to Lead to Errors < possible classic proactive interference memory & learning effect Workflow Solutions For Use Inside Care Facilities < 2011 mHealth Summit - Technology Tracks Every EHR Vendor Consults Doctors [but] “This EMR software doesn’t have the workflow that I and my doctor friends use” “EMR systems are usually designed by software engineers rather than physicians… don’t understand physician and office workflow” Gauging Maturity of your BPM Strategy: 1) Unconscious Incompetence, 2) Conscious Incompetence, 3) Conscious Competence, 4) Unconscious Competence BPM Plays a Critical Role in Healthcare Compliance “healthcare organization's information-handling processes are well suited for BPM methodologies” "poor integration with clinical workflow is Achilles heel hindering CDS [clinical decision support] success… alert fatigue… 'overly sensitive mess'" 5 points of view from an EHR end user < standardize data, not UIs, let market drive EMR usability Golden Oldie from HIMSS 2005 - Future Of EHR Workflow Management Systems AKA EMR BPMS: education, exception handling, workflow patterns, process mining, compacity management, workflow coordination Accessing Medical Records on Mobile Devices Part 1: Android Best Practices for Embedding BI into your Software Solution "analytics can add as much as 20 to 30% of top line revenue" < relevant to EMR EHR BI, especially if add process mining KPIs and Process Mining Flag and Identify EMR / EHR Workflow Bottlenecks Taxonomy Boot Camp 2011 Presentations < motherload of great content < relevant to searchable, navigable EMR EHR content Semantic Information Integration within the Healthcare Sector Natural Language Processing Turns [EHR] Text Into [Usable] Data Explaining Social BPM “also known as collaborative modeling…healthcare cooperative…brought customers into its business process design efforts” EHR safety: IOM report a good start "Usability problems: Too many screens or clicks needed to use the EHR system, causing user error" CMIOs Look Beyond EHR Implementations "shift in informatics from implementation to workflow optimization" BPMN (Business Process Model and Notation) at Vanderbilt Center for Better Health New journal on Interactive Intelligent Systems “research about intelligent systems that people interact with” < IMO relevant to truly “intuitive” EHRs Process-centered design "business-centric approach for designing user interfaces" < compare user-centered design < EMR EHR Usability Maturity Model: Human Centredness Scale < relevant to human-/centered-design EMR EHR QPR ProcessAnalyzer < process mining transaction logs, MS Excel UI, patient flow example (zoom in on screenshots) Learning Features in Human-centered Voluntary Medical Incident Reporting < human factors, usability, medical error, patient safety Systems medCafe "User designed, adaptable interface" "Patient-specific view of health record" Healthcare Systems & Management Engineering: Past, Present & Future Don't Regulate EHRs Like Cars "debate about dangers of health IT centers around Americans' unrealistic expectations of healthcare system & misconceptions about risk" De Zorg voor BPM / The Care for BPM < BPM in healthcare, in Dutch, Google Translate to English is a hoot! NEJM: EHRs should offer adverse event reporting "recent experience: good intentions, a lot of effort, and little demonstrable effect”" Activity Theory and Context-Based Design < from computer-centered to user-centered to context-centered design How to Make an EMR Truly Yours: quest for software that replicates your workflows & mimics your forms "business process management based solutions that provide the information systems needed to achieve and measure improved patient care" Editorial: “last thing this industry needs is more regulation & standardization of EHRs to squelch innovation. Let the market decide which systems are usable” “By optimizing clinical workflows for the most common diseases, Siemens also makes healthcare faster, better and more cost-effective” < Soarian uses workflow engine, process defiinitions, analytics IOM for Independent Health IT Safety Agency “if the FDA got too involved could inhibit innovation” Healthcare process automation company named 2011 Nashville start-up of the year Clinical Groupware, Care Coordination, and EMR Workflow Systems: Key Ideas SBP: Social Computing, Behavioral-Cultural Modeling & Prediction < “Health applications of SBP” Impact of EHR implementation on patient flow metrics in pediatric emergency depart < Time-to-physician, left-without-being-seen, length-of-stay all higher "[Windows-based] EMR apps are unwieldy on the iPad" < need big buttons,screen at a time workflow < workflow engine & BPM Should be "familiar" or "intuitable" EMRs EHRs, *not* "intuitable" unless they "perceive patterns of user behavior & draw inferences" Excellent diagram mapping Meaningful Use requirements to Workflow for Primary Care Fundamentals of Industrial Engineering < excellent short outline IE domain < future EHR BPM systems will embed Advances in Clinical Question Answering: Watson meets Healthcare < plus 3 question answering systems Analysis of Triage Workflow in the Pediatric Emergency Department < “minimizing ‘door-to-door’ time” Extended Usability Framework to Support Clinical Information System Design for Collaborative Care Delivery < multiple users, processes, admin oversight Electronic Workflow Solution in Community-based Research “electronic workflow systems have numerous benefits” < clinical context Tools for Continuously Improving Processes by Which Health Care is Delivered “precise definition, careful analysis & execution of processes” Rigorously Defining and Analyzing Medical Processes: An Experience Report Temporal Responsibility, Generating UIs, Retrospective Analyses to Identify Problems < “workflow process models” & Time-BPMN Medication Reconciliation Work Domain Ontology, Prototype Development & Predictive Model < parallels BPM process modeling & mining Understanding Work of Pediatric Inpatient Medicine Teams “To support physician work, it is important to acknowledge the actual work they perform” < so true! Automated plan-recognition of chemotherapy protocols < IMHO relevant to intelligent EHR UIs Business process management life cycle - design, modeling, execution, monitoring, optimization - resembles User-Cented Design cycle Apple iCloud: An IT nightmare < why Apple shouldn’t design EHRs? “workflow efficiency solutions…improved St. Joseph Hospital’s registration process by drastically reducing patient admissions check-in time…by 75 percent” 2012 Symposium on Human Factors and Ergonomics in Health Care: Bridging the Gap Systematic Yet Flexible [EMR EHR] Systems < reminds me > BPM vs Adaptive Case Management debate 2nd Issue: ACM Special Interest Group on Health Informatics < letter & table of contents HIMSS “Workflow #1 EHR usability pain point throughout all 17 EHR modules & components surveyed” Is Increased Patient Safety Of EMR Worth The Inefficiency? “too time consuming to make it worth their effort” NEJM: What’s Keeping Us So Busy in Primary Care? “urgent we understand actual work of primary care & find ways to support it” “innovative/adaptable workflow engine…to optimize provider performance from patient access to patient financial services” National Ambulatory Workfkow Survey 19. Did implementing EHR adversely affect productivity? 1 Yes (Go to 19a) 2 No (SKIP to 20) TaskMap in Health Sciences < build visual process model < becomes user interface Beyond X-Raying a Care-Flow: Adopting Different Focuses on Care-Flow Mining Siemens - Solutions for Healthcare - Workflow $54.9 million… workflow management solution to reduce surgery wait times & cancellations, increase patient throughput & experience Slides (3,9): Theories of Tool Use < Heidegger "breakdown" Norman's gulfs of interpretation/execution Tool for Documenting [EHR] Workflows with Guiding Questions < begs for next step > EHR BPM system Healthcare Process Management and BPM for Healthcare "Workflow engines [execute] business processes, not just [clinical] decisions… beginning to be utilized in the healthcare industry" "NLP can radically change healthcare documentation... eliminating... pointing & clicking in an EMR" 2011 Medical Device Alarms Summit reference materials, presentations, notes National Survey Ranks Top Alarm Issues < alternative title "Raising Alarms about False Alarms not False" "intelligent, customizable rules-based management & workflow engine...fills EMR gap between current EMR functionality & much hoped for "ideal" EMRs of the future" A Challenge For Healthcare Web Applications - From Data- To Process-Orientation "New process-oriented technologies like business process management systems...tools for process design, execution, administration & integration & guarantee performance & scalability" Review of Health Information Technology Usability Study Methodologies "2025 references were initially retrieved from the Medline database from 2003 to 2009" Siemens Healthcare Remote Service Platform, medical workflow apps, process analysis, workflow optimization Ontological Implementation of a Role-Based Access Control Policy for Healthcare Information "workflow management system for community-based palliative and seniors’ care" 249 page full-text Pre-symposium 2011 Proceedings Foundations of Health Info Engineering & Systems Compliance Check of Health Care Process Models "compliance check of process models and configuration of information systems" < patient safety ProHealth'11: 4th Int. Workshop on Process-oriented Information Systems in Healthcare Human-computer interface progress vital to success of EHRs "inability of many physicians to use EHRs without losing productivity" MIE 2011 Abstract: Ingredients for Health Adaptive Information Systems "user-composable...simple drag and drop interfaces without the intervention of programmers" 1997: Usability testing in medical informatics: cognitive approaches to evaluation of information systems & user interfaces Abstract "Heuristic evaluation…is useful for uncovering usability issues in a human-computer interface such as the EMR" Technological Iatrogenesis "emergent property resulting from technological innovation creating [healthcare] system and microsystem disturbances" Seminar: Usability, Workflow & Human Centered Design < "workflow improvement as an extension of usability...healthcare example" Master's Thesis Towards Cost-Awareness in Process Mining < highly relevant to EMR EHR BPM systems EMR Software Usability Optimization < example management consulting "People, Process & Innovation" Human‐Centered Systems Engineering: Unified Approach to Product Safety Engineering Design Science Approach to Modelling & Facilitating Clinical Workflow "BPMN model for asthma guidelines… transformed into BPEL scripts & executed in workflow engine for enactment" Role for Semantic Web Technologies in Patient Record Data Collection "BPM System...orchestrating...data entry of structured patient record content