January 2015

The Business Case for Process Management
By Sandy Kemsley
For The Record
Vol. 27 No. 1 P. 26

Health care information systems (HIS) and EHRs track every detail of a patient's interactions with health care providers. However, these systems are often focused on documenting what happens in manual health care processes—in order to meet regulatory and compliance requirements—rather than providing the highest quality patient care. To improve patient care standards in a time of aging populations, increasing costs, payment reform, rapidly changing best practices, and a data explosion, it's no longer feasible to rely on manual processes; health care processes must be automated wherever possible.

To this end, business process management (BPM) systems—which include workflow, integration, rules, and analytics—have made significant contributions to improving the quality, efficiency, and flexibility of HIS, and are now seen as essential. "Workflow takes [our EHR solution] to the next level in terms of functionality, and organizations that are not using it are missing an opportunity," says Kay Cartwright, vice president of continuum of care and chief nursing officer at Reid Hospital in Richmond, Indiana.

How can BPM technologies be applied within health care environments to improve quality of care, compliance, and efficiency? With help from case studies provided by Siemens Healthcare, industry experts offer several tips.

Why Use BPM in Health Care Environments?
Health care organizations must meet high-reliability standards to ensure compliance with industry regulations and their own best practices to reduce adverse events. Process improvement and automation can root out inefficiencies and reduce costs, while process intelligence can provide context to improve decision making and patient care quality.

The integration of BPM with the line-of-business HIS/EHR systems is critical to providing an efficient environment that allows health care workers to focus on the patient. BPM can help manage processes and data across all aspects of patient care, connecting the right person with the right task and information at the right time, while providing the ability to quickly adapt processes to changing requirements. "Workflow is not an afterthought; we think about how it can be leveraged to accomplish our strategic plans for both costs and patient care metrics," Cartwright says.

Debbie Eckhoff, director of clinical informatics integration at Reid, adds, "Workflow comes to mind first in planning sessions. We're always thinking 'what can workflow do to help us?'"

With BPM, patient care quality and administrative efficiency are no longer conflicting goals in health care processes. Applying BPM in health care processes can do the following:

• enforce standard processes and protocols to reduce errors and improve patient safety;

• automate non–value-added tasks such as scheduling notifications, allowing clinicians to focus on patient care;

• monitor, predict, and improve care processes while in progress, not after the patient has been discharged;

• predict and avert resource bottlenecks before they occur;

• automate early identification of time-sensitive conditions, based on vital signs monitoring and analytics;

• reduce waste within processes in terms of wait time, inventory, and resources; and

• capture quality and compliance metrics to reduce administrative paperwork.

What Is BPM?
BPM has expanded from its roots in workflow and integration to become a collection of technologies for improving business processes. BPM integrated into industry-specific applications, such as HIS/EHR, provides management and monitoring of business processes within that informational context.

The following are several key BPM capabilities in health care scenarios:

• Process modeling allows a process analyst to create graphical, flowchartlike process definitions, which can contain both human and automated tasks. Modeling can also include analysis and optimization techniques such as process simulation, where a process runs in a simulated runtime environment to identify bottlenecks, determine resource requirements, and compare what-if scenarios before it moves to a live production environment.

• Structured process execution runs the predefined process model for each new case, with little variation. Human tasks are assigned to people or roles; automated tasks run scripts or make calls to other systems. These are essentially automated versions of the procedure manuals, checklists, standard forms, and guidelines that form the backbone of standard hospital procedures, plus the capture of metrics that document adherence to the standards. These processes are deeply integrated with hospital information systems—often to the point where they appear to be part of the HIS—and interface with sensors and devices to automate and respond to the capture of patient vital statistics. Most of the data related to the process are structured EHR data stored in the HIS/EHR system.

• Dynamic process execution, or goal-oriented case management, allows a participant to create tasks for a specific case on the fly. These processes predominate in outpatient chronic care management scenarios, where the actions at any given point are highly dependent on the current context. The care processes may not be fully defined in advance, but created as the case manager, patient, and practitioners select specific activities while the case progresses. Tasks may not need to be executed in any particular order, but simply exist on a checklist of items to be completed. Although there will be some amount of structured EHR data as part of the case information, a case usually includes a permanent case folder that can contain various content artifacts, including unstructured documents.

In general, the goals of structured processes include improving quality, safety, and efficiency through standardization and increased automation. In contrast, the goals of unstructured processes include flexibility and the support—not control—of human knowledge work. These are not necessarily in conflict, but the tools for designing, executing, and monitoring these can appear significantly different.

• Business rules are incorporated in both structured and dynamic processes to enforce regulations and an organization's best practices. Rules may evaluate a complex set of conditions and decide on the next best action; the process then acts on these decisions by alerting participants, escalating a case for immediate attention or triggering automated actions.

• Process intelligence (analytics) collects data about processes as they execute, then analyzes and displays that information to provide context and track key performance indicators.

Getting Results With BPM
University Hospitals (UH) Elyria Medical Center (formerly EMH Healthcare) uses BPM to improve care delivery and team collaboration, especially for time-sensitive activities and escalations. With the workflow engine embedded within the EHR system, UH Elyria is able to create processes customized to its specific needs.

"The workflow engine works behind the scenes to gently remind and guide our teams to care for patients in a manner consistent with the evidence. This level of decision support is a key to success in today's fast-paced health care environment," says Charlotte Wray, UH Elyria's vice president of clinical operations and information systems and chief clinical and information officer.

Mountain States Health Alliance (MSHA) relies on BPM for early detection of sepsis by correlating patient metrics and raising alerts much earlier than traditional techniques. "The workflow engine behind Soarian is very powerful and capable of uniquely identifying data unlike any other system I've seen," says Paul Merrywell, CIO of MSHA. Using BPM integrated with other information systems, MSHA has reduced its average time to treatment to two hours, down by more than 75%, which can drastically improve survivability and reduce critical care time (and costs) for patients.

Summary
BPM—including both structured processes and dynamic case management—can add significant value to health care processes. The combination of people, process automation, rules, and analytics can improve care quality while achieving regulatory compliance and administrative efficiency.

— Sandy Kemsley is an independent analyst and process architect specializing in business process management (BPM). She consults to end-user organizations and BPM vendors globally, writes a popular BPM blog at www.column2.com, and is a featured conference speaker on BPM and related topics.