eHealth: Innovations and Issues

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eHealth Innovations and Issues

• Lecture 5
• Business Processes, Workflow Management, IT in
  Healthcare
• Norm Archer

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Agenda

• Increased emphasis on eHealth in Canada (Canada
  Health Infoway)
• Business process modeling
• Business process redesign (BPR)
• Process innovation
• Failures of BPR
• Success factors for BPR
• Best practices for BPR
• Standards for business process models
• Workflow management
• Workflow management systems
• Workflow management coalition

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Increased Emphasis on eHealth in Canada
Spending and Innovation
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Increased Emphasis on eHealth Spending in Canada

• Challenge - pull together the current IT silos or
  paper systems that support 121B spending per
  year for healthcare in Canada (85B Govt, 36B
  Private)
• (more than 10 of Canadian GDP)

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Canada Health Infoway (CHI 2005)

• CHI Federal Agency provides joint funding for
  health infostructure projects. 1.2 B available
  for capital investment
• Business Plan 2005-06
• CHI provides 75 funding for eligible projects
• Collaborates with provincial health ministries
  and private sector partners
• By March 31, 2006, 646 million will be approved
  for specific projects (54 of total available)

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CHI

• Primary focus is on supporting interoperable
  health information systems with electronic health
  records across Canada (for U.S.A. see Brailer
  2005)
• Estimated savings for a completed system would be
  6.1 B annually
• Target is to be supporting 50 of Canadian
  population with such systems by 2010

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CHI Funding and Targets

• Client provider registries 110M
• Diagnostic imaging systems 220M
• Drug information systems 185M
• Lab information systems 150M
• Interoperable EHR systems 175M
• Telehealth 150M
• Public health surveillance 100M
• Innovation and adoption 60M
• Infostructure 25M

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Discussion

• Likelihood of IT project failure increases as
  project size and scope increases
• Need to focus on
• Involvement of all the stakeholders (governments,
  private corporations, healthcare providers,
  citizens)
• Evolution if possible, revolution if necessary
• Standards, interoperability
• User acceptance
• Smaller projects that will link together to
  support overall objectives
• Major edge that CHI has is that its projects make
  use of existing technologies.
• Major handicaps
• Many stakeholders with differing agendas
• Huge differences in levels of IT sophistication
  across the healthcare sector

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Business Process Modeling and Workflow Management
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Business Process Modeling

• Major tool for communication between developers
  and users graphical, backed up with
  documentation
• Complete description of a business process needs
  information
• describing constituent business process
  activities
• resources assigned to activities, (objects
  necessary for execution of activities, - actors,
  documents, data and so on
• controls of the business process - when and
  which activity will be executed
• flow of data in the process
• organizational structure - organizational units,
  people, roles, competence etc.
• Business process modeling approaches should
  enable the modeling of all these types of
  information
• provide facilities for tracing, simulating and
  graphically animating the constructed business
  process models.

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Business Process Workflow Models

• A business process model is a process abstraction
  that depends on the intended use of the model.
• When such a model is intended for business
  process implementation and automation, it is a
  workflow model.
• A business process model can be seen at two
  levels at the reengineering level and at the
  automation (implementation) level. Thus, the
  model produced at the re-engineering level is
  later transformed to another model at the
  automation level in order to be used by
  application development programs (e.g. WMS) or to
  be directly executed in an existing working
  environment.

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Business Process Redesign

• BPR closely related to major projects to
  implement IT, including Enterprise Resource
  Planning (ERP) systems, such as SAP, Oracle, etc.
• But it should be used for every overhaul of
  existing systems or implementation of new systems

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Process Innovation (Davenport 1993)

• Framework for process innovation
• Identifying processes for innovation
• Identifying change levers
• Developing process visions
• Understanding existing processes
• Designing and prototyping the new process
• Enablers of process change (change levers) can
  include information technologies and/or changes
  in organizational structure

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Failures of BPR (Bergey 1999)

• Contributing reasons for failures
• Adoption of a flawed BPR strategy
• Inappropriate use of consultants
• Workforce tied to old technologies
• Failure to invest in training
• Legacy system out of control
• IT architecture misaligned with BPR objectives
• Inflexible management team
• Lack of long-term commitment

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Success Factors in BPR (Paper 2005)

• Environmental success factors top management
  support, risk disposition, organizational
  learning, teaming, compensation and reward
  systems, information sharing, and resources.
• People success factors training, education,
  politics resolution, ownership, and empowerment.
• Methodology success factors appropriate guiding
  principles, buy-in, direction, continuous
  monitoring, graphical process map, and customer
  support.
• Technology perspective success factors IT
  knowledge, IT belief system, and IT architecture.
• Transformation or change vision success factors
  vision development, vision communication, vision
  deployment, and vision flexibility.

