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Business Process Management and its evolution An ACOG example - steve hasley and denis gagne


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Presentation made at HSPC Feb 2019

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Business Process Management and its evolution An ACOG example - steve hasley and denis gagne

  1. 1. Business Process Management and its Evolution An ACOG example Denis Gagné CEO & CTO, Trisotech Steve Hasley CMIO, ACOG All logos, trademarks and registered trademarks are the property of their respective owners.
  2. 2. OMG Standard Body • One of the most successful forums for creating open integration standards in the computer industry • Middleware platforms (DDS™, CORBA® and related specs) • Modeling platforms (UML®, BPMN™, SysML® and related work) • System Assurance (SACM, DAF for SSCD ...) • Vertical domain specifications (Finance, Healthcare, C4I, ...) • Member-controlled industrial consortium • Both vendors and users • Not-for-profit • Adopted specifications are freely available to all • Visit • Path to adoption by ISO and other standards bodies
  3. 3. The evolution of business applications “Giving back control to business” Data Process Rule Business Application Process Rule Business Application Data Process Rule Business Application Data Process Business Application Data Rule Legacy Modern From systems of records to systems of engagements
  4. 4. What are BPMN, CMMN and DMN • Open Standards published by the Object Management Group (OMG) • Unambiguous graphical notations for modeling processes, cases and decisions • Platform agnostic • Modeling techniques that can easily be learned by both clinicians and informaticians Business Process Model & Notation Case Management Model & Notation Decision Model & Notation
  5. 5. BPM+ • BPMN • Flow diagrams • Good for processes • DMN • Can make complex decisions • Can input numbers, T/F, valuesets, dates and durations • Can have multiple outputs • CMMN
  6. 6. Trisotech is a global leader in digital enterprise solutions, offering innovative and easy-to-use software tools that allow customers to discover, model, analyze and find insights into their digital enterprise. BASIC ELEMENTS Pool Event Activity Gateway FLOW 20161007 BPMN Quick Guide A simple, basic, yet complete, BPMN reference accessible to everyone. Start Event Service Task Decision Task Data Object End Event End Event Intermediate Message Event BPMN is a universal graphical notation for documenting business processes and driving process improvement initiatives. It enables a disciplined process approach that allows organizations to become more efficient. Download Free BPMN, CMMN and DMN templates at Sequence Flow Message Flow Data Association Subprocess Case TaskTriggers a new process instance External Participant to the process What is done next Task to be completed Routing Information required as input End state of the process External communication Business Process Model & Notation
  7. 7. Stage BASIC ELEMENTS CONNECTOR Trisotech is a global leader in digital enterprise solutions, offering innovative and easy-to-use software tools that allow customers to discover, model, analyze and find insights into their digital enterprise. 20161007 Download Free BPMN, CMMN and DMN templates at Timer Event Non Blocking User Task Process Task Discretionary Task Decision Task Milestone Case File Item User Event [Update] Case Plan Model Blocking User Task CMMN offers a common notation for graphically expressing work patterns that require management of a case. It enables a paradigm shift from prescriptive processes to supporting knowledge-intensive work facing uncertain contexts. Task done at the user's discretion Manually activated stage Occurrence of a change in the file information A required task Action Condition Event The context in which to react to events. Event- Condition- Action Termination criteria EVENT CONDITION ACTION Discretionary Association OnPart Connector Task Criterion Event Listener Case File Item Case Management Model & Notation
  8. 8. Decision Input Data Decision 1 Decision 2 Input Data 3 Input Data 1 Input Data 2 Knowledge Source BASIC ELEMENTS REQUIREMENTBusiness Knowledge Model 20161007 Download Free BPMN, CMMN and DMN templates at Trisotech is a global leader in digital enterprise solutions, offering innovative and easy-to-use software tools that allow customers to discover, model, analyze and find insights into their digital enterprise. DMN provides a modeling notation to capture business decision requirements and decision logic. It increases an organization’s agility and adaptability by capturing the business decisions independently from where they are used. Decision logic using a Decision Table Decision Requirement Diagram (DRD) Each row is a rule Conditions Result Defined decision logic Re- usable decision logic Input required for the decision Authority source of this data Information Knowledge Authority Decision Model & Notation
  9. 9. Variable Every work effort instance looks slightly different Unpredictable The exact course of action is unknown and highly situation specific Emergent The exact course of action only emerges during process execution when more information becomes available When to use BPMN, CMMN or DMN
  10. 10. OMG BPM Health Work Group Goals: • Exploring a Model Driven approach to capturing Clinical Pathway • Use OMG open standards BPMN, CMMN, and DMN to define the workflow of care and decision-making at the level of granularity that offers a complete, flexible solution, including semantic clarity, robust decision logic, human readable AND machine executable. Deliverables: • Field Guide to Shareable Clinical Pathways • Pilot use case: Antenatal Care Models
