BPM+ HEALTH INDUSTRY WORKSHOP
Nashville, TN24-25 September 2019TAble ofContents TOC \o "1-3" \u Introduction PAGEREF _Toc22085235 \h 1Key Results PAGEREF _Toc22085236 \h 1Next STeps PAGEREF _Toc22085237 \h 4Appendicies PAGEREF _Toc22085238 \h 5Authoring Community PAGEREF _Toc22085239 \h 6Institutional Adoption Community PAGEREF _Toc22085240 \h 7Implementation/Vendor Community PAGEREF _Toc22085241 \h 10Methodology PAGEREF _Toc22085242 \h 12BPM+ Panel Discussion PAGEREF _Toc22085243 \h 14IntroductionHealthcare throughout the world is growing in expense and complexity. While Health Information Technology has the potential to improve the efficiency and quality of clinical care, it has yet to be realized on a consistent, industry wide basis. To help address this challenge, The Object Management Group (OMG) launched the Business Process Management Plus (BPM+) Health community at a September 24-25 workshop in Nashville, TN. The goals of the workshop: Educate on the value of BPM+ in clinical quality improvementDiscuss approaches to launch BPM+ initiatives within organizationsCultivate a community devoted to improving healthcare by leveraging BPM+ standards;This report summaries the high-level outcomes and next steps. The appendices provide the detailed notes and presentations from the workshop.Key ResultsPositive OutcomesEngaged and constructive dialogueDevelopment of relationships across disciplines, interests and organizationsDiverse community of stakeholdersNew and innovative thinking from both a technical and operational perspectiveDevelopment of clear actions and deadlines for demonstratable progressBuilding a sense of urgency around our possibilities, our ideas, our challenges and our solutionsGrassroots advocacy is workingPrinciples and Business RulesHonor the relationshipProvide value to the patientIncrease role of BPM+Seek a common terminology and set of processesIdentify and improve standardsFour Main Pillars: Processes, cases, decisions, situational dataCommon Development StepsIdentify shared or best practicesDevelop case studies and use casesIdentify, refine and mature the toolkitDevelop short, mid-range and long-term work plansIdentify, lead and participate in conferencesIdentify and leverage clinical examplesFoster, build and sustain the communityConduct an analysis of stakeholdersConsider, develop and communicate an impactful storyCommon ChallengesAmong the biggest challenges in Healthcare is connecting and sharing evidence based best practice to the point of care, especially as increasing mobile patients transition among site and institutions of care. Identifying and developing sustainable actions and outcomes.Identifying and influencing funding sources.Engaging quality measures across a diverse spectrum of platforms, inputs, systems and outcomes.Summary Intended OutcomesDevelop best practices around modeling and sharing clinical pathways, clinical guidelines, and other healthcare knowledge; Promote the use of standards such as BPMN, DMN, and CMMN to produce deliverables to maximize their usefulness and shareability and to promote their adoption; Cultivate a knowledge ecosystem devoted to improving national and international health by leveraging open and available industry standards to remove barriers to sharing knowledge; Improve the precision and compliance with best practices, resulting in better implementations; Seek collaboration with other standards developing organizations in the Healthcare industry.Panel Summary Question: What is the elevator pitch describing what happened over the last two days?The topic of situational data and clarifying the interface between the process and the data.One of the standards that has been around for a long time that business use to automate processes. There is a smart group of people coming together to apply that to health care.This group is thinking two or three shots down the line to address the fragmentation of interoperability.This has been a series of people getting together to tackle the 17-year problem to shorten time from bench to bedside. Formalize ways to capture what is now only in human readable format.It’s one thing to carry your record from provider to provider…wouldn’t it be nice to also carry your care plan? This group is attempting to make that happen.BPM+ Health Community: Vision, Overview, and Community StructureNext STepsCategoryActionWhoWhenBroader BPM+ Health CommunityEstablish governance processesVersion 2 Field GuideDevelop a sandbox environmentCapture, document, and share resultsAuthoring CommunityBuild business case12 monthsBuild 101/Fool’s Guide12 months2 articles for publication and present them12 monthsHIMSS 2020 Interoperability Showcase participationMeeting CadenceBi-WeeklyInstitutional Adoption CommunityBuild membershipEveryoneDevelop Ambassador ProgramBethEstablish CoP ProcessKen, et alIdentify/document structured use casesJaneJanuary 2020Create an adoption “maturity model”Develop and deploy toolkit (review, sandbox, review/inventory tools)Ken and JaneGather feedback for specific BPM+VA, Mayo, IntermountainIdentify ExemplarCapture and share resultsImplement-ation/Vendor CommunityAchieve 10 organizations interested in modeling pathways/GLs in BPM.OMG create different membership levels for professional orgs/nonprofits.Create toolbox of useful, open source functionsMeeting CadenceWeeklyAppendicies Authoring CommunityNeeds – Better modelsPhysician-clinician, Patient-family-community and vendor-developer centricShared practices/commonalities – Modeling expertise, useful guidanceWorkplan – 12 MonthsBuild a business case for physician societies/ trade associationBuild a 101/Fool’s Guide on how to convert clinical policies/practice guidelines to digital roadmaps and protocols that are both human and machine readable and platform consumable Send 1 and 2 for publication, present at major conferences, make accessible online using webinars and/or podcastingObstaclesData availability/blockage E.H.R. constraints Business model for sustainmentDevelopment costs CadenceFocus on HIMSS 2020 Interoperability showcase participation. Potential Use-Case: Care transitions for 1st trimester bleeding emergenciesBi-weekly meetingsInstitutional Adoption Community‘Systems are perfectly designed to produce the results that they deliver’Potential PrinciplesHonor the healthcare team-patient relationshipProvide value to the patient – healthcare team and enterprise are relevant to care.Ensure that work is impactful and valuableCompleted ActionsDefined a community goalIncrease the adoption of BPM+ sharable clinical pathways with a goal of improving patient safety, decreasing “never events”, improving efficiency and effectiveness, and providing decision-making support to health care teams. Identified adopting institutions’ needs:Clear, concise representation of best practicesFramework for implementing best practicesOrchestration of tasksDetailed patient contextTranslation into health IT SystemsBusiness Model that includes ROI and/or value addIdentified key stakeholders:GovernmentHealthcare EnterprisesProfessional SocietiesPayorsVendorsHealthcare TeamPatientsIdentified helpful cClinical examples that are helpful:First trimester bleeding ACEP and ACOG- intersection across specialtiesCancer- ACSCKD (BPM+) Work PlanBuild membership of the Institutional Adoption CommunityDevelopment of an Ambassador Program: Includes elevator pitch, different personas, use cases and value propositions Potential use of the BMP+ guidelines and evaluation by a care organizationEstablish Community of Practice (CoP) Process- Ken et al Identity and document structured case studies – Goal: January 2020Problem StatementsMethodologyObstacles Lessons learned Current status Develop and deploy a toolkitReview Field Guide Version 2Included- Communications and change management Increase usability-Derivative and digestible contentSandbox Identify tool (logical sandbox) Other test environments User interface and test in contextIdentify and inventory toolsEditing/authoringHSPC (e.g.) Execution toolsGather feedback within a sandbox/pilot location for a specific BPM+ (VA, Mayo, Intermountain) Build the BPM+ modelExecute the model in a sandbox (dB) Validation tools/cognitive process Feedback based on experience – may need specific documentation and Identify potential challenges and benefitsFuture WorkplanDefine what success looks likeDevelop of framework for Adoption Community of PracticeIdentify an approach to collaborating with vendors and other organizations Create a communication plan to increase awareness of the initiativeDevelop and track key process and performance indicatorsPilot adoption of specific sharable pathways (VA, Mayo, Optum, Intermountain) Development of framework for CoP (adoption use-case)Increase awareness of the initiativeIdentify and develop collaborative approach to working with other vendors/organizations Develop and track process and KPI measures (e.g. ambassador increase) Tell the story that will enable stakeholders to affect uptake Value proposition of participation Adopt an existing protocol that has been developedTechnical and operational alignmentAsk them specific questionsIdentify and understand stakeholders Payors, vendors, healthcare team, patientsProfessional Specialty SocietyHealthcare team/Provider/Patient - Design a pilot project that can meet the needs of peopleHigh priority projectFocus on a specific problem that can be usedIdentify telehealth societies - unified stream and BPM+ Protocol endorsement by Telehealth vendors Encourage update of BPM+ update for the care planning Build ecosystemsPreliminary analysis of different stakeholdersCommunity NeedsObstaclesValueEnterpriseProviders/physiciansMake the right thing easy and timely to doIncent providers Team Based Care Professional Specialty ServicesVendorsRevenue Cycle Reporting BPM+ adoption model (ete Melrose 9/24/2019) Stage numberReadersProducersConsumersIIgnoranceIgnoranceIgnorance2Aware of model types and applicationsMake and merge BPMN and DMNRum simulator on models3Cab read and interpret model detailsMake and merge BPMNn DMN and CMMN and executeRun models in production and interactionAdditional Note:The Adoption Workgroup deliberations via J. Peter Melrose d.b.a. CHARTSaaS, LLC – recommendation is that the adoption agenda mirror or at least be compatible with the OMG document Business Process Maturity Model v1,0, as summarized in Table 11.1 on page 80. Seeking comment on the recommendation, and further discussion via email or phone as necessary.Implementation/Vendor Community GoalsDefine how traceability is measuredDefine how to operationalize/localize (extensibility points)Define relationship between modelsDefine testing requirements and toolsCreate registry and awareness of what’s been done