into a research registry" NIST: Technical Evaluation, Testing & Validation of the Usability of Electronic Health Records Usability — A Key Limitation for EHR Systems "average nursing home resident has… one primary disease & eight secondary diseases… 70% of rehospitalizations… are due to the progression of secondary disease and/or the onset of new disease" < role for clinical intelligence Function Analysis "enables healthcare organizations to optimize patient care, patient flow, staff workload, facility design & workflow" measure, analyze, model, simulate, predict CostOfCare.org "inclusion of explicit cost info in" EMRs & EHRs < also need activity-based costing 4 rent, salary, overhead Natural language processing in electronic health records < NLP for meaningful use, predictive care, effective billing 22nd International Workshop on Principles of Diagnosis Usability Assessment of Process Modeling Languages < basic elements: start, end, tasks, decision, merge, split, join, event Ambulatory Information Systems: The Last Frontier "Most [EMR EHR] vendors draw the line when it comes to helping w/ office workflow changes" < Ironic: BPM vendors relish it! AHRQ guide to reduce unintended EHR consequences "Carefully reviewing skipped or rejected alerts" Tablet & PDA for "Time study, sampling & work measurement software" One-Size-Fits-All Software Root Cause of Lost Productivity "specialization automatically leads to usability" Mobile Healthcare: Beyond Devices "innovation…trending toward efficiently & effectively sharing information among clinicians & w/ patients" NEJM: Avoiding the Pitfalls of Going Electronic "cautious in using templates that constrain creative clinical thinking and promote automaticity" Speech Recognition Software Could Lead to Imaging Report Errors - iHealthBeat The Big Idea: How to Solve the Cost Crisis in Health Care < time-driven Activity-Based Costing < requires BPM to be practical! Comparing BPM approaches in the healthcare domain: Case handling vs Model driven engineering Wow! "rather than producing more desirable, less expensive products [EHR vendors] accuse docs of being Luddites & get Washington to mandate use of deficient products" Is meaningful use the right incentive to get physician's to use EMR's? < billing/coding vs meaningful use vs easier/more productive OPTIMI$ER Process Tech Suite < Workflow Management System for medical offices "optimizes day-to-day workflow" "Clinical Workflow Solutions help local & remote healthcare teams improve collaboration, streamline workflows, enhance patient examinations & consultations & make critical decisions more quickly" Meaningful Use w/o PC? understandable as subway, summary on smartphone screen…social media reminders, apps for specific conditions "Horizon Healthcare to discuss how… BPM Center of Excellence helps Horizon successfully introduce new tech & BPM concepts" Natural Language Processing structures transcribed text, applies SNOMED CT for richer data abstraction & analysis Website "navigational metaphors & display of content…more tactile-looking, chunkier visual design" < EMR EHR will too 5 keys to EMR usability: supportiveness, flexibility, naturalness, efficiency, effectiveness Model-Driven Approach to Design User Interfaces for Workflow Information Systems < deriving UIs from workflow models Event-based Clinical Reference Process Model for Standardized and Automated Retrieval of Key Performance Indicators in Hospitals Health IT Top Needs Next 5 Years: Health management tools integrated w/ communication technologies, workflows & analytics Process Mining Driven Framework for Clinical Guideline Improvement in Critical Care Call For Collaborative Health Record of CHR < AKA Clinical Groupware < Social BPM EMR EMR PHR Tailor EHRs to Existing Workflow: 1 customizable EMR, 2 customize, 3 staff data entry, 4 patient-clinician interaction, 5 support What Kind of EMRs, EHRs, and Clinical Groupware Would Captain Sullenberger Design? Intuitive, Usable, Safe AHRQ Report on Consumer Health Apps Usability: single-tap functionality, 2 to 3 items/menu, one task per screen < EMR EHR usability too 3 Ways to Make Checkboxes, Radio Buttons Easier to Click < relevant to EMR EHR usability: size & affordance Jakob Nielsen on Mobile Usability: big buttons, multiple screens, less on each, don't tax memory btwn them > EMR EHR too! EHRs Work Badly if Your (???) Workflow is Out of Whack < EMRs Work Badly if ***Their*** Workflow is Out of Whack Rep. Ellmers Urges HHS To Study Health IT-Related Medical Errors - iHealthBeat Free open source workflow management system YAWL allows hospitals to more efficiently manage the co-ordination of expensive surgery-related resources Hospital EMR "cumbersome to use & difficult to adjust for doctor's particular needs" < need EHR workflow systems "make sure all steps when patient in front of you are included in workflow of EHR in consistent & clinically logical pattern" IHE Cross-Enterprise Document Workflow (XDW) "workflow management apps coordinate activities for health professionals" "EHRs lack USABILITY. Most EHRs are inefficient … Many EHRs are ineffective … And users … are not satisfied" Clinical Intelligence: How Blue Cross Blue Shield manages healthcare costs Usability & Accessibility in Consumer Health Informatics "horizontal scrolling, clumsy searches, endless menus & chaotic layouts" Got Clinical Intelligence? Applying Business Intelligence to Care Delivery Processes "what will make [an EHR] work efficiently within unique workflow & data management needs of ophthalmology practice" < ophthalmology-specific process definitions? Joint Process Solution Award: Siemens Healthcare Cordys BPM implementation "innovative & exemplary" BPM "workflow engine…coordinates teamwork among clinicians…allocating tasks, adjusting to…patient conditions…right time & sequence" Interesting workflow/ productivity analogy: Doctor’s Offices, Fast Food Restaurants & Web Servers need to be Event-driven Supporting Full BPM Life-Cycle Using Process Mining & Intelligent Redesign < relevant to EMR / EHR BPM Systems Process mining "automatically detect deviations from medical guidelines based on actual data" Case Study No. 2 Health Care Comes Home: Human Factors, systems/task analysis, care coordination systems, usability testing Government's Role in Efforts To Boost EHR Usability Questioned - iHealthBeat Commentary: Make Patient Safety Goals Part Of Meaningful Use < workflow, usability, featuritis issues remain Scaling BPM at Horizon Healthcare by Building a BPM Center Of Excellence Personal Health Record uses BPM-Suite for flexible process integration How the cloud computing model could change health IT 2002: Patient Record Web-based Workflow System, collaboration, coordination, continuity of care "Very rare": EHR solution that actually improves physician productivity...and qualifies for the government incentives "Death by Keystroke" need adaptive displays (role, setting, time, patient) standard healthcare icons IT for Healthcare eManagement: Usability functionality levels: Generation 4 = Partner w/formal workflow (slide 11) Improving EMR Usability: A Method for Both Discovering and Prioritizing Improvements in EMR Workflows Based on Human Factors Engineering + 1 "without requiring changes in the clinicians' documentation workflow" real-time clinical decision support Introducing the EHR.BZ REPORT on EMR / EHR Workflow, Usability & Productivity Video - How BPM Software Helps The Healthcare Industry: standardize workflow; model, not code; 80-90% component-based Our First EMR Workflow Engine < Not likely a "workflow engine" in the BPM sense, but glad to see the phrase Healthcare's Move from Paper to Pixels Slow: comments include workflow & usability issues VitalHealth EHR Uses a Workflow Engine to Customize Provider Workflow (see Figure 11) What is Workflow? Impact of EHR EMR Implementation on Workflow (slides) The American Medical Association wants standard components of user interfaces for electronic health records Harnessing the Power of Feedback Loops | Magazine Master Thesis Proposal: Business Process Enactment in Healthcare (pdf) Expanding Your Business Into Healthcare IT | Technibble What is BPM? | What Is Business Process Management? | USF Leveraging EMRs EHRs for Comparative Effectiveness Research: natural language processing Pegasystems to Showcase Collaborative and Connected Health Solutions at AHIP Conference Frost & Sullivan Recognizes EDDA Technology for Its Pioneering Role in Medical Imaging Analytics | Gamut News Impact on Your Workflow | Epocrates EHR Are Healthcare Insurers Prepared for Reform? - Insurance & Technology: BPM, task-level workflow analytics Letter to ONC: "context of usability is not just a single user at a single screen" SIIM TRIP Society of Imaging Informatics in Medicine Transforming the Radiological Interpretation Process: define workflow, key performance indicators Docs Tell Congress EHR Adoption Presents Serious Challenge: 4-6 patients/hour dropped to 1/hour EHR Meaningful User Numerator and Denominator | LinkedIn: need workflow design, management ACM Call for Papers - Intelligent Systems for Health Informatics: EHR/EMR Usability: Natural, Consistent, Relevant, Supportive, Flexible Workflow EHR Usability Interface Design Considerations "Products designed to... reflect... work patterns of physicians... reduce EHR implementation difficulties" Primary Care Physicians' Experiences with EMRs "Complex HIT UI... patients complained... physician attention... workflow compromised... struggled to efficiently make notes" EMRs Can Slow Medical Charting by Requiring too Much Info "otitis media chart should take about ten lines on paper" Designing Healthcare Solutions with Microsoft BizTalk Server: Usability is not skin deep. It is "aggregate of how well individual components that make up the system work together" Test drive a BPM process designer, "key part of EHR initiatives", patient scheduling EHR Adoption Increasing in Texas but "usability problems / threaten physician practice viability, patient safety & continuity of care" Healthcare Business Process Management Solutions Process-Aware Information Systems: Lessons to from Process Mining Workflow Opportunities and Challenges in Healthcare Point-&-Click EMRs "highest workflow efficiencies / highly-refined templates / speed workflow dramatically / faster than dictation" Doc-developed EMR in Canada Boosts Workflow: "templating vs. free text in EMR documentation / seconds instead of minutes / click / maintaining eye contact with the patient" 2001: Workflow Management Systems: Healthcare Tech of the Future (still not widely appreciated) Failure to Provide Clinicians Useful IT Systems: Opportunities to Leapfrog Current Technologies: need "user-determined flexibility & customization" What checklist can teach about medical business processes: BPM, adaptive case management, healthcare context EMR not boosting productivity? "pediatricians & family physicians were never able to regain pre EMR