Possible biases[ edit ] When disease management programs are voluntary, studies of their effectiveness may be affected by a self-selection bias ; that is, a program may "attract enrollees who were [already] highly motivated to succeed". A review paper examined randomized trials and meta-analyses of disease management programs for heart failure and asserted that many failed the PICO process and Consolidated Standards of Reporting Trials: Within the intervention group, participants had lower Medicare payments i.
However, these systems are often focused on documenting what happens in manual health care processes—in order to meet regulatory and compliance requirements—rather than providing the highest quality patient care.
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 HIS, and are now seen as essential. This paper describes how BPM technologies can be applied within health care environments to improve quality of care, compliance, and efficiency.
Health care organizations must meet high-reliability standards to ensure compliance with industry regulations and their own best practices to reduce adverse events. 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.
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. Applying BPM in health care processes can do the following: BPM has expanded from its roots in workflow and integration to become a collection of technologies for improving business processes.
There are several key BPM capabilities in health care scenarios: 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.
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 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.
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 various 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. Rules may evaluate a complex set of conditions and decide on the next best action; the process then acts on these decisions by alerting participants, escalating a case for immediate attention or triggering automated actions.
With the workflow engine embedded within the EHR system, UH Elyria is able to create processes customized to its specific needs.
Summary BPM—including both structured processes and dynamic case management—can add significant value to health care processes.
The combination of people, process automation, rules, and analytics can improve care quality while achieving regulatory compliance and administrative efficiency. The case studies and customer quotes have been approved for publication by the respective parties.
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