Identify reusable activities within modelsAchieve composability /reuseGuidelines for DevOps pipeline and run-time toolsVersioning strategyAnswer the question: “What does it mean to be a BPN and Vendor”?Engagement with EMR vendors, data registries, modelersHow does implement model get delivered to end-users?Define “non-operational” use of shareable pathwaysModel MetadataAttributional M.D.Care setting: Hospital, Emergency Department, ClinicEvidence BaseData (coded) knowledgeData collection requirementsData TypeFormatOptionality CardinalityEnumerationsBest Practices/Lesson LearnedBusiness Case-Value PropSuccess stories/ DemonstrationsQuality Measures-FeedbackPublicationHL& and OMG CrossoverMVPFunctions/Situational Data/Expression Language/KnowledgeSustainable CommunityReference ArchitectureOutcomes/Metrics RegistryQuality MeasurementLag behind Data Revolution Opportunity for BPM +70 to ease quality data captureQuality Indicators vs. Measures BMN vs. CQLBMN + Sandbox (out of several resources or authored)Workplan – 6 MonthsFrom Now the BPM and Authoring will be successful if….10 organizations interested in modeling pathways/GLs in BPM?OMG create different membership level for professional orgs/nonprofits. Create a toolbox/library of useful, open source functionsCadenceOnce a week at 7am/4pm (Belgium time)On Tuesday---- Zoom (Charles McCkay)Roster-what is quorumConfluence Site (Ask Denis)Roster-what is quorumConfluence (Ask Denis)MethodologySituational DataDFD / UML would be another language?Formal binding to current to future modeling languageStandard for binding PIM to PSM QWICK (HL7)How does FHIR fit in?Simple forms of Situational Data is that it’s just a binding to same external data and local dataNeed formal constraint and approachSDMN must “integrate” with existing OMG standards such as BPMN, CMMN, and DMN so EHR and other vendors will implementSDMNContextual data binding/ Open EHR need Look at meta model for CQL as a way to solve the problem of reuse of item definition (uses)KPMNMeta data -Metrics to show that a Knowledge Package (KP) is effectiveCMMN has a notion of applicability Capture everything needed to reuse KP (Service and deployment specifications, variables used, flows)Potential effects of a KP (e.g. blood thinning, ulcer treatment, cancer)Implementing with method/steps(Pedigree and Provenance usage)An International view of Guideline Adoption into Clinical Practice: Spotlight UK National Health Service. BPM+ Health Industry Workshop presentation slide deck. Charles McCayBPM+ Panel Discussion Panelists: Charlie MacKay, Beth Meyers, Steve Brown, Thomas Beale, Dev KalyanQuestion: Overall ImpressionsThe various groups can help each other build support in organization. There is great value in community.Focus on dissemination over the next yearBPM+ solves a series of problems within the health care environment on both payer and provider. Key for adoption is to get the test cases and use cases out there to build feedback mechanismQuestion: Next best step for this group?Have a clear deadline for demonstrable progress at HIMSS; delivering on the cadence of what we have to do to achieve that.Build the communication. Everyone is an ambassador; we each have to take ownership and move these forward to grow the movement.Grassroots advocacy is already working. Build from here.Get core activities organized so work happens before the next workshop.Question: What is your biggest concern?How does this fit in with the bigger landscape of healthcare initiatives? Need to understand the scope clearly.Will be a challenge to make implementation easy enough to convince people to do it.Levels of repository management and managing libraries of models for re-use and modification will be a major challenge. Run the danger of getting tied to the evidence basis rather than focusing on the standard. The correctness of the guideline rather builds the process of localization and creation. Additional Comments, GeneralWhat providers will we appeal to? We are funded by the organizational provider. Real potential for these processes to get to the people who will actually use the standards. Root is medical education and helping doctors become comfortable with change. Changing practice of medicine to dynamic evidence-based standards. Gap between the clinical folk and the technical. What we are pitching sits in between – how do we make it easy on both sides and fill the gap?Learning health system space. Standard of care -> outcomes -> inform future standard of care.Question – What is the elevator pitch describing what happened over the last two days?The topic of situational data and clarifying the interface between the process and the data.One of the standards that has been around for a long time that business use to automate processes. There is a really smart group of people coming together to apply that to health care.This groups is thinking two or three shots down the line to address the fragmentation of interoperability.This has been a series of people getting together to tackle the 17-year problem to shorten time from bench to bedside. Formalize ways to capture what is now only in human readable format.It’s one thing to carry your record from provider to provider…wouldn’t it be nice to also carry your care plan? This group is attempting to make that happen. ................
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