productivity" Health Standards: Cross Enterprise Document Workflow (XDW) Cross-organizational healthcare workflow process definitions Slides - Introduction to Workflow Technology: represent healthcare processes in workflow editor, execute with workflow engine Adaptive Medical Workflow Management for a Context-Dependent Home Healthcare Assistance Service Physicians More Skeptical of Electronic Medical Records - Health Blog - WSJ WHO: Workflow management system is one of three basic components E-Health Air traffic overhaul hinges on "human factor" - CNN.com: don'overwhelm cognition! Greece: Digital Health Services Lab: BPM process-oriented context-aware workflow systems focus of 5/7 faculty "physician-centric...workflow engine...filter/control communication...practice workflow/personal pref" BPM Healthcare Case Study "Activity Eliminated in Automated BPM Environment" BPM-based Patient Tracking System better managed clinical pathways, resources, improved patient experience, reduced uncertainty, scheduled Rx Transforming Healthcare Through Improved Clinician Workflows: Failure to address EHR workflow threatens entire health IT initiative Guarded Optimism For Healthcare IT "workflow embedded in many health IT apps isn't user-friendly or intuitive" Math of [HealthIT] Simplification: IHMO Argument EMR EHR BPM systems here! psHEALTH: components, executable process model, zero code, doubled throughput Health system uses BPM System plus business rule management system Costs, Productivity Impeding EHR Implementation: increasing percent docs believe EHRs slow them down Report: Excessive EHR Alerts Can Complicate Clinicians' Work: need to visualize, organize, track alerts NYT: A Family Doctor Looks to Retire: "money & time needed to buy & master an EMR will alone be to much" The Elements of Player Experience | UX Magazine: lessons for EMR usability Healthcare Providers Voice Gripes At EHR Usability Hearing "doctors frustrated with complicated electronic health record software" Designers Should Seek Complexity First: Apple products not intrinsically simpler Testimony: EHRs "do not reflect typical workflow process of healthcare workers" What is health experience design and why do EHRs need it? " fit of an application to a clinical workflow is quite subjective" Integrated, Real-Time Decision Making: A Prescription for Improving Patient Outcomes and Your Bottom Line Five Technologies for ePatients | HealthTechnica: includes medical workflow management systems Workflow Management Systems for Healthcare Processes, Encyclopedia of Healthcare Info Systems Mobile Medical Workflow Software: ergonomic handheld device, process-driven workflow, large icons > usability & efficiency AMA report: Standardizing EMRs would 'stifle innovation' - FierceEMR Conference on Collaboration & Technology in Rio: includes workflow management systems Aligning Soarian Workflow to Clinical Transformation While Meeting Meaningful Use Requirements EMR usability affects loyalty: argument that EHRs should follow Microsoft User Interface Guidelines (Bad Idea!) OM Workflow Management System: Opportunity Manager For Intelligent Healthcare Workflow Management Business Process Management Guide for Healthcare Visualizing Decision-Making Workflow and Performance in Medical Simulations page 1 Pre-Conference Workshops - e Health 2011: include workflow & human factors/usability A Nurse Speaks Out Against Bad EMR Software: usability, workflow Workflow-Driven Cognitive Decision Support Systems for Clinicians: "workflow-centered design" EHRs: Friend or Foe to Decision Making: study of workflow & EMR usability in critical care Differences between Adaptive Case Management (ACM) and Business Process Management (BPM) IMHO relevant to health IT

51 Slides: IBM Healthcare BPM Executive Briefing #EHRbacklash Isn't About Electronic Health Records; It's About Kludgy, Standalone, Workflow-Oblivious #EHR Applications My Collected Blog Posts on Clinical Natural Language Processing From Medical Processes to Workflows: Modeling of Clinical Pathways with the Unified Modeling Language H-EHR-T Healthy EHR Doesn’t Give Physicians Heartburn! Happy Valentines Day! Business Process Management Platform Components < relevant to EHR & HIT design Multiple comments decry impact of Meaningful use on workflow Cloud Computing and Big Data: Looking for Healthcare Workflow Optimizing Workflow in Face of Meaningful Use Meaningful Use and EHR Business Process Management My comment: Workflow Is The New Plastics - Forbes Why electronic health records failed - Washington Post "What should be a robust market for reducing administrative costs, the authors write, has been skewed a bit by poor planning in the rush to meet federal meaningful use deadlines, resulting in the need for repeated investment in software tweaks and workflow burdens for some doctors and nurses." Brief History of Speech Recognition < nice graph: "back to basics" "info extraction" Analysis Framework for EHR Systems < Telling: 10 pages, small print, comprensive, no mention of workflow :( Healthcare and Complex Event Processing – A Discussion (Video) Impressive: dialogue management & context-driven listening > Simon: Open-Source Speech Recognition My comment: EHR workflow management systems, domain-specific languages, checklists, mobile Activity stream design pattern < EHRs need this plus structured task management and workflow Explaining the epic failure of EMRs Eventing Systems Will be Crucial to Improving Currently Low EHR Productivity Task-based emergency workflow model for a patient-physician encounter Interesting workflow modification: use drug selection to update problem list Sighting! Workflow engine listed in training materials for ambulatory EHR Facebook-like EMR (Part II) < task management features 2012 Amazon Web Services (Health) User Conference Trip Report < Health, Mobile, Cloud, Security, Scalability, Workflow Interesting to see "event monitoring" listed as most important function of EHR, even in content farm content! Lotus Notes Now IBM Notes: the groupware origin of "enterprise social" today. 3Cs: Communicate. Collaborate. Coordinate NIST on user-centered design < cycle: understand workflows, engage users, set performance objectives, design, test & evaluate Mobile capture trend hinges on BPM "difficult w/o process automation and cloud, mobile and social integration" especially true for healthcare Two Languages Divide but don’t Conquer < medical examples Understanding Adverse Events: Human Factors Perspective "A system is simply a set of interdependent components interacting to achieve a common specified goal" < very close to definition of workflow "patients depend on many people doing the right thing at the right time for them: they depend on a 'system' of care" < model system as executable process model Textbook chapter 1: Introducing User Interface Design < p. 17 iterative design & evaluation < BPM live cycle Health Analytics Using Process Mining < Wiki "users without any technical acumen or coding experience can create their own voice flow" plus task analytics Vendor white paper on intelligent business process management suites EMR adoption doesn’t have to hurt a bit < workflow customization is key "powerful workflow engine ... frees up radiology professionals to focus on providing better, faster patient care" Phase 1: Bugs, Phase 2: Usage, Phase3: Processes (IMO needs BPM) > Safety Advocates Seek National Safety Goals for EHRs Petri Nets and Clinical Information Systems—A Perfect Match Cloud Computing in Healthcare "dynamic and collaborate BPM (Business Process Management)" EHR Best Practices Highly Touted, But Don't Exist "workarounds" symptoms of bad EHR design < Donald Norman's gulfs of interpretation and execution Major BPM vendor and major health IT vendor Expand Strategic Alliance < we'll see more of this! Vertically-oriented smart process apps will be built on BPM platforms "vertical application vendors, such as Siemens in hospital management systems, have built industry-specific custom applications" What Can Human Factors Contribute to Improve EHR Usability & Patient Safety? < "user-centered" not mentioned, "workflow" mentioned 10 times Growing Recruitment of Medical Professionals in BPM sector Build It With The User in Mind: How to Design User Flow < user-centered & workflow-centered not mutually exclusive "Coding is the root of all software evil...That illogical techniques like coding are used to control our airplanes and hospital equipment is frightening" The problem with meaningful use < call for NLP Process Mining In Healthcare: A Case Study Special Issue on Healthcare Workflows and Services Survey Says… MU Isn’t Usable "the more likely a product is to achieve Meaningful Use, the less satisfied users are with it" Computer generation of natural language shift summaries from complex heterogeneous medical data New Book: How Knowledge Workers Get Things Done < I contributed a chapter about BPM, ACM, NLP in healthcare! Pluses And Minuses Of Electronic Medical Records < comments are so angry and anti-EHR... People are experts at what they do - but are unable to articulate their own work practice < problem for EHR design Improving Test Result Follow-up through EHRs Requires More than Just an Alert "Workflows related to certain high-risk areas...must be well-defined" < and executable? Recommendation Algorithm to Capture End-users' Tacit Knowledge < interesting to apply to EHR use Blog comment on meaningful use and workflow/processes 63% of respondents reported Resistance to Workflow Changes as the leading obstacle to CPOE adoption Generic Patient Controlled Analgesia Pump Model < uses state machines WHO: Human Factors in Patient Safety < Culture, Leadership, Communication, Team Structures & Processes, Team Leadership, Situation Awareness, Decision Making, Stress, Fatigue, Work Environment Healthcare Workflow-as-a-Service? One-Minute Interview and 6 Questions for KISSFLOW CTO "NLP's promise for medicine & health [includes] Improved workflow for EHR users" slide 3 Workflow Accelerator "manages Emergency Department patient throughput" < interesting graphics "As EMRs implemented, underlying assumption is physicians will be less productive" language tech + workflow tech = winner How Does EHR Design Affect Implementation and Optimization? "Programmable workflow engines could make CDS easier to test, implement, and deploy" IVR Deconstructed » Call Flow Design < relevant to conversational EHR Where Did I Misbehave? Diagnostic Information in Compliance Checking < hospital example Eventifier: Extracting Process Execution Logs from Operational Databases < define uses in health IS environment Can BPM be effective? < top-down, desire improvement, routine (standard stuff) "Doctor's 'processes' should be represented as checklists, so that users can completely understand all of the tasks, and can easily modify the process as required" "Workflows can be expressed with high fidelity using directed graphs, so obviously a mathematical treatment for clinical