From Aerospace to Healthcare:
Perspectives on Business
Modeling
Ken Wong, Ph.D.
Senior Systems Analyst
McKesson Medical Imaging Group (MIG)

From Aerospace to Healthcare …
Aerospace refugee (ex-Hughes/Raytheon)
Air Traffic Management – STARS, …
Air Command and Control – ACCS
“Systems Engineer” (SE)
Healthcare immigrant (ALI/MIG)
Radiology Information Systems (RIS) - HRM
Picture Archiving and Communications Systems
(PACS) - HRS
“Systems Analyst” (SA)

Overview
Meeting customer “operational needs”
From SE perspective
From BA perspective
From Healthcare perspective
Workflow Redesign
What are we doing at MIG?

Systems Engineering

Systems Engineering
Emerged in 50’s driven by US DoD
Applied to large system acquisitions, e.g.,
missiles and missile-defense systems
Mandated disciplined development
MIL-STD-499A
“A logical sequence of activities and decision
that transforms an operational need into a
description of system performance parameters
and a preferred system configuration”

Systems Engineering Process
From DOD SFE

Operational Concept
How the system will serve its users
Operational need definition
System mission analysis and performance
Operational sequences and environments
User and maintainer roles

NATO Air Command and Control
System (ACCS)
From www.nacma.nato.int

Business Analysis

Business Analysis
IIBA (www.theiiba.org)
“The business analyst understands business
problems and opportunities in the context of
the requirements and recommends solutions
that enable the organization to achieve its
goals.”

Rational Unified Process

Business Modeling
Provides business context
Organizational structure, roles and processes
Similarities with SE operational concept
“Optional”???

Healthcare

Healthcare and IT
IT is relatively new to Healthcare, e.g.,
Hospital Information Systems (HIS), Electronic
Healthcare Records (EHR), Computerized
Physician Order Entry (CPOE), …
Key drivers
Patient Safety – “To Err is Human …”
Efficiency/Cost
Buzzword: Workflow

Radiology Workflow
From Siegel and Reiner

Introducing PACS

Radiology Workflow with PACS
From Siegel and Reiner

Workflow Redesign

Workflow Interruptus
Software will impact users and workflows
E.g., FAA controller
requirements
Conservative
Safety-critical
From hf.tc.faa.gov

Workflow Reality Check
Operational <-> Functional disconnect
Users out of the loop
Workflow disrupted
“Unintended consequences …”
Patient safety issues
Users are revolting
E.g., NATO ACCS “HMI Optimization”

Workflow Redesign

MIG

ALI/MIG
Then …
“Four people in a room and 6 months later …”
Workflow Redesign
... and now
Over 200 in R&D and growing
“Whither the business model?”

MIG Requirements Process
Functional Analyst create business model
Enterprise and Usability Analyses
E.g., Business Use Cases, Personas, …
Systems Analyst create system model
Software Requirements and UI design
E.g., System Use Cases, Interaction Design, …
Process being test driven as we speak

Business Model
Users: Personas
Workflows: Business Use Cases
New customer workflow with system
Identifies user goals -> System Use Cases
Validated with customer

E.g., Critical Test Result Reporting
1. The interpreting physician detects critical
condition in study.
2. The interpreting physician sends critical test
result to the referring physician, which is
logged.
3. The referring physician is periodically reminded
to retrieve the message.
4. The referring physician acknowledges receipt,
which is logged.
5. Hospital administrator creates critical test
reporting communications report.

Conclusions
Operational <-> Functional disconnect
Issue across domains and industries
Software WILL impact workflow
Workflow redesign
Business modeling a necessity
Business Use Cases help transition customer
workflows

References
MIL-STD-499A, Engineering Management, 1 May 1974
System Engineering Fundamentals (SFE), DOD, January
2001
The Rational Unified Process-An Introduction, Philippe
Kruchten, Addison-Wesley, 2003
Work Flow Redesign: The Key to Success When Using PACS,
Eliot Siegel and Bruce Reiner, AJR, March 2002
To Err Is Human: Building a Safer Health System, IOM, 2000
Some Unintended Consequences of Information Technology
in Health Care: The Nature of Patient Care Information
System-related Errors, Joan Ash et al., JAMIA, Mar-Apr 2004