Expanding a Vision of Clinical Informatics: James M. Walker, M.D. Shifts from the Provider to the Vendor Sphere

Yes, that’s it. And it becomes unaffordable to manage such processes on paper. You need the electronic health record, and then a business process management set of solutions behind that. The complexity of all the processes involved in care management can be daunting, which is why it can be difficult to make sure that Mrs. Jones gets reminded to get her diabetic eye exam. And that’s one of the things that brought me to Siemens. There are very few health IT vendors with a robust business process management system at the heart of their solution—often described as a workflow engine. That is something that is still just starting to be used in healthcare; we’re late compared to many other industries.

There’s a feeling in the industry overall that we’re still relatively early on the journey of 1,000 miles, when it comes to clinical transformation and core IT solutions. Do you agree?

Yes. I do believe that we’ll make a quantum leap in the next five years in producing solutions that are far more sophisticated, efficient, and better. We have an infrastructure, a basic set of software and services,  that really do poise us to do the kind of process optimization that needs to be accomplished; and very few vendors are in a position like that to achieve that kind of process in any short timeframe.

What should CIOs and CMIOs be thinking about right now, per the movement towards the new healthcare?

I think one of the things is to really help their organizations prepare for this new healthcare, as you call it; to use the workflow or business process management engine, requires organizations to optimize their processes. And Al Casale [Alfred Casale, M.D., the cardiothoracic surgeon who led the first implementation of the ProvenCare process in the elective CABG arena] led the way; and the first miracle there was that the seven cardiothoracic surgeons sat down and talked together. So what’s needed is to get everyone in a clinical area to sit down and talk with each other. And that was one of the miracles that took place at Geisinger: the first time, it was like pulling teeth, and it took nine months; by the second time, in perinatal, everyone knew where the process was headed.

So, educating everyone about the process change, and finding ways to educate everyone about the power of process change, can be so powerful. Doctors and nurses aren’t chuckleheads; they don’t resist change just to resist change, but because things have been dropped on them that haven’t improved their workflow or their lives. I’m convinced that that’s at least 80 or 90 percent of it. And then the other thing for CIOs and CMIOs, is to really think about workflow engines and business process management software.

In my previous position, I started saying, we’re going to need heavy-duty business process management software; and can we agree together what we would do with it? Can we agree on one that we would run financials and clinicals on at one time? So that’s another element, on the business management and planning level, to make the case for this. I think most leaders of most organizations will realize in the next few years that they need business process management. If you’ve begun to think about processes and everyone’s needs in your organizations, you’ll be sort of ready when the CEO says, OK, we’re going to do business process management now. And that will be a piece of work for most organizations.