processes is possible" Merging Social Software with Business Process Support < relevant to care coordination, participatory medicine "Choose an EMR system that will allow you to make changes within the system WITHOUT the need for custom programming. " Physician’s clinical perspective during development promotes success < so should customize workflow during use BPM systems are the best decision for decision-support software < vendor pitch to healthcare Process mining clinical pathway patterns from medical behaviors The State of BPM 2012 Automating the formalization of clinical guidelines using informati... Patient-Centered Workflow "specific needs of healthcare make it ideal match w/workflow concepts" > workflow technology? Will BPM eventually replace traditional programming as a way for businesses to rapidly deploy IT solutions for their business problems? < will happen to EHR/HIT too Pediatric medical center uses BPM < human resources Using Business Process Management to Improve Healthcare Processes Comment and my response re: User-centered vs Process-centered EHR design and usability Case Study: Business Process Management—Health care Healthcare system to use BPM suite to assist in automating processes throughout the organization IVR platform "Non-technical business users can now change and update components of live applications" < will see this in healthcare Healthcare Industry Getting More Social (needs BPM too) "current state of social and collaboration tools in healthcare is somewhat undeveloped" EMR Featuritis, Usability, and Workflow: A Video Design Call Flows by Using Interactive Voice Response < workflows BPM fills some application modernization needs < replace "legacy applications" with EHR/HIT systems Book: Enabling Flexibility in Process-Aware Information Systems < by e-Health expert Worksocial for Business < imagine meaningful use EHR on this social, mobile, cloud platform Social Workflow + Social Enterprise = The Future Of BPM (And Work!) < relevant to care coordination Medical History Workflow Workflows: Add a new tool to your arsenal < making toast workflow analogy Vendor diagram: surround ICD-10/9 codes with BPM layer communicating with EHR Do worklists work? Re-engineering [ICD-10] Coding Workflow < current, future, gaps, expectations, change BPM drives deployment of speech recognition system in healthcare organization Vendor: ECM -> BPM -> ACM for process frequency & flexibility < healthcare customers My comment on multi-modal user interfaces and "Frozen Workflow" My comment on Fitts’ Law and the Small Distant Target “Small is a flaw!” Healthcare Cost Cutting Hinges On IT "by 2037, national health spending will grow faster than the economy, increasing from 18% to about 25% of GDP" Business Process Management Notation is Incompatible with Adaptive Case Management < relevant to EHR BPM / ACM systems Tutorial - History & Definition of Finite State Machines < formalism important to NLP, BPM, safe & reliable embedded systems, medical devices Meeting embedded requirements of high- integrity systems < finite state machines recommended for safer embedded systems < relevant to patient safety "we also want to recognize Charles Webster, MD, a multi-talented BPM and workflow technologist with a specialization in all topics healthcare..." < that is so cool! Thank you!! Won’t See EHR Consolidation Soon "tech yet to stabilize, significant development investments are required" Population healthcare management through EHR-enabled care plans, decision support & user-configurable workflows Happy Path < "normal" path of execution through a use case Theory of Constraints and Software Engineering < workflow aspects Care Management Software Vendors Scramble To Meet Requirements < relevance of BPM case management? Half of medical practice EHR shoppers not first-time buyers < support & functionality issues < "Iron Triangle" Meaningful Use Stage 3 Full Steam Ahead < increased care coordination will require coordination tech, AKA BPM & case management Clinical process analysis and activity-based costing at a heart center Master the 'ABCs' of Activity-Based Costing < nice fit w/BPM and process mining Activity Based Costing (ABC) For Hospitals < consultancy User-Centered Design: Analysis, Design, Prototype, User Feedback < resembles PDCA and BPM life cycles Pattern Language for Dialogue Management < relevant to multimodal, conversational EHRs "Custom Mobile Workflow - rapidly deploy custom developed apps and content to improve current workflow in the field" < medical device market What is an EHR problem list? Relevant to checklist discussions in BPM Vendor: "We understand the crying need for workflow design that makes sense to a physician's mindset and working world" Mining electronic health records: towards better research applications and clinical care < see Box 1 for NLP pipeline/workflow Social media to raise productivity of interaction workers, high-skill knowledge workers, 20-25% < relevant to healthcare Social Media Could Add $1.3 Trillion to the Economy < includes "healthcare workers personally figuring out patients’ needs" Group Practice Targets Analytics to Help it Survive < needs event-driven workflow Critique of a Knowledge Worker Cockpit < medical example Human Factors Principles in the (Re)Design of Bar Code Medication Administration (slides) Relationship of Usability and Patient Safety with Health Information Technology (video) Interruption Awareness: Developing a Safer Norm in Nurse Practice Settings Electronic health records changing the character of the family doctor < for the worse, need better workflow Healthcare pays more (17%) than any other industry (29) for information technology < 12 reasons (spot on!) #HIT #HealthIT Battle for usability against excessive clicks (Spanish translation to English) < nice to see my blog post on EHR featuritis featured! $200M Health Plan/Insurance provider chose dynamic BPM to automate Appeals & Grievance process Using a "'workflow engine', which can complete the actions explained in a workflow, in the order and with the derivation rules specified in it, workflows can be employed by people who are not experts in programming for the health area" "EHRs Just Don’t Work: Unless you plan on adding two hours to your workday, you need to weave speech recognition into your workflow” < bit more complicated, I’m afraid 500 beds create 1500 msg/day to medical staff sub-groups, each w/own rules & processes for managing communication flow Weighing BPM, CRM and EHR for health care compliance Avoid Unreliable Voice Recognition - How to Use Dictation With Your EMR < interesting to see attack on VR, getting better so now a threat! My comment: EHRs should use BPM and ACM tech to manage a presentation layer and improve usability Complex Event processing in health care management One-quarter of small practices eyeing closure < argument for EHRs that make practices hyperefficient Optimizing U.S. Health Care Processes -A Case Study in Business Process Management Future Technology of BPM « relevant to clinical NLP Component-Based Process Modeling in Healthcare EventMine: Extracting events w/meta-knowledge from biomedical text Virtual whiteboard hospital workflow automation tool < usability engineer's "radar view" So... where does BPM come from? "wide array of very different products” < not healthcare-specific, but good overview: embeddable engines, doc management, SOA, pure-play, case management Enabling Flexibility in Process-Aware Information Systems < highly relevant to EHR & HIT Speech Understanding: The Intelligent Speech Alternative < “workflow” mentioned 19 times in 5 page white paper, also "Workflow Orchestration” and “workflow orchestration” clear BPM-style features IV Barcode Workflow Systems < efficiency & patient safety Predicting Disease Transmission from Geo-Tagged Twitter Data Video Interview: BPM and EMR Workflow Management in Primary Care Structured vs unstructured #EHR "needs to fit the workflow of clinical medicine like a glove" Guarded Process Spaces (GPS): A Navigation System towards Creation and Dynamic Change of Healthcare Processes from the End-user’s Perspective Saudi Food and Drug Authority Expands BPM Program Process Mining in Healthcare (slides, pptx format) < excellent overview Unraveling the IT Productivity Paradox: Lessons for Health Care "mismeasurement, mismanagement, and poor usability" "Lost in the MU rhetoric…healthcare providers must deploy BPM… & workflow processes within industry-leading BPM tech" My comment in response to "Can you provide more info/references on BPM suites?" Voice Enabled Mobile Workflow < classic workflow = call flow application EHR certification lacking usability, doctors say Creating a Test Corpus of Clinical Notes Manually Tagged for Part-of-Speech Info < #NLProc Improved Patient Care < hospital BPM "workflow solutions maximize clinician productivity and improve clinical decision-making” < vendor touting workflow management Healthcare analytics applications to enable a comprehensive understanding of patient data < NLP How I Became Interested In EHR Workflow Management Systems “Traditional health software is on Medicare, being kept alive like grandma....complexity & lack of user friendliness" Xerox: "workflow automation from business management … EMR … exceedingly difficult to use … don’t fit into workflow" Remote Scribes Put The ROI In EHRs "Despite the…benefits EHRs promise, most doctors despise the technology for one simple reason - it slows them down" "The doc uses the workflow engine to initiate and control workflow" < unclear! Is the human scribe the "workflow engine"?! Managing Exceptions in the Medical Workflow Systems "doubling the national average for outcomes ... repeated testing and re-ordering of steps in the process ... rapid iteration will become the norm" HIMSS Davies Award Winning EMR Workflow Systems Workflow & EHRs in Small Medical Practices < different workflow across patients, offices, regions < needs to be customisable How Natural Is Natural Language Understanding? nice overview commercial tech < mentions Clinical Language Understanding Workflow-Oriented Framework-Driven Implementation & Local Adaptation of Clinical Info System < engine? definitions? BPM? My comment: Will a System Approach Heal Medicine? < automated process checklists require combination of BPM & ACM As EHR Adoption Rises, Experts Raise Concerns About Safety of Systems "errors that disrupt a physician's workflow" need BPM model checking & process mining Process Mining on YouTube (English subtitles) < imagine if applied to healthcare! Workflow Technologies Help Or Hype In Healthcare "In the next five years, we’ll see someone leapfrog to bring us to the next generation that mimics the workflow of doctors and nurses" Clinical decision support for oncology based on BPM and adaptive case management Geisinger Health System Wins Global Award for Excellence in BPM & Workflow - SmartBrief Adaptive autonomy - Wikipedia iDash "tools, data, and educational resources for developing and applying NLP to clinical text” EHR user as User-Programmer? (analogy to citizen-soldier) < in Clinical Groupware as Clinical Teamware HealthcareAnalytics.info Enhancing Healthcare Quality and Management with Analytics Cigna Healthcare and BPM Process-Centric Tools "flexible workflow engine based on NCQA/URAC process support" National Committee for Quality Assurance/ Content Management and Workflow Automation: Critical to Successful EMR Implementation Screenshot hospital efficiency dashboard: category, measure, opportunity, trend, facility, performance, comparison group, basis Understanding Task-Driven Information Flow in Collaborative Networks < relevant to social and mobile EHR and PHR BPM and ACM systems From Discovery to Design: The Evolution of Human Factors in Healthcare EHR/EMR Workflow System Usability–Roots in Aviation Human Factors Debunking the myths of the NIST EHR Usability Protocol Process Mining Framework for Clinical Guideline Improvement in Critical Care How EMRs Will Change in the Near Future "complex healthcare workflows ... 