Wednesday, January 7, 2015

Workflow = Flexibility

Consider McDonald's, Wendy's, and Burger King, and your favorite sit-down restaurant, and your favorite diner, and you favorite sushi place.  Do they all do the same thing?  Basically.  But their processes are very different. Would a nice sit-down restaurant benefit from adopting processes from Burger King?  Probably not. And vise-verse.  And leave my favorite Sushi place's processes alone.

What in those processes can and should be standardized?  And where does the value-add come in?  In all the discussion of the importance of workflow, one thing that we must realize is that very little workflow in this world is ever standardized.  Even Amazon and Barnes and Noble have different workflows, and let's not even add eBay into the discussion.  At best we might standardize on certain names for products and methods of preparation, and how food is permitted to be treated (e.g., storage temperatures).  And even names are challenging.  Ever order your steak Chicago-blue and get a charred mess?

Let us consider even the simplest healthcare workflow: Identifying the patient.

Do you:

  1. Obtain a patient identifier from some official document (e.g., a driver's licence) and then look them up in some global database to get their demographics?
  2. Get their demographics from them directly, and then verify their identity?
  3. Verify their identity with one document, and get their healthcare identifier from another?
  4. Or are the two linked together somehow?
  5. Do you need more than one identifier for them?
After that, do you:
  1. Collect their co-pay, and if so, how do you determine how much it is?
  2. Bill their insurer (or the government, or both, them and the others)?
  3. Collect their co-payment after billing?
  4. How do you determine who pays and in what order?
Many of these very simple workflows vary, not just at the international level, but even within the same practice depending on the patient, and for a single patient depending on their age, payers and other stuff, even the type of practice they are visiting.

Could we simplify this?  Possibly.  Even probably for the really small stuff.  But once we get into bigger stuff, it isn't clear.  Part of the reason for this has to do with inference based on process and workflow. Once a particular workflow step has been completed, there are a lot of assumptions and inferences that can be made about what has already been done.  For example, in many places, the admission/registration process includes updates to the allergy list.  And so, a person familiar with that organization's workflow can rest assured that allergies have been update.  But elsewhere, they cannot, and so even though the patient has been admitted, the allergy list cannot be assumed to be up to date.

That may be an oversimplified example, but it should make the point.

What most people really mean when they say that workflow is important is that flexibility is important, so that your product (or mine, or anyone else's) is integrated with something else, the two can work together, regardless of whatever workflow the other assumed.


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