Workflow

Understanding the organisation through process and information modelling

Healthcare organisations around the world are constantly seeking to deliver high-quality service at affordable costs. While this challenge is common amongst many service-oriented industries, healthcare providers have the particular characteristics of being information-intensive, highly specialised, highly regulated, and with little room for error.

With these issues in mind, it is particularly important for healthcare organisations to understand and optimise their business processes and their interrelationships with information, organisations and rules.

What are the drivers?

The main drivers behind modelling business processes can be characterised in two ways: the 'carrot' — the incentive to increase efficiency and implement best practices; and the 'stick' — rules and pressures to comply with regulations.

Efficiency and best practices

Each process within a healthcare organisation not only must be precise and well-defined but often requires interdisciplinary cooperation and coordination. Not only are processes shared between organisations, but critical information and data is constantly flowing between groups. Understanding interrelationships between data, process, and organisation is critical. A patient record, for example, passed between and updated by many groups, must be 100% accurate and timely or serious consequences can arise.

Understanding the flow of processes and their interrelationships with key information is facilitated by the use of graphical models underpinned by a metadata repository. The models provide readily understandable views of key processes and the repository stores the definitions, business information, and relationships around these processes so that reports and queries can be generated for a variety of constituencies.

Regulation and governance

Increased regulation and government oversight in both the healthcare industry and IT are requiring many organisations to implement best practices and improved auditing. Detailed models outlining the best-practice-driven workflow and the roles and responsibilities in an organisation are one way to meet this need. Reports driven from a common metadata repository help meet auditing requirements for such questions as what data is used by a given process. For example, who has visibility into patient records? When and how is sensitive patient information updated and shared?

What is a business process model?

Think of a process model in its simplest form as a flowchart that outlines the workflow of an organisation. It uses familiar graphical shapes to visualise the various steps of a process such as: what prompts a process to start/stop; what tasks are done along the way; and what decisions are made which might change the path of a process.

For example, if the patient is visiting the clinic for the first time, a specialised set of tasks need to be done to register that patient into the system.

The Business Process Modelling Notation (BPMN) is an emerging standard from the Object Management Group (OMG) that is gaining buy-in from a wide variety of vendors and organisations. Part of its success stems from its use of commonly understood graphics that are both familiar to an average business user and are at the same time robust enough to created detailed executable process models for IT engineers.

Figure 1 (below) shows a simple example of a business process model using the BPMN. This model uses the concept of swimlanes to represent the participants in a process: a patient and the hospital.

A swimlane acts as a visual container to show the activities done by a certain actor in the process. The other visual objects in the model most likely are already familiar. A circle represents the initiation of a process. Boxes represent tasks, or steps in the procedure. A diamond represents a gateway, or a decision point which causes a branch in the flow of a process. Arrows indicate the direction of flow, and a dotted arrow shows that a message is sent between parties.

Often message flows are associated with data or information which is updated, read, created or deleted. The BPMN allows extensions to show representations of specific data objects.

In this example, the patient database is updated when a patient registers into the hospital. Specifically, data can be created, read, and updated, as indicated by the 'C, R, U' on the diagram. CRUD reports, which represent data created, read, updated, and deleted, are a common way for organisations to audit what process, people, and organisations affect data records.

Why use a business process model?

We’ve all heard the saying, “A picture paints a thousand words”. Graphically visualising the steps of a process provides an intuitive way for multiple constituencies in the organisation to understand the basic workflow. Often the process itself of creating the model provides insight and analysis of the way the organisation operates that would not otherwise be understood.

Once the as-is state of affairs has been documented, it is easier to determine which areas need to be optimised. Many modelling tools provide simulation capabilities which not only provide a visual indicator of process flow, but provide metrics and analysis to determine such factors as: where bottlenecks occur, where resources can be added or removed, what tasks add the most time to a process, etc.

For organisations using a service-oriented architecture (SOA), business process models can serve as the orchestration mechanism for the web services running automated processes. The BPMN can be mapped to execution languages such as BPEL (business process execution language, from the OASIS consortium). This allows the model to drive the actual run-time processes of the organisation, ensuring consistency, efficiency, and automation of critical workflow.

Conclusion

With the careful rigour and efficiencies required for healthcare industries, using a model-driven approach is an excellent way to increase understanding of core processes and their interrelationships between information and organisations for improved efficiency. Models can also become the drivers of the processes themselves, acting as a best-practices-based approach to ensure proper automation of core tasks.

Donna Burbank, Director Enterprise Modeling and Architecture Solutions, Embarcadero Technologies