'coordinators' amongst multiple systems" UX Design as a Two-Way Conversation < Grice's Maxims < also relevant to EHR usability Activity-Based Computing for Medical Work "Activity-Based Computing. A computing infrastructure, which supports users to create, save, manage, suspend, resume, move, share, and discover computational activities." Work-Centered Design "tools & long-term breakthroughs 4 HIT usability & workflow challenges" (short video) Oncotheraper: Knowledge-Driven Business Process Management < ACM: Adaptive Case Management FP7 MobiGuide - Google Search "MobiGuide: Guiding Patients Anytime Everywhere" Soarian Clinicals Workflow Engine - A focus on outcomes Fast Detection of Exact Clones in Business Process Model Repositories < benchmarking EHR & HIT processes & workflow Future of Clinical Documentation Technology "tremendous performance advantage over competitors is possible thanks to [a] workflow engine" Business Process Mining: From Theory to Practice "existing commercially available business process mining tools and have listed their capabilities within a comparative analysis table" Medical practices need workflow automation systems in order to go paperless The Extent and Importance of Unintended Consequences Related to Computerized Provider Order Entry < "workflow" mentioned 19 times Designing for Experience in EMRs "fundamental shift in thinking about EMR systems, a shift to adapting those systems to existing workflows rather than the other way around" "A good user interface *should* disappear. The day that the EMR effectively disappears from view will be the day we finally get it right" "Alert Fatigue" Clinical Decision Support vs BPM "reduce burden on clinician while improving efficiency & effectiveness" Powering healthcare transformation [with BPM] to accelerate change, improve quality and reduce costs. - YouTube Clinical interoperability & workflow engine receives FDA 510(k) clearance as a class II medical device NIST publishes guidance for electronic health record usability and security Stellar comment on my blog "BPM workflow systems and overall user design theories...bleed into EMR and truly explode to the next level" EHR Beyond Meaningful Use: Productivity "billions of dollars implementing productivity-killing electronic health record applications" SMART Platform: early experience enabling substitutable applications for electronic health records < gonna need BPM-style workflow engines and process definitions to glue together "lack of actionable clinical data…practical, real-time info on what shortfalls needed to be immediately addressed…getting financial report cards and requests to follow quality standards" CMIO blog comment "I realize just how primitive medicine is in BPM maturity" Well-meaning Efforts "trying to fix something that wasn't built the way it should have been and that is making it more cumbersome on the front end for providers to use" < letter to editor on EHRs EHR Business Process Management: From Process Mining to Process Improvement to Process Usability My blog comment: Krug's "Don't make me think!" Cognitive Science, EMR Usability & Workflow -> EHR Design Talk w/Dr Rick EHR Design Talk "Humans Have Limited Working Memory " Process mining human-patient simulation for medical education and assessment Does Your EMR Increase or Decrease Productivity? Clinical intelligence is essentially the healthcare equivalent of business intelligence. The goal is to collect and analyze data to support better clinical decisions Electronic Medical Record Workflow Management The Workflow Of ... - PDF Sugar NEJM: Patient-centered care poor solution to doctor-centered care Reduce and manage risks in healthcare with an ECM and BPM solution Health care and patient safety: The failure of traditional approaches – how human factors and ergonomics can and MUST help Blog "Talk to many doctors… their EMR stinks…workflow is still inefficient…dozen steps to get tasks handled" Herbert Simon’s Well- vs. Ill-Structured Problems, Adaptive Case Management, and Clinical Groupware Physician Perspectives About HIT "particularly pessimistic about ability EHRs 2 lower costs" « need business process management plus activity-based costing "Not the complexity of healthcare workflows that creates issues, it is the variability…can't know the durations" Mining Processes in Dentistry < “We argue that the introduction of workflow management technology is needed in order to make digital dentistry a success.” < true for EHRs too! “HatCam” goes to #HIMSS12: Video Interviews, Fisheye Tours, BPM & Process Mining < process mining video interview and marketing of BPM in healthcare “As a physician, I believe natural language processing is the most accurate and efficient means of documenting patient encounters" My blog comment: BPM, WfMS, ACM, PAIS, EHR, healthcare & need for systematically improvable executable process models Modeling Emergency Care Service Improving The Emergency Department Performance Using Simulation < relevant to optimizing EHRs Using Simplified Discrete-Event Simulation Models For Health Care Applications EHR data entry and peripheral vision "no secret in the healthcare industry that the labor force is possibly the most expense cost center" We aren't getting our money’s worth from electronic medical records "Cognitive science? Did someone say cognitive science?" Nurses' new approach to care improves patient satisfaction < medical & error patient safety Process mining – creating passive management systems? « implications for current EHR & HIT systems "workflow technology to help streamline the patient care process across the enterprise, including physician offices, outpatient and inpatient settings" YouTube - "What if Your Hotel Bill Was Like a Hospital Bill?" < U of Chicago med student < I was one too Healthcare Systems Process Improvement Conference 2012 Overview Healthcare Simulation Lab "Operating Theater Efficiency...Dementia Care...Delayed Discharge" Health IT and Patient Safety: Building Safer Systems for Better Care EMRs & Preserving Primary Care Physicians' Time "strong complaints...about EMRs cutting efficiency steals 60min/day from me!...tears welled" Four day course: Operations Research for Surgical Services "Use of economically rational ordered priorities to make patient flow decisions" "combination of process mining with ontology mining" « use to increase EHR efficiency, effectiveness & user satisfaction AKA usability Create a Care Coordination Team using Spare Parts "mathematical model can help predict ROI by simulating the effects of a new process on quality, access and cost" EHR: "Workflow Gets Better…can be customized for any type of clinic…workflow plan maximizes efficiency in office" MGMA: Productive, profitable practices focus on workflow Siemens “workflow engines help improve performance of clinical processes...embedded workflow and rules engines...and embedded analytics" Development of a Workflow Integration Survey (WIS) for Implementing Computerized Clinical Decision Support Risks of Lawsuits Due to EHRs < EHRs "are to malpractice what the electron microscope is to microbiology" Acquisition “Improving workflow is…key to higher-quality, safer patient care [&] improving efficiency & productivity” The coming storm in healthcare #healthcare #BPM #EMR | BPM For Real Analytics Alone Cannot Improve Healthcare: Integrating w/Quality Improvement < “actionability” likely requires process mining to pinpoint process problems "Despite its simplicity, the paper form — with every data category assigned to a fixed location on the page — is a powerful cognitive tool" BPM Process mining & visualisation tool featured on Building Better Healthcare Methods for Analytics Program Excellence "comprehensive, coordinated and forward looking analytics capabilities" < Health IT context Learning Features in Human-centered Voluntary Medical Incident Reporting Systems Usability 101: Applied Methods and Insights "measuring the effectiveness, efficiency and satisfaction of the user experience with an EHR" Selecting an EMR for Your Practice: Evaluating Usability "9 EMR usability principles...7 steps for comparing EMR usability" medCafe: A Composable Interface for Clinicians "basic tenets of a composable architecture" Healthcare Workflow: "Process mining as visualization technique" < short but sweet Video: 2011 Adaptive Case Management award for process-aware EMR EHR BPM system < at 19:00 Interesting bio: human factors, safety, emergency medicine < visual cues, mistakes, EHR screen design Why Good News Health IT is So Bad "complexity & lack of user friendliness" New Electronic Health Record Usability Assessment Tool at HIMSS < assess "level of 'usability maturity' in relation to their EHR" Effective EHR Workflow kit "Process mapping is a workflow diagram used to bring forth a clearer understanding of a process" < why process mining is so cool! Organizational Workflow & Its Impact on Work Quality, In: Patient Safety and Quality Natural language processing in EMRs < NLP alternative to "[click]... [click!]... [click!]... [click!]... [click!]... [click!]