  11. 11. Motivation • Healthcare Information Technology (HIT) has a great potential to improve efficiency and quality of clinical health care • Our goal is to make an explicit, understandable connection between HIT and the methodical improvement of clinical health care • To make Clinical Pathways shareable it is recommended to use internationally accepted standards where possible • Process Management: BPMN • Case Management : CMMN • Decision Management : DMN
  12. 12. Sharable Clinical Pathways A clinical pathway is a care process (activities and resources) involving orchestration and coordination of multidisciplinary care organizations along with the patient to realize the patient’s Care Plan Well documented clinical pathways can improve communication by providing consistent and coordinated workflow steps and goals to patients and care team members, to ensure common practices and results Sharable Clinical Pathways are meant to be explicit guidelines with formal, repeatable semantics that are understandable by care team members and patients as well as being computer interpretable
  13. 13. Field Guide Antenatal Pilot
  14. 14. Overview of ACOG Projects OPA FPAR 2.0 Modeling Shareable Clinical Pathways Electronic Clinical Quality Measures (eCQMs) ACOG Prenatal Record - Dorsata ACOG Comprehensive Women’s Medical Record Birth Registry iGroup Antenatal Care Pain and Bleeding Genetics Menopause
  15. 15. Narrative Documents Benefits Gaps And we don’t seem to be able to move the needle on Outcome metrics
  16. 16. Outcomes Maternal Mortality 2x up over last 20 years 01 Many other US metrics at third world levels 02 Delivery of preventive services less than 40% 03 Only 40% of pregnant women get a flu shot 04 Only 7% (in Louisiana) get 17-OHP 05 We are failing in basics! So how do we get our guidance to the Point of Care?
  17. 17. Current State Most EHR’s are transactional billing systems, with some provider stuff tacked on. Think of a transaction at WalMart • Date/Time/Location • Item Number • Amount • Your credit card number Woefully inadequate to understand where this patient is on a care pathway
  18. 18. Narratives require: • Interpretation • Translation • Fill in the gaps • Version control EHR must contain: • All discrete data elements • Metrics and Dashboards • CDS and Pathways • Duplicates of all other sources of data • Immunizations • Labs • PDMD • Med Lists
  19. 19. Future State • APIs • Interoperable Data Models • FHIR • Care pathways for digital platforms • BPM+ • BPMN • DMN • CMMN • Thoughtful separation of concerns • Knowing what belongs where • No more square pegs in round holes
  20. 20. Library of Pathways EHRApp for Care Pathway Dashboards, Metrics, etc. PDMP Immunization registry
  21. 21. What are the goals of the ACOG IT Group? • External to ACOG • Create Care Pathways for digital platforms • EHRs • Mobile • Web-based • Apps • Other • Coordinate with other professional societies • AAFP, ACS, ACEP, ADA, VA, CDC, ACR, • HSPC, OMG, MITRE • Internal goals within ACOG
  22. 22. Care Pathways Provide clear, precise, unambiguous instructions for software engineers • Platform independent • Transparent methodology • Include necessary: • Data elements • Rules • Decision models • Performance measures • eCQMs • CQL scripts
  23. 23. ACOG Experience with the approach • Transforms our narrative guidelines into computable artifacts • Enforces rigor in our guideline development process • Having CDS in the context of workflow reduces burden • Data derived from the models supports guideline evaluation
  24. 24. How do we translate narratives to “Artifacts”? • Scrape Recommendations from ACOG narratives • Called out Recommendations • Link Recs to Problems • Had to create a curated PL for OB • Make the BPM+ model • SME review • Working Group for triaging • OK to go out the door • Nothing per vagina for Placenta Previa • Needs more formal ACOG review • Check for A fib if patient on levothyroxine, refer to cardiology
  25. 25. So…. Why do this? Improve process of care • Hopefully move the needle on outcomes Reduce provider burden • Documentation • Pre-auth and billing • Empower our members’ survival in a Value- based care system We need the data • Close the loop on the Learning Healthcare system
  26. 26. Thyroid Disease in Pregnancy Guideline Example
  27. 27. Hypothyroid Pregnancy: Sharable Clinical Pathway Model
  28. 28. Hypothyroid Pregnancy: Adjust Synthroid Dose Decision
  29. 29. A single visual Knowledge Artifact is created for clinicians and for automation • The model is the specification • The model is the logic • The model is the documentation • The model is the code
  30. 30. Demonstrating Automation of Sharable Pathway
  31. 31. CDS Hook • A vendor agnostic remote decision support specification • Created by the team behind SMART CDS Service • A service that is invoked by the EHR via a Hook, evaluates its own logic using FHIR data and returns decision support via Cards
  32. 32. FHIR • The basic building block in FHIR is a Resource • All exchangeable content is defined as a resource • Resources all share the following set of characteristics: • A common way to define and represent them, building them from data types that define common reusable patterns of elements • A common set of metadata • A human readable part Automate healthcare data sharing and improve patient care
  33. 33. BPM+ Health Community Forming a robust and thriving community-of-practice of healthcare institutions, professional societies, and vendors Established to foster the sharing and promulgation of best-practices around modeling and sharing: • clinical pathways, • clinical guidelines, and • other healthcare knowledge
  34. 34. Questions ??