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Pragmatic Interoperability, Workflow Engines, and Cost Transparency: Emerging Trends In Healthcare

by Chuck @wareFLO Webster, MD, MSIE, MSIS, President, EHR Workflow Inc.

Workflow technology plays an increasingly important role in healthcare interoperability and cost management.

The scope of my expertise is primarily healthcare workflow and workflow technology. I see three priorities, issues, or trends emerging. The key word is “emerging.”

Pragmatic (Workflow) Interoperability

The first trend is toward what I call workflow, or pragmatic, interoperability. I first wrote about this idea in 2014 (for the HIMSS14 blog carnival), but it is finally gaining traction. You can think of workflow/pragmatic interoperability as the next level up from data interoperability.

  • Data interoperability is about syntax and semantics, both ideas borrowed from linguistics.
  • Syntactic interoperability is about encoding, sending, and parsing healthcare data.
  • Semantic interoperability is about interpreting the shared meaning of data. Pragmatics is the third major subfield within linguistics.

“Pragmatic interoperability (PI) is the compatibility between the intended versus the actual effect of message exchange.” (Towards Pragmatic Interoperability in the New Enterprise — A Survey of Approaches)

Pragmatic interoperability may be a simple as making sure a task sent from one healthcare organization to another is, indeed, accomplished, or a complicated as a promise, from one healthcare organization to another, to complete an entire workflow in a timely and transparent fashion.

Emergence of Healthcare Workflow Engines

Pragmatic interoperability requires workflow technology to be implemented well. You can think of pragmatic interoperability as the science behind the engineering of workflow interoperability (about which I have also written, see Achieving Task and Workflow Interoperability In Healthcare).

Workflow interoperability is "the ability of two or more workflow engines to communicate and interoperate in order to coordinate and execute workflow process instances across those engines." (Workflow Management Coalition, 1995) Workflow engines have been prevalent outside healthcare for literally decades, but are only now beginning to appear in health IT applications.  Five years ago, there was virtually no mention on any HIMSS Annual Conference exhibitor website. Last year, five percent mentioned “workflow engine.”

Distinguishing Between Price Versus Cost Transparency

I hate to brag, but this is indeed relevant to my argument. I was an accounting premed major at the number one ranked accounting school (I’ve never met or heard of that combination elsewhere).

Many confuse “price” with “cost.” Markets and regulations set prices.

  • Costs are based on resource expenses necessary to create a product or provide a service.
  • Price transparency is a market phenomenon external to healthcare organizations.
  • Cost transparency is an internal cost accounting, management, and IT phenomenon.

In the long run, healthcare organizations cannot set market prices without knowing internal costs. Apple knows exactly how much each iPhone or iPad costs. Healthcare organizations do not know how much each ambulatory encounter or hospital procedure costs.

This is beginning to change in pioneering healthcare systems. It is only a matter of time before cost transparency is, essentially, commercialized into products.

Guess what is essential for healthcare cost transparency? Understanding healthcare workflows to a level of granularity that you can use  these models, or maps, to assign and aggregate costs.

Stakeholders addressing the above emerging priorities include startups based on workflow platforms for sharing clinical information and coordinating patient care over a variety of channels.

  • Traditional health IT vendors are retrofitting workflow engines into existing systems.
  • Progressive healthcare systems are beginning to experiment with new (to healthcare) workflow-based cost management concepts.

Pragmatic interoperability, workflow engines, and cost transparency have in common what academic workflow researchers call “process-awareness.” Process-aware information systems have a model or representation of work or workflow that is executed or automatically consulted to perform or facilitate workflow.

Historically, these were called workflow management systems. Today, they are frequently called business process management systems, although BPM systems are no longer the only process-aware information systems. Process-awareness is showing up in:

  • messaging systems,
  • real-time location services,
  • interface engines, imaging systems,
  • speech recognition software, and
  • a wide variety of other health IT products.

However, these products don’t come with “process-aware” stamped on their figurative foreheads.

The way forward, in which to accelerate further emergence of the process-aware technologies, including workflow engines, pragmatic workflow interoperability, and cost transparency, is a "Healthcare Workflow Triple Aim."

  • Educate healthcare and healthcare professionals about workflow and workflow technology.
  • Encourage more commerce, intellectual and economic, among healthcare, health IT, and workflow technology vendors.
  • Find and highlight health startups and vendors leveraging or embedding workflow thinking and technology.

Where will I be during HIMSS16?  Here are some of the sessions I plan on attending.

Actionable Analytics: From Predictive Modeling to Workflows

Solving Care Management with Intelligent Digital Workflows

Why Secure Text Messaging Apps Aren't Enough

Clinical Collaboration: The Power of well-designed Workflows

Optimizing Patient Flow to Improve Patient Satisfaction

Rethinking patient engagement and provider workflow

Federate? Migrate? Capitulate? ACO Driven Interoperability & Workflow

Now, where to start? Follow the link in the following tweet. . .

Tell your workflow story on Twitter using the #HIMSS16 hashtag.

If you mention workflow, you can be sure I’ll find your tweet, retweet, reply, follow, etc. I’m a HIMSS Social Media Ambassador (for healthcare workflow)! Consider using my unofficial hashtag: #HIMSSworkflow and follow me on Twitter at @wareFLO.

See you at #HIMSS16!


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