..." maybe! CMIO "Meaningful Use, increasing demands for clinical workflow automation, and healthcare reform necessitate that every hospital larger than 50 beds have a full or part time designated CMIO" "'dressed up' twenty-year old billing systems are not going to increase staff efficiency, increase patient throughout, decrease admin/clinical errors or improve outcomes for individual patients" Tips for Success with EMRs "Get Software for Your Specialty (or Plan for How You’ll Tailor It)" < might mean workflow? Intro to Industrial Engineering in Healthcare < includes: Benchmarking, Reporting, PDCA, Process mapping, Simulation "When physicians raise concerns about how a technology will impact their workflow, they don't need a time-tracking study of random clinicians. They need help solving their specific workflow issues" Personalized Access Control Framework for Workflow-Based Health Care Information Guarded Process Spaces (GPS): A Navigation System towards Creation and Dynamic Change of Healthcare Processes from the End-User’s Perspective Reusing a Declarative Specification to Check the Conformance of Different Ccomputer Interpretable Guidelines (Clinical Guidelines/Clinical Decision Support) Negotiating Deadline Constraints in Inter-organizational Logistic Systems: A Healthcare Case Study Digital pen "innovative approach to EHRs that captures structured and actionable data with no change in workflow for providers" < note emphasis on *not* changing physician workflow Capability Maturity Model < relevant to other maturity models, including EHR usability, BPM, and care coordination Hospital KPI "dashboards use a visually intuitive, point-and-click interface to provide updates on key performance indicators (KPIs) and benchmarks" "Most of the older EMR’s on the market cannot adapt, most are having to come out with new solutions, some of the vendors that came out a little later and employed [BPM] were smart and will have a great marketplace in the future" User Centric Highlights User Research, Usability, and User-Centered Design in Free Webinar Series < 16 free webinars, some relevant to zEHR design BPM Technology Adopted by Nation's Leading Comprehensive Provider of Healthcare Cost Management Solutions "In-putting and retrieving patient information can be laborious and, due to complexity and poor workflow design" < EHR workflow usability issues at NHS HIE "Collaboration platform: Unlike traditional EHR products, EHR-Lite [was] created with care coordination and collaboration in mind" Patient Encounter Medical Office Workflow < showing off a flowcharting product Business Process Management 2011 - Demo: Supporting Healthcare Processes with YAWL4Healthcare Healthcare billing company touts "Technology - Workflow engine and business process improvement tools" < will more on clinical side too Process Mining Put into Context "analysts should take into account the context in which events occur when analyzing processes" < relevant to EHR process mining Physician Owners More Likely To Cite Difficulty in Adopting EHRs "35% reported that EHR implementation was very difficult" What is business process management (BPM)? "systematic approach to making an organization's workflow more effective, more efficient and more capable of adapting to an ever-changing environment" What is Process Mining? Exceptions & Exception Handling in Computerized Information Processes < relevent to medical error & patient safety in EHRs Health Care Business Intelligence and Analytics Report < nice overview, but nothing about process mining Team Creativity: A Process Model < transactive memory systems, page 3 < relevant to EHR groupware BPM Center < [EHR] BPM execution, diagnosis, design, implementation < relevant to healthcare "How, when & where Industrial Engineering tools are being successfully applied across…healthcare" < sounds like a good column! " Complex Event Processing (CEP) is about identifying an issue caused by multiple process events, analysing its impact, and kicking off a new process to resolve the issue" < relevant to EHR workflow systems 1st Workshop on Human-Centric Process-Aware Information Systems < not specific to healthcare but relevant to EMR EHR workflow systems White Paper: How to Achieve an ROI for Healthcare BI < improved if included healthcare process mining Driving Inpatient Throughput "ED, inpatient units, critical care units and hospitalists all had opposing interests" < simulation helped create consensus Concepts and Issues in Healthcare Simulation "covers the healthcare simulation waterfront" Modeling and Optimizing Emergency Department Workflow < simulation predicted patient volume, wait-time, length of stay, treatment time w/i 0.5% of actual Making Simulation Accessible to Healthcare "graphical interface and online experimentation by users" < IMO relevant to process mining medBPM "designed to model, analyze optimize and communicate complex healthcare processes" Partnering to Right-Size and Right-Flow the Massachusetts Eye and Ear Infirmary "series of simulation, animation, and queuing network models" Patient Flow Improvement: How Long are Your Clinic Appointments? "EMRs can be used to measure and monitor appointment length" Healthcare Systems Process Improvement Conference "Process improvement is the only way for health systems to advance" < I agree! PS I'm speaking! A BPMS must include the following 10 component capabilities: < still good list < will it apply to EHR BPMSs? EHRs "are not designed to accomplish a very valuable goal, which is coordinating teamwork—a group of people coordinating their work over time" EHRs "are ill-designed and clunky; poorly integrated into clinical workflow; and often times create more work " HIMSS CBI Committee "Clinical Business Intelligence solutions extract data from [HIT] systems into a centralized, secure, historical repository, for the purpose of making better clinical decisions within and across healthcare settings" Comparative Effectiveness Research Hub aim "Make proven NLP tech broadly available for enhancing use of EMR data" Top 10 Health Technology Hazards for 2012 < no mention EHR BPM and healthcare — Why has it taken so long? Hospital Management System to Improve Patient Flow "Full visibility of patient flow processes...Optimal patient flow across entire hospital simultaneously" Graph-Based Approach For Process Model Similarity Evaluation < might be relevant to comparing healthcare processes "Many EHR systems fail to impress clinicians simply due to the busy and cumbersome UI" - EHR Usability Archives Fear shouldn't hold small practices back "With just a couple clicks, I [the physician user!] saved the staff a lot of time" < importance of user customizable workflow RE Process Mining: Figure 2. A Spaghetti process discovered based on an event log containing 24,331 events referring to 627 gynecological oncology patients and 376 different activities Workflow Analysis: "great way to test [EHR] vendor’s knowledge of specialty-specific workflows" Will the Apple iPad Force Healthcare to Finally Abandon Outmoded User Interface Designs? EHR Usability Factors "EHR usability is typically associated with user satisfaction, but usability is actually more aligned with physician and patient workflow integration" Click-tation "Computer-assisted documentation" technologies include pick-lists, auto-fill, paste-forward, templates, canned text and other methods to bypass natural language" 6 Health IT Usability Myths "What drives usability, he said, is complex multi-user workflows, collaborative timing and handoff requirements" Healthcare Experience Design Conference 2012 Improving Health through Human-Centered Design and Technology 1st Workshop on Human-Centric Process-Aware Info Systems < relevant to user-centered design of EMR & EHR workflow systems EMRs & EHRs Need to Solve “The BPM Problem”: Why Not Use BPM to Help Do So? Pin Factory EHR < "no coherent method of placing each worker in his/her station of the continuum of care, and there is no standard process by which workers hand off work from station to station" Flipping the Process Life Cycle "Consider a patient today interacting with a healthcare [provider]…” < how EMRs EHRs should/will be implemented NIST Response to Comments Received on Draft EHR Usability Protocol < needs better intro & explanations, incorporate suggestions, tighter summary OccupyYourEMR! “you’re going to be steamrolled into using a platform that’s awkward, ugly, inflexible and slow… Demand an EHR that helps your workflow” < topical Does hospital IT need airline-style certification? “Absent in health IT are the mandatory standards that underpin air safety” Case for Modular EHR “It’s all about workflow and productivity” < If only this was true or at least true from the beginning! Approaches to Business Management < includes “workflow...person-to-person interaction and person-to-system interaction” < that’s an EMR EHR usability problem New Medical Reference Design Unveiled at Medical Design Conference "supports remote device connectivity with a BlackBerry PlayBook tablet" < fantastic HW & OS Alarm Management Systems manage vast numbers of medical device alarms to avoid fatal patient consequences < workflow! EHR Adoption To Reach 80% By 2016 "EHR vendors... will have to do a better job of designing products that are more user-friendly" “Routing Engine – A flexible, fast, scalable imaging workflow engine that dramatically improves medical imaging workflow based on customer-defined instructions” Feature Extraction in Medical Image using Ant Colony Optimization: A Study Process Mining - Futura Process Intelligence “discover & document processes… conform to internal & external guidelines?... where are the bottle necks?” "Complete coding Workflow Management System...fits into existing workflow" Healthcare context > "The art of BPM is in creating a highly adaptable and even amorphous solution that can allow for ad hoc, on-the-fly, user-controlled changes to a process" EHR Association responds to NIST draft proposed EHR Usability Protocol (EUP) on Technical Evaluation, Testing & Validation of the Usability of EHRs (NISTIR 7804) BPM Apps for Health Care "health care facilities need tools such as BPM to keep track of all their data—whether it’s from the emergency room or the oncology department" BPM Could Save Your Life "process times, steps, measurement, alerting…systemic approach to overall care-giving processes" Comment "The key problem is the workflow in EHR is geared to a specific type of user, as opposed to the movement of work through a process." Rant "drive for data to ration health care dollars trumps…UX of clunky software that doesn’t fit workflow" New Report Echoes Call for National EHR Safety Board "unannounced, randomly scheduled, on-site EHR safety inspections" EHRs "like this slow us down rather facilitate better care" < EMR usability, human factors, ergonomics Litmus Test for Detecting Frozen EHR Workflow Engineering Demand for Safety & Quality with Human Factors < medical device focus Learning from TIGER: What Matters Most about Usability & Design for Clinicians medCafe: Composable Interface for Clinicians < components, customization, usability Finding the Right Workflow Using an Ambulatory EHR "attributes of workflow applicable to both manual & automated processes" Nine Usability Mistakes Your (EMR EHR Developer) Team Is Probably Making (And How to Fix Them) Interacting hospital departments & uncertain patient flows: theoretical models and applications < queueing threory, scheduling Usability Consultancy "A medical software product with a well-designed user interface that fits your customer's workflows" Introduction: Making the Case for Context-Based Design < "shift from user-centered design to context-based design" < relevant to EHR EMR User-Centered Design Nine EHR Usability Problems and How