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Best Practices in BPR (Reijers 2005a)

• Eliminate unnecessary tasks from business
  processes (i.e. those tasks that add no value
  from the clients point of view)
• Consider removing batch processing and periodic
  activities from business processes (this may
  speed up handling of specific tasks, but consider
  that significant economies of scale may be
  achieved for large transaction volumes)
• Move controls towards the client (helps to
  eliminate errors)
• Consider integration of business processes with a
  supplier (may apply, for example, to ordering
  medical/surgical supplies)
• Consider whether tasks may be executed in
  parallel (may speed up execution substantially)

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Best Practices in BPR

• Design business processes for typical situations,
  and isolate exceptions from normal workflows
• Let workers perform as many steps as possible for
  individual situations, providing that they have
  the expertise to do so
• Treat geographically dispersed resources as if
  they were centralized (for example, through
  better communications, specialist resource
  expertise can be made available when and where
  required, even if not physically present)

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Best Practices in BPR

• Avoid assignment of task responsibilities to
  people from different functional units (this and
  the following two best practices are the basic
  idea behind service bundling approaches)
• Consider assigning teams out of different
  departmental workers to take care of complete
  handling of specific work assignments.
• Appoint one person as the case manager, with
  responsibility for handling each work assignment
• Consider making resources more specialized or
  more generalized, depending on the particular
  task classification.
• Give workers most of the decision making
  authority and reduce middle management (this
  reduces the overhead and time spent on
  authorizing work that has been done by others,
  resulting in smoother operations)

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Fragment of Business Process Map
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Standards for Business Process Modeling (Graham
2005)

• UML (Unified Modeling Language) supported by
  Object Management Group (OMG) consortium
• XMI (XML metadata exchange) proposed by OMG
• BPEL (Business Process Execution Language)
  supports automated application development
  directly from business process models
• BPMN (Business Process Modeling Notation)
  provides a standard way to share process
  information with business users, integration
  developers, customers, business partners.

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Workflow Management
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Workflow Management

• Workflow Management
• The automation of a business process, in whole or
  part
• documents, information or tasks are passed from
  one participant to another for action, according
  to a set of procedural rules.
• Business workflows can be well defined,
  predictable, and frequently executed - structured
  business workflows
• Structured workflows can be automated by machines
  to reduce clerical tasks and potential human
  intervention errors
• Workflow management systems (WMS) are systems to
  facilitate automation of structured business
  workflows.

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Sample Workflow Map (Mentzas 2001)
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Workflow Management (Reijers 2005b)

• Performance measures
• Lead time, i.e. the time between the arrival of a
  case and its completion (also known as cycle
  time, completion time, and turnaround time),
• Service time, i.e. the time spent by resources on
  the processing of a case,
• Wait time, i.e. the time a case is idle during
  its life cycle,
• Utilization of involved human resources, i.e. the
  ratio of activity versus their availability.

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Workflow Management Coalition

• Workflow Management Coalition
• Formed in 1995
• Over 300 member organizations worldwide
• http//www.wfmc.org/
• Develops recognized standards for WFM systems,
  approaches
• In the early 1990s, when WFM became a recognized
  approach, it was suitable only for structured
  workflows, resulting in many failures of WFM
  systems because of a lack of flexibility
• WFM has now evolved to become more flexible/
  adaptable in handling workflows, including
  exceptions. Also standards developed for XML
  formats, etc. Still of most value to large
  organizations with existing infrastructures of
  systems like ERP, etc.

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References

• Bergey, J., Smith, D., Tiley, S., Weiderman, N.,
  Woods, S. (1999). Why reengineering projects
  fail. Pittsburgh, PA Carnegie Mellon Software
  Engineering Instititute.
• Brailer, D. J. (2005). Interoperability The key
  to the future health care system. Health Affairs
  - From The Field, W5, W520 - W522.
• CHI. (2005). Corporate Business Plan 2005-06.
  Retrieved January 29, 2006, from
  http//www.infoway-inforoute.ca/Admin/Upload/Dev/D
  ocument/2005-0620Business20Plan20FINAL-Eng.pdf
• Davenport, T. H. (1993). Process Innovation
  Reengineering Work Through Information
  Technology. Boston MA Harvard Business School
  Press.
• Graham, R. (2005). Development meets business
  process modeling A QA with IBM. Retrieved
  January 29, 2006, from http//www.developer.com/de
  sign/article.php/3492721

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References

• Mentzas, G., Halaris, C., Kavadias, S. (2001).
  Modelling business processes with workflow
  systems An evaluation of alternative approaches.
  International Journal of Information Management,
  21, 123-135.
• Paper, D., Chang, R.-D. (2005). The state of
  business process reengineering A search for
  success factors. Total Quality Management, 16(1),
  121-133.
• Reijers, H. A., Mansar, S. L. (2005a). Best
  practices in business process redesign An
  overview and qualitative evaluation of successful
  redesign heuristics. Omega, 33, 283-306.
• Reijers, H. A., van der Aalst, W. M. P.
  (2005b). The effectiveness of workflow management
  systems Predictions and lessons learned.
  International Journal of Information Management,
  25, 458-472.

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eHealth Innovations and IssuesEnd Lecture
5Business Processes, Workflow Management, and IT
in HealthcareNorm Archer, Ph.D.archer_at_mcmaster.
cExt. 23944