Business Modeling In Healthcare - BA World 2007

From Aerospace to Healthcare: From Aerospace to Healthcare: Perspectives on Business Perspectives on Business

ModelingModeling

Ken Wong, Ph.D.Ken Wong, Ph.D.Senior Systems AnalystSenior Systems Analyst

McKesson Medical Imaging Group (MIG)McKesson Medical Imaging Group (MIG)

From Aerospace to Healthcare From Aerospace to Healthcare ……

Aerospace refugee (exAerospace refugee (ex--Hughes/Raytheon)Hughes/Raytheon)Air Traffic Management Air Traffic Management –– STARS, STARS, ……

Air Command and Control Air Command and Control –– ACCSACCS

““Systems EngineerSystems Engineer”” (SE)(SE)

Healthcare immigrant (ALI/MIG)Healthcare immigrant (ALI/MIG)Radiology Information Systems (RIS) Radiology Information Systems (RIS) -- HRMHRM

Picture Archiving and Communications Systems Picture Archiving and Communications Systems (PACS) (PACS) -- HRSHRS

““Systems AnalystSystems Analyst”” (SA)(SA)

OverviewOverview

Meeting customer Meeting customer ““operational needsoperational needs””From SE perspectiveFrom SE perspective

From BA perspectiveFrom BA perspective

From Healthcare perspectiveFrom Healthcare perspective

Workflow RedesignWorkflow Redesign

What are we doing at MIG?What are we doing at MIG?

Systems EngineeringSystems Engineering

Systems EngineeringSystems Engineering

Emerged in 50Emerged in 50’’s driven by US s driven by US DoDDoDApplied to large system acquisitions, e.g., Applied to large system acquisitions, e.g., missiles and missilemissiles and missile--defense systemsdefense systems

Mandated disciplined developmentMandated disciplined development

MILMIL--STDSTD--499A499A““A logical sequence of activities and decision A logical sequence of activities and decision that transforms an that transforms an operational needoperational need into a into a description of system performance parameters description of system performance parameters and and a preferred system configurationa preferred system configuration””

Systems Engineering ProcessSystems Engineering Process

From DOD SFEFrom DOD SFE

Operational ConceptOperational Concept

How the system will serve its usersHow the system will serve its usersOperational need definitionOperational need definition

System mission analysis and performanceSystem mission analysis and performance

Operational sequences and environmentsOperational sequences and environments

User and maintainer rolesUser and maintainer roles

NATO Air Command and Control NATO Air Command and Control System (ACCS) System (ACCS)

From From www.nacma.nato.intwww.nacma.nato.int

Business AnalysisBusiness Analysis

Business AnalysisBusiness Analysis

IIBA (IIBA (www.theiiba.orgwww.theiiba.org))““The business analyst understands The business analyst understands business business problemsproblems and opportunities in the context of and opportunities in the context of the requirements and recommends solutions the requirements and recommends solutions that enable the organization to achieve its that enable the organization to achieve its goals.goals.””

Rational Unified ProcessRational Unified Process

Business ModelingBusiness Modeling

Provides business contextProvides business contextOrganizational structure, roles and processesOrganizational structure, roles and processes

Similarities with SE operational conceptSimilarities with SE operational concept

““OptionalOptional””??????

HealthcareHealthcare

Healthcare and ITHealthcare and IT

IT is relatively new to Healthcare, e.g.,IT is relatively new to Healthcare, e.g.,Hospital Information Systems (HIS), Electronic Hospital Information Systems (HIS), Electronic Healthcare Records (EHR), Computerized Healthcare Records (EHR), Computerized Physician Order Entry (CPOE), Physician Order Entry (CPOE), ……

Key driversKey driversPatient Safety Patient Safety –– ““To Err is Human To Err is Human …”…”

