Workflow, Usability, Safety & Interoperability Perspectives by Dr.Charles Webster, @wareflo — Part2 #AMIA2016
Interoperable Health IT and Business Process Management: The Spider In The Web: Part — 2
“Workflow is a series of tasks, consuming resources, achieving goals.”
This article has been re-published with the authors permission. The article was first published by Dr. Charles Webster on his blog here
- Dr. Charles Webster
If you pay any attention at all to interoperability discussion in healthcare and health IT, I’m sure you’ve heard of syntactic vs. semantic interoperability. Syntax and semantics are ideas from linguistics.
Syntax is the structure of a message. Semantics is its meaning. Think HL7’s pipes and hats (the characters “|” and “^” used as separators) vs. codes referring to drugs and lab results (the stuff between pipes and hats).
What you hardly every hear about is pragmatic interoperability, sometimes called workflow interoperability. We need not just syntactic and semantic interop, but pragmatic workflow interop too. In fact, interoperability based on workflow technology can strategically compensate for deficiencies in syntactic and semantic interoperability. By workflow technology, I mean Business Process Management (BPM).
Why do I highlight BPM’s relevance to health information interoperability? Take a look at this quote from Business Process Management: A Comprehensive Survey:
“WFM/BPM systems are often the “spider in the web” connecting different technologies. For example, the BPM system invokes applications to execute particular tasks, stores process-related information in a database, and integrates different legacy and web-based systems…. Business processes need to be executed in a partly uncontrollable environment where people and organizations may deviate and software components and communication infrastructures may malfunction. Therefore, the BPM system needs to be able to deal with failures and missing data.”
“Partly uncontrollable environment where people and organizations may deviate and software components and communication infrastructures may malfunction”?
Sound familiar? That’s right. It should sound a lot like health IT.
What’s the solution?
A “spider in the web” connecting different technologies… invoking applications to execute particular tasks, storing process-related information in a database, and integrates different legacy and web-based systems. Dealing with failures and missing data. Yes, healthcare needs a spider in the complicated web of complicate information systems that is today’s health information management infrastructure. Business process management is that spider in a technological web.
Let me show you now how BPM makes pragmatic interoperability possible.
I’ll start with another quote:
“Pragmatic interoperability (PI) is the compatibility between the intended versus the actual effect of message exchange.”
That’s a surprisingly simple definition for what you may have feared would be a tediously arcane topic. Pragmatic interoperability is simply whether the message you send achieves the goal you intended. That’s why it’s “pragmatic” interoperability. Linguistics pragmatics is the study of how we use language to achieve goals.
“Pragmatic interoperability is concerned with ensuring that the exchanged messages cause their intended effect. Often, the intended effect is achieved by sending and receiving multiple messages in specific order, defined in an interaction protocol.”
So, how does workflow technology tie into pragmatic interoperability? The key phrases linking workflow and pragmatics are “intended effect” and “specific order”.
A sequence of actions and messages — send a request to a specialist, track request status, ask about request status, receive result and do the right thing with it — that’s the “specific order” of conversation required to ensure the “intended effect” (the result). Interactions among EHR workflow systems, explicitly defined internal and cross-EHR workflows, hierarchies of automated and human handlers, and rules and schedules for escalation and expiration are necessary to achieve seamless coordination among EHR workflow systems.
In other words, we need workflow management system technology to enable self-repairing conversations among EHR and other health IT systems. This is pragmatic interoperability. By the way, some early workflow systems were explicitly based on speech act theory, an area of pragmatics.
That’s my call to use workflow technology, especially Business Process Management, to help solve our healthcare information interoperability problems. Syntactic and semantic interoperability aren’t enough. Cool looking “marketectures” dissecting healthcare interoperability issues aren’t enough. Even APIs (Application Programming Interfaces) aren’t enough. Something has to combine all this stuff, in a scalable and flexible ways (by which I mean, not “hardcoded”) into usable workflows.
Which brings me to usability, tomorrow’s guest blog post topic.
Tune in!
Additional Blog Posts by the Author
- Five Guest Blog Posts On EHR & HIT Workflow, Usability, Safety, Interoperability and Population Health
- Interoperable Health IT and Business Process Management: The Spider In The Web
- Usable EHR Workflow Is Natural, Consistent, Relevant, Supportive and Flexible
- Patient Safety And Process-Aware Information Systems: Interruptions, Interruptions, Interruptions!
- Population Health Management and Business Process Management
Author
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[content title=”About Dr. Charles Webster”]
Dr. Charles Webster
HIMSS14, HIMSS15, and HIMSS16 Social Media Ambassador! If you’ve got a healthcare workflow story, I want to tell it, blog it, tweet it, interview you, etc. Dr. Webster is a ceaseless evangelist for process-aware technologies in healthcare, including Workflow Management Systems, Business Process Management, and dynamic and adaptive case management.
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- My Foreword and Chapter in Business Process Management in Healthcare, Second Edition
- BPM-based Population Health Management & Care Coordination: Workflow, Usability, Safety & Interoperability Perspectives
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November 08, 2016 at 09:00PM