to Fix Them with Workflow Technology HIMSS 2011 Slides “Putting the USER in Use(r)ability” < page 107 Who Controls User Experience < moving from programmer to user “With an entire body at your command, do you seriously think the Future Of Interaction should be a single finger?” < proctology? seriously, Buxton chapter 15 Norman & Draper 1986 User-Centered System Design made same point HIMSS Statement on IOM Report on #ptSafety & #Health IT "usability must be aligned with clinical workflow to avoid the risk for patient safety errors" Improving Patient Safety through Health IT < gonna need process models, checking & mining Usable Clinical Groupware Requires Modular Components & BPM (Business Process Management) High-Performance Medical Home and EMR Workflow Systems: Key Ideas …Workflow… Engine for Large Scale Healthcare Solution < “Workflow engine with import/export of data from one step to another” Ever-Expanding Use Cases for BPM Software “Healthcare has jumped on board in a big way… cost is clearly a driver… Mobile BPM is making big waves” Health IT & Patient Safety: Building Safer Systems for Better Care “enhance workflow by automating mundane tasks or streamlining work, without increasing physical or cognitive workloads” IOM Institute of Medicine calls for new Federal agency, not FDA, to oversee Health IT & patient safety, impact on innovation? < gonna need process models EMR/EHR usability marketing message < keep-it-simple, systems-based, uncluttered screens, needs less training, real-time charting, no post-encounter data entry or transcription Why Rigid Process Management Technology Hampers Computerized Support of Healthcare Processes Tablets in Healthcare: Not Just for Pills Anymore Building Smartphone-based EMR from Concept, Design to Prototype < usability: responsiveness, security, features, modularity, consistency Event-Centric Ontology for EHRs “infer which events are critical in detecting onset severe sepsis & septic shock” User-Interface Design of Smartphone Device for Elder People UMassAmherst: Process Programming and Workflow < some application to healthcare Process Programming to Support Medical Safety: A Case Study on Blood Transfusion Temporal Reasoning Tool for Analysis of Medical Device Adverse Events < process mining natural language reports (sorta) Digital Crumbs from EHR to Identify, Study & Improve Health Care Teams < converging w/ process mining Development of a Workflow Integration Survey for Implementing Computerized Clinical Decision Support Info Breakdowns in Critical Care Handoff Communication < lack of standardization, incomplete pre-turnover activities Process Mining for Healthcare Process Improvement | Research Group on Health IT and Informatics What would SIRI mean to health care & how can it change the way we view EHRs? < why Apple should design EHRs? Closed Claims Project “9214 closed anesthesia malpractice claims designed to identify major areas of loss, patterns of injury & strategies for prevention” “Contemporary error research suggests that the quest to eradicate error is misguided” < clinical context Slides: Electronic Health Record Informatics Workshop: 28th Human-Computer Interaction Lab Symposium SAP User-Centered Design life cycle resembles BPM life cycle < convergence? Value-Oriented Coordination Process Modeling < relevant to care coordination & medical home “software simplifies…clinician workflow, not how care is provided…tailored based on who & where they are” < user-aware, location-aware ROME4EU: Process-Aware System for Smart Devices “Roman Orchestration Mobile Engine for Emergency Units” Health IT: A Boon or Bane for Patient Safety?  “new safety features and practices likely will place an additional burden on clinical users & vendors” Certificate and planned Master of Science Wireless Health at Case School of Engineering MATH (Modeling & Analysis Toolsuite for Healthcare) for Evidence-based HIT @ AMIA Usability Workshop < note use of BPMN beginning slide 8 Analysis of Patient Treatment Procedures "real-life event log taken from Dutch Academic Hospital analyzed using process mining" Rules & Workflow Engine Services (Soarian) | LinkedIn < Process Modeling Open source BPM, rules & event processing with a Healthcare focus The phenomenology of slowly-loading webpages < curiously relevant to EMR usability Orion Health Acquires from Microsoft "HPM (Health Process Management) Suite" Thesis: Disease surveillance systems < 2011, full text, excellent intro & current overview "Workflow Engine offers… ability to have their pharmacy technicians work more efficiently while at the same time reducing costs" Event-based , Role-based Authorization Model for Healthcare Workflow Systems Interesting to note 2010-present "spike" in Google searches for "workflow engine" on Google Trends Alarm Safety Takes Center Stage at Two-Day Summit "goal of ensuring that, by 2017, no patient will be harmed by adverse alarm events" Expert Review Usability Criteria < review NIST Technical Evaluation, Testing & Validation of EMR EHR Usability Development of Primary Care Physician Task List to Evaluate Clinic Visit Workflow "12 major tasks, 189 subtasks" Is EHR Usability most important factor hindering adoption? < technically unsubstantiated but probably true One practice’s reluctant adoption of EMRs "we are not adopting EMR because we think it will enhance our productivity, reduce costs or improve the quality of care we provide" Model Checking Timed Properties of Healthcare Processes "Healthcare workflows (careflows)…model checking…can reduce errors" < patient safety Declarative Workflow (Wil van der Aalst) flexibility vs support, groupware vs workflow management systems Paperless Clinical Trials Using Process‐aware Mobile Workflows "a clinical trial can be understood as a workflow process" EHR is a Platform, not an Application "workflows vary according to institution, specialty, local policy & provider personal preference" End-­‐to-­‐End Process Analysis – An Overview of “Process Mining” < excellent short introduction MIE 2011 Abstract: Event-Driven Architecture for Health Event Detection from Multiple Sources Fit between Clinical Workflow & Healthcare IS "Clinical work is fundamentally multitasking, cognitive, distributive, collaborative, interpretative, interruptive, responsive & reactive" Healthcare "workflow engine...simple to use, yet flexible and sophisticated workflow system manages tasks, user assignments, timelines, alerts, and data integration" Wow! "buy one of these dogs (legacy EMR products)… slow down your practice in learning the new technology (RAND survey suggests 18% less productivity)… and make even less money" 10 Things You Hate About Your EMR < usability, cumbersome, distracts from patients Unsung Benefits of HIT Dashboards < integration of dashboards with hospital workflow management systems Human-Centered Systems Engineering: Managing Stakeholder Dissonance in Healthcare Delivery SLIDES State-Based Context-Aware Declarative Process Model < medical example: catheterization domain, state, law, event, goal Web-based Hospital Software is ICD-10 Ready "built-in workflow engine enables HIM managers to create electronic worklists for coding staff automating manual handoffs" Rest in Peas: Unrecognized Death of Speech Recognition < relevant to EMR EHR NLP Work Domain Ontology "defines the basic structure of work that a system, in conjunction with human users, will perform" < similar to EMR EHR workflow definition/process model? Clinical Intelligence: Best Practices in Surgical Care "automatic & embedded performance monitoring" "near-real-time alerts to ensure compliance with best practices" HealthFlow "eForms and electronic workflow (eWorkflow) for healthcare facilities…extends & improves EMRs EHRs" "Replaces manual workflow and routing with automated electronic workflow" Designing Enterprise Architectures Using BPMN: an Application in Hospitals "demonstrating feasibility & usability, reducing complexity & time for modeling" Human-Centered vs User-Centered Design < "a human is much more than eye & finger movements" < lessons for EMR EHR usability? Principles of Workflow Analysis & Redesign < "improve workflow & eliminate the 8-types of waste found in healthcare" Eleven hospitals pilot app store for doctors < app store usability < domain expertise Emerging Approaches to Evaluating the Usability of Health Information Systems "lack of ease of use of health information systems has been a major impediment to adoption" Lost Productivity: Most Common Symptom of Weak Workflow Analysis & Redesign < and EMRs EHRs w/o workflow engines, process definitions What happens after calling the ambulance: Information, communication & acceptance issues in a telemedical workflow EMR is "practitioner’s de facto workflow engine…as a workflow manager EHR products are not particularly well designed" Natural language processing does "turn your text into structured data and put it in your EHR" NLP does "not disrupt the physicians’ workflow" Conference Session: BPM provides opportunities for e-health < translated from Dutch via Google Translate Primary Care Physicians' Use of an EMR: Cognitive Task Analysis "Automaticity, especially in combination with interruptions, emerged as the main cognitive factor contributing to errors" Health care supply company prescribes itself mobile Business Intelligence software 5 Tech Every Hospital Should Use < "Programmable & app-driven" ECM system Alfresco includes Activiti BPM How To Build The Next Great Mobile Health App "Focus groups & smart designers aren't enough. Developers need to dig deeper into patient's world & clinician's workflow" KMR-II: A Knowledge Management Architecture For Healthcare < 2nd gen Clinical Decision Support < Complex Event Processing EHRs need similar:"do-it-yourself workflow application builder…drag and drop…no coding required [Users] can build solutions in hours or days…fraction of cost of traditional [SW] development…Reduce dependence on IT, optimize workflow & increase ROI" Process Mining Manifesto < see Table 1: event log maturity levels < medical device example < relevant to patient safety What is MarketScape for Ambulatory EHR/EMR? "buyers should consider readiness of providers, workflow & human factors" Electronic Health Record Workflow Management Systems: The Next Step in EHR Evolution "flexibly tailored to local processes and user preferences" Gov Report "Reducing costs associated w/ switching EHRs…can help drive market competition to improve usability" Utility, Usability & Likeability Healthcare software usability/user experience consultancy "task analysis, flow diagrams, user personas, cognitive models" Incorporating Process Mining into Human Reliability Analysis < many applications in healthcare re patient safety & medical error Review: Process Mining: Discovery, Conformance & Enhancement of Business Processes "High-quality book on a very relevant topic" Athenahealth Launches Coordinator "structured order workflow btwn physicians & their affiliated hospitals, imaging & surgical centers" Process Mining Manifesto by the IEEE Task Force on Process Mining: Request for Input Fundamental EMR EHR conflict "structured data capture...