revised workflow
As a parent I’ve learned there are two types of tasks–those my children won’t do the first time I ask them, and those they won’t do no matter how many times I ask them. Here’s the segue.
Let’s agree for the moment that workflows can be parsed into two groups—Easily Repeatable Processes (ERPs) and Barely Repeatable Processes (BRPs). (I read about this concept online via Sigurd Rinde.)
An example of an ERP industry is manufacturing. Healthcare, in many respects, is a BRP industry. BRPs are characterized by collaborative events, exception handling, ad-hoc activities, extensive loss of information, little knowledge acquired and reused, and untrustworthy processes. They involve unplanned events, knowledge work, and creative work.
ERPs are the easy ones to map, model, and structure. They are perfect for large enterprise software vendors like Oracle and SAP whose products include offerings like ERP, SCM, PLM, SRM, CRM.
How can you tell what type of process you are trying to incorporate in your EHR? Here’s one way. If the person standing next to you at Starbucks could watch you work and accurately describe the process, it’s probably an ERP.
So, why discuss ERP and BRP in the same sentence with EHR? The reason is simple. The taxonomy of most, if not all EHR systems, is that they are designed to support an ERP business model. Healthcare providers are faced with the quintessential square peg in a round hole conundrum; trying to get BRPs into an ERP type system. Since much of the ROI in the EHR comes from being able to redesign the workflows, I think either the “R” will be sacrificed, or the “I” will be much higher than planned.
What do you think?
Pale Rhino Consulting 
The “I” will be much higher than planned!
That’s a really good way to break this down – the two modes of operation idea. I’ve spent 20+ in healthcare IT and I’m trying to work though in my mind the service lines I’ve been exposed to. If they have the data, Reg is pretty ERP. The ED is way out there in BRP. I worked exclusively in Cardiology for 6 years and that seemed like it was very ERP most days until I reconsidered the definition: collaborative events, exception handling, ad-hoc activities, extensive loss of information, little knowledge acquired and reused, and untrustworthy processes. They involve unplanned events, knowledge work, and creative work.
BTW, Starbucks is missing a great opportunity – they bought the company that was making these $11,000 dollar coffee machines. These machines had the ability to tweak all kinds of parameters and then store the recipe and make the perfect cup for you again. The recipes were shared online among the owners of the machines – until Starbucks bought them out. They stopped all that damn data sharing. What they COULD do is issue a card or RFID key fob to each customer that would track back to your recipe and your credit card and a customer loyalty plan. Start a website portal for sharing the recipes – I think there is a metaphor in here somewhere that relates to healthcare services, but I’m too tired to find it!
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Well said. Perhaps the Starbucks idea relates to the FaceBook healthcare model that was discussed briefly. Ex AOL chief Steve Case may be doing something along those lines. While it’s a poor analogy because it’s overly simplistic, I think we can compare the future healthcare model to the current ATM model. Clearly the healthcare version of my “ATM” card will require much more functionality, and the providers would need the ability to read and update my card, but it seems that once the additional data conversion was complete, the approach would be less costly and much simpler to standardize.
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