Sponsored by Siemens Medical Systems (now owned by Cerner), I have posted this since it is no longer available via the Siemens site.

1. Business Process Management
In Healthcare
June 2014
Kemsley Design Ltd.
www.kemsleydesign.com
www.column2.com

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Overview
Healthcare information systems (HIS) and
electronic health records (EHR) track every detail of
a patient’s interactions with healthcare providers.
However, these systems are often focused on
documenting what happens in manual healthcare
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 this explosion of patient data,
it’s no longer feasible to rely on manual processes:
healthcare 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 healthcare information systems,
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”, states Kay
Cartwright, VP, Continuum of Care and Chief
Nursing Officer at Reid Hospital in Richmond, IN.

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This paper describes how BPM technologies can be
applied within healthcare environments to improve
quality of care, compliance and efficiency.

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Why Use BPM In Healthcare
Environments?
Healthcare organizations must meet high-
reliability standards, to ensure compliance
with industry regulations and their own
best practices to reduce adverse events.
To assist in this, 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 healthcare 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”, says Reid’s Cartwright. Adds
Debbie Eckhoff, Director of Clinical
Informatics at Reid, “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 healthcare processes.
Applying BPM in healthcare processes
can:
Enforce standard processes and
protocols to reduce errors and
improve patient safety
Automate non-value-add 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

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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
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.
There are several key BPM capabilities in
healthcare scenarios:
Process modeling allows a process
analyst to create graphical, flowchart-like
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
pre-defined 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

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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 is 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 a wide variety of 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

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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
In Healthcare
University Hospitals 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 used at UH Elyria, they are
able to create processes customized to
their 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 healthcare
environment,” says Charlotte Wray, UH
Elyria’s VP of Clinical Operations and
Information Systems and Chief Clinical
and Information Officer.
Mountain States Health Alliance relies on
BPM for early detection of sepsis by
correlating patient metrics and raising
alerts much earlier than traditional
techniques. Says Paul Merrywell, CIO at
MSHA, “The workflow engine behind
Soarian is very powerful and capable of
uniquely identifying data unlike any other
system I’ve seen.” Using BPM integrated
with other information systems, they have
reduced their 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.

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Summary
BPM – including both structured
processes and dynamic case management
– can add significant value to healthcare
processes. The combination of people,
process automation, rules and analytics
can improve care quality while achieving
regulatory compliance and administrative
efficiency.
About the Author
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.
Sponsor
This white paper was sponsored by
Siemens Medical Systems, who also
provided the details of the Reid Hospital,
University Hospitals Elyria Medical Center
and Mountain States Health Alliance case
studies. The case studies and customer
quotes have been approved for
publication by the respective parties.

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The outcomes achieved by the Siemens customers
described herein were achieved in the customers’
unique settings. Since there is no “typical” hospital
and many variables exist, there can be no
guarantee that others will achieve the same
results.
Siemens Medical Solutions USA, Inc.
51 Valley Stream Parkway
Malvern, PA 19355-1406
USA
Telephone: +1-888-826-9702
www.usa.siemens.com/healthcare
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Printed in USA 06-2014. All rights reserved.
© 2014 Siemens Medical Solutions USA, Inc.