[vs]...fast way to capture complete information for clinical documentation" TURF: Toward Unified Framework of EHR Usability "accomplish goals…performing certain sequences of tasks" < workflow BPM Squeezing Balloons: How Tech Shifts Workload < EHR increase physician's workload < reason to use EMR workflow automation iPad EMR inspired by lack of EHR usability “Technology wasn’t speeding things up… Doctors have to ignore the patient” “Safeware”: Safety-Critical Computing and Health Care Information Technology EHRs: Getting to Meaningful Usability "EHRs confine physicians to a linear workflow, whereas healthcare... involves... constant adjustment" Survey: 77 percent of current #EMR users say #usability was primary reason for #EHR adoption Whitepaper "Healthcare industry should move from antiquated computer platforms & support the mobile devices" "rules and workflow engines to facilitate efficient patient encounters and secure exchange of clinical and financial information" Comment on "Breaking Even: Amount Of Time for ROI for Adopting An EHR" "Understanding a medical practice's workflow is critical to selling healthcare IT solutions" -1 "Another EMR / EHR usability problem is expectation of physicians that point…is to make them more efficient & happy" < :-( Proposal to include patient safety goals in Meaningful Use criteria "icon-oriented interface… personalized home screen… pre-programmed task sequences… workflow protocols… rules & checklists attached to tasks" What BPM Technology Can Do for Healthcare Process Support - DBIS EPub "busy gynecologic surgeons... terrified EHR system will slow them down or disrupt workflow" < need EMR workflow system A Healthcare Business Process Management System - Healthcare Workflow Software Requirements for EHRs in Ophthalmology "clinical workflow ... systems ... used intuitively & efficiently by ophthalmologists" Clinical Business Intelligence "collection, integration, analysis & presentation of clinical info for better clinical decision-making" Making a Difference with Workflow & Healthcare Process Management Technology < BPM: workflow engine, process model, clinical intelligence, care coordination New Book: Business Intelligence and Analytics for Healthcare Organizations (PDF TOC & intro) Clinical Intelligence, Complex Event Processing and Process Mining in Process-Aware EMR / EHR BPM Systems "unstructured & complex nature of healthcare processes poses a challenge for process mining" – Case Study No. 1 Redefining EMR Usability "will be judged based primarily on error prevention… ignoring an often-mediocre user experience" NYT: Assessing the Effect of Usability Standards on EMR/EHR Innovation Proceedings: Patient Safety Informatics - Adverse Drug Events, Human Factors & IT Tools for Patient Medication Safety EMR Vendor: Watch first, code later? "bending it to a particular clinician’s workflow" < need EHR workflow system! EHR & Usability "most important question pertaining to workflow is whether EMR software meshes w/current workflow" "Successful HIT adoption is as much about understanding & re-engineering workflow as it is about learning the software" 2011 Global Gold Award for Excellence in Adaptive Case Management: Healthcare WfMS/BPM Prototype Using Business Process Management and Business Intelligence to Improve Healthcare With context-sensitive workflow "I can spend every second with your child w/o having to fumble with computers" Usability-Focused CDS w/ Semantic Tech "Reengineer EHR into clinical WfMS" workflow engine/builder (slides 3, 8) Multitasking and Interrupted: A Time-Motion Study of Hospitalists (abstract) NIST EMR / EHR Usability Workshop: A Highly Annotated Tweetstream Clinicians list workflow as their No. 1 usability pain point, 84% complain < therefore fix workflow to fix usability, right? SHARPC NCCD: research addresses urgent usability, workflow & cognitive support issues of HIT Orchestrate Lab/EHR workflow & dataflow w/ powerful, behind-the-scenes business rules. Custom-match workflow for each office OptumInsight LifeCode Natural Language Processing Technology Receives U.S. Patent | SYS-CON MEDIA EHR Usability - Let Physicians Decide | EMR Straight Talk Order Optimizer Merging Engine Recognized as Unique, Awarded Patent | Business Wire BPM Solutions by Industry: Healthcare | Appian BPM Physicians Electronic Records are the Core Engine that Drives Healthcare | | Single Most Important Document: description of manual workflow re annual financial reports Medical Technology Symposium | BPM.com Business Process Management: wikipedia entry Successfully Leveraging EMR EHR Data: natural language processing CMIO News Portals | EMR-EHR | CMIO Summit: Projects don't end at implementation Automate Your EMR Cow Paths *and* Reengineer Them Too! MedFORCE/VGM Partnership: BPM plus home medical equipment Expert Points to IT Power of ACOs: BPM, automated workflow, workflow management systems EMR in Your Pocket - HealthLeaders Media HPCwire: Bringing Natural Language Processing Home New EHRs Perform Better, But Transition Pains Doctors: need to make sure don't cause workflow problems Students to create smartphone apps - University of Illinois at Urbana-Champaign: TaskPop sounds cool! Keynote: What BPM Can Do for Healthcare Process Support: process-aware information systems A Community-Building Workshop:  Measuring, Evaluating and Improving the Usability of Electronic Health Records Blog comment: Traditional EMRs for physicians are cumbersome, slow w/ so many clicks & text boxes, lacking user flexibility & hard to figure out Productivity first, electronic records second "Docs / don"t have time / clunky UIs / throughput / patient tracking engine" Evaluating EMR Usability "Pick up any Apple product and it just works, logically and simply. The same cannot be said about many EMRs" EHRs "still slower than the pen" - Modern Healthcare "Until new innovations in [EMR] graphical user interface / resistance will continue" Dangerous Decade: Challenges for Builders of National Health info Systems "tech maturity of the aviation industry in the 1950s" Blog Comment: "Checking a check box with touch can be painful if the check box is too small, no?" Electronic Medical Record Shift: Signs Of Harm Emerge As Doctors Move From Paper Health Industry is Far From Process-Minded to Help the Sick A Hospital-Based Dynamic Platform Workflow Management, Int. J. Computer Science Perspective on Meaningful Use and EMRs "workflow killers...workflow busting...as high as a 50% deinstallation rate" Digital Medical Records Evolving at Cedars-Sinai Medical Center "long lists of options...pressed for time...pick the wrong option" HIMSS - State of EHR Usability & Human Factors Engineering "The cockpit of a jet...is easier to learn, more intuitive &...safer to use" BPM enables healthcare providers to model processes in zero-coding environment & benefit from continual process optimization eBook Series: BPM in Healthcare "Hospitals and pharmaceutical companies are embracing BPM" Sarasoto Hospital Selects Communications Solution "customizable workflow platform...build or adjust clinical workflow routines" Workflow Analysis: EHR Deployment Techniques (no mention of workflow engines, process definitions or BPM) Business Process Modeling Of Clinical Pathways And Their Simulation In Hospital Settings Workflow for healthcare: A methodology for realizing flexible medical treatment processes Thesis: Workflow Modelling of Coordinated Inter-Health-Provider Care Plans Effective Smartphone Apps: Context sensitivity/awareness, take user to next likely task Intrinsically Mobile, Context-Aware Apps: "Context-aware apps leverage a user's context of use to improve user experience" Mobile User Experience Trends: "Touchscreens are more natural way to interact w/digital world & are proliferating" (problem for traditional EMR EHR) Survey: most important...next 3 years...Meaningful Use & ACO "communication & workflow integration into...Health Info Systems" Healthcare "Workflow Engine" Sighting: McKesson's Complete CVIS Workflow Engine Adaptive Case Management: Healthcare example "Ad hoc intervention capabilities ACM reduce errors during processing of workflows" MGMA Study Reveals #1 Reason Physicians Fear EHRs "lost productivity and lack of usability are one & same" EMR Usability Discussion: "Can usability be measured in way that does not stifle innovation?" Video: Import BPM into healthcare for optimization driven by regulatory change & drive to reduce costs Taking Patient Care to the Next Level | Appian BPM Don’t Mimic Real-World Interfaces — The Brooks Review Hospital IT systems failing patients: "I can't spot any point in the workflow where there's not some fault in the system or disruption to the way ED docs work" What Makes Apps Delightful? "speed w/which you can use app's core value proposition" 5 Questions For Wil van der Aalst on Process Mining Book: healthcare processes highly variable Usability key to EHR adoption, AHA tells HIT panel: speed, reliability, efficiency, accuracy, intuitiveness, design, workflow Physician-centric rule-based communications workflow engine: filter & control based on practice workflow & personal pref Healthcare Workflow | Wikipedia "workflow engines can be very useful to manage processes" Discover, Interact, and Optimize for Smarter Healthcare with BPM... BPM for Accountable Care: Getting to "Systemness" Meaningful Use: too complex to be attractive? "every extra step, mouse click & check mark" Docs fear productivity loss with EHRs "missing is a commonsense approach to workflow" ProHealth'11 4th International Workshop on Process-oriented Information Systems in Healthcare From the Chair: Usability... Still In the Eye of the Beholder - EHR Decisions Geisinger Health System Recognized for Innovative Use of TIBCO's Business Process Management Software Usability Testing for EHRs is a Bad Idea Improving Usability with Fitts Law The Changing Nature of Work: From Structured To Unstructured, From Controlled To Social Book: Clinical workflow & HIT "fragile compatibility with the contingent and pragmatic workflow of care providers" See Rouse Error Classification Scheme table last page: IMHO relevant to EHR workflow usability Ph.D. Thesis (full text) Workflow Support for the Healthcare Domain Workflow Impacts Choice of Connectivity Solution | Medical Connectivity Improving Clinical Workflow with EMR "design methods are feature-based...to exclusion...of how value proposition will be realized in workflow" Business Intelligence Trends in Healthcare: after public sector, least adoption BI, clinical pain points Dissertation: Towards Usable openEHR-aware Clinical Decision Support: A User-centered Design Approach Quantifying impact of health IT implementations on clinical workflow: time vs "flow of work"

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