Efficiency/CostEfficiency/Cost

Buzzword: WorkflowBuzzword: Workflow

Radiology Workflow Radiology Workflow

From Siegel and ReinerFrom Siegel and Reiner

Introducing PACSIntroducing PACS

Radiology Workflow with PACS Radiology Workflow with PACS

From Siegel and ReinerFrom Siegel and Reiner

Workflow RedesignWorkflow Redesign

Workflow Workflow InterruptusInterruptus

E.g., FAA controller E.g., FAA controller requirementsrequirements

ConservativeConservative

SafetySafety--criticalcritical

From From hf.tc.faa.govhf.tc.faa.gov

Software will impact users and workflowsSoftware will impact users and workflows

Workflow Reality CheckWorkflow Reality Check

Operational <Operational <--> Functional disconnect> Functional disconnectUsers out of the loopUsers out of the loop

Workflow disruptedWorkflow disrupted

““Unintended consequences Unintended consequences …”…”Patient safety issuesPatient safety issues

Users are revoltingUsers are revoltingE.g., NATO ACCS E.g., NATO ACCS ““HMI OptimizationHMI Optimization””

Workflow RedesignWorkflow Redesign

MIGMIG

ALI/MIGALI/MIG

Then Then ……““Four people in a room and 6 months later Four people in a room and 6 months later …”…”

Workflow RedesignWorkflow Redesign

... and now... and nowOver 200 in R&D and growingOver 200 in R&D and growing

““Whither the business model?Whither the business model?””

MIG Requirements ProcessMIG Requirements Process

Functional Analyst create business modelFunctional Analyst create business modelEnterprise and Usability AnalysesEnterprise and Usability Analyses

E.g., Business Use Cases, Personas, E.g., Business Use Cases, Personas, ……

Systems Analyst create system modelSystems Analyst create system modelSoftware Requirements and UI designSoftware Requirements and UI design

E.g., System Use Cases, Interaction Design, E.g., System Use Cases, Interaction Design, ……

Process being test driven as we speakProcess being test driven as we speak

Business ModelBusiness Model

Users: PersonasUsers: Personas

Workflows: Business Use CasesWorkflows: Business Use CasesNew customer workflow with systemNew customer workflow with system

Identifies user goals Identifies user goals --> System Use Cases> System Use Cases

Validated with customerValidated with customer

E.g., Critical Test Result ReportingE.g., Critical Test Result Reporting

1.1. The The interpreting physicianinterpreting physician detects critical detects critical condition in study.condition in study.

2.2. The The interpreting physicianinterpreting physician sends critical test sends critical test resultresult to the to the referring physicianreferring physician, which is , which is logged. logged.

3.3. The The referring physicianreferring physician is is periodically remindedperiodically remindedto retrieve the message. to retrieve the message.

4.4. The The referring physicianreferring physician acknowledges receiptacknowledges receipt, , which is logged.which is logged.

5.5. Hospital administratorHospital administrator creates critical test creates critical test reporting communications reportreporting communications report..

ConclusionsConclusions

Operational <Operational <--> Functional disconnect> Functional disconnectIssue across domains and industriesIssue across domains and industries

Software WILL impact workflowSoftware WILL impact workflow

Workflow redesignWorkflow redesignBusiness modeling a necessityBusiness modeling a necessity

Business Use Cases help transition customer Business Use Cases help transition customer workflowsworkflows

ReferencesReferences

MILMIL--STDSTD--499A, Engineering Management, 1 May 1974499A, Engineering Management, 1 May 1974System Engineering Fundamentals (SFE), DOD, January System Engineering Fundamentals (SFE), DOD, January 20012001The Rational Unified ProcessThe Rational Unified Process--An Introduction, Philippe An Introduction, Philippe KruchtenKruchten, Addison, Addison--Wesley, 2003Wesley, 2003Work Flow Redesign: The Key to Success When Using PACS, Work Flow Redesign: The Key to Success When Using PACS, Eliot Siegel and Bruce Reiner, AJR, March 2002Eliot Siegel and Bruce Reiner, AJR, March 2002To Err Is Human: Building a Safer Health System, IOM, 2000To Err Is Human: Building a Safer Health System, IOM, 2000Some Unintended Consequences of Information Technology Some Unintended Consequences of Information Technology in Health Care: The Nature of Patient Care Information in Health Care: The Nature of Patient Care Information SystemSystem--related Errors, Joan Ash et al., JAMIA, Marrelated Errors, Joan Ash et al., JAMIA, Mar--Apr 2004Apr 2004