Care Flows: Patient-centric, Long-running Workflows

While I was working at my last world-renowned cancer center, we were faced with a unique challenge, the Center's leadership invested substantially to initiate a new survivorship program. By definition, cancer survivors are those who have completed the treatments in their treatment plan but who need continuous monitoring and support from their care teams.  As the first step towards building the program, we needed to identify a cohort of patients who have completed their treatment - sound simple?


We discovered that there is no simple way to find those patients in the EMR system without physicians spending weeks reading through clinical notes and charts.  It is a harsh reality that despite the huge amount of data in each patient’s record, there is no quick way of identifying any patient's current stage of their care journey. 

According to the 2010 IBM Healthcare and Life Sciences Thought Leadership study, Redefining Value and Success in Healthcare: Charting the Path to the Future, healthcare ranked as the least efficient industry in the world, with more than $2.5 trillion wasted annually.  Today the healthcare industry is facing similar challenges that other traditional manufacturing and commercial industries faced in the 1990s:Medical directors are trying to make their organizations fitter and smarter, in order to survive competition and further flourish.


Healthcare organizations are beginning to look at optimizing the healthcare IT environment to make it more flexible, with the ability to adapt to evolving business requirements.

The healthcare industry’s unique needs make it difficult to find a good solution.

The healthcare industry is unique, its overall processes are complex, and most importantly, it is not only operations-centric, but also people-centric. Traditional business process management techniques such as Six Sigma cannot meet comprehensive requirements such as these.

By being people-centric, business managers of healthcare organizations need to be able to visualize their current processes in the quickest and smartest way, and to hypothesize different scenarios without interrupting the current patient care processes.  They also need to focus on patient experience and dynamic case management.

With the absence of computerized tools, most healthcare organizations are adopting LEAN methodology which means manually conducting process improvement activities. After extensive discussions and a roomful of post-it notes and wall charts, all workflow is statically drawn on separate pieces of paper. There is no real-time connection between the paper workflow and the physical processes in the clinics.  Moreover, the data that can be mapped to the new workflow will not be available for the reporting team to query until months later.  

If we start thinking even more patient-centric, we quickly get out of the single office visit workflow, e.g. from arrival to departure, into "long-running workflows" in which many others may participate in ensuring the patient completes his/her care plan action items.  Such long-running workflows, which we call "care flows", are typical in specialty-care and chronic-care management.

In my next blog post, I will be writing about the kind of care flow management platform that will actually work in the healthcare environment.