Modelling the Preoperative Surgical Journey

An introduction to Business Process Management for Healthcare (BPM+ Health)

Presented at the BCS Health and Care by

John Svirbely, MD, CMIO, Trisotech
Denis Gagne, CEO & CTO, Trisotech

This webinar provides an introduction to BPM+ using the Preoperative Surgical Journey as an example.

Speakers demonstrate visual modelling and automation for the Preoperative Surgical Journey based on the three open standards that make up BPM+.

BPM+ Health is a multidisciplinary initiative, with high levels of participation from clinicians, to improve the quality and consistency of healthcare delivery. It is achieving this by applying business process modelling standards to clinical best practices, care pathways and workflows directly at the point of care.

Further information on BPM+ Health can be found at https://www.bpm-plus.org.

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What is Low-Code/No-Code/Pro-Code?

Low-Code No-Code (LCNC), or low code no code as it is sometimes written, refers to how to make an app – computer and mobile applications – that doesn’t require traditional programming skills (Pro-Code.)

Conceptually, using no code platforms, anyone can figure out how to create an app using a few clicks. With low-code solutions, power users and subject matter experts (citizen developers) can build applications using a business-friendly expression language, and, of course, pro-code solutions utilize programming languages like JavaScript, Java, Python and C# where professional development teams are the app creator.

Simply put:

No-Code

=

drag-and-drop and clicks

Low-Code

=

business friendly expression languages

Pro-Code

=

programming languages

Low-code/no-code adoption is a very rapidly growing pillar of the digital transformation movement. With the growing shortage of professional developers, and the increasing requirements for business agility, application leaders are setting up environments where anyone can be a developer. According to Forrester, low-code platforms have the potential to make the software development process up to 10 times faster than traditional development methods.

What is No-Code?

A No Code app builder enables citizen developers, sometimes called business technologists, to create applications without using a programming language. Gartner defines a citizen developer as “a user who creates new business applications for consumption by others using development and runtime environments sanctioned by corporate IT”. Citizen developers can drag-and-drop reusable components, connect them together, and create applications.

A no-code approach empowers citizen developers. No-code platforms are designed to help non-programmers create applications with no coding at all and are often used to replace, or even enhance, what would otherwise have been achieved using a spreadsheet. They are also used for simple websites.

Spreadsheets, while powerful, don’t lend themselves to creating an application with a rich user interface. But no-code applications can create an attractive user interface using forms for an application on top of a backend powered by a spreadsheet or a database.

Some of the primary reasons organizations utilize low-code platforms are that: they can build applications 6 to 10 times faster, they can build apps without pro-developers (a scarce and expensive resource), and, the production of no-code applications become up to ten times more affordable.

What is Low-Code?

Low-code and no-code both provide drag-and-drop functionality through an easily navigable graphical user interface (GUI) that pro and citizen developers can use to create applications without having to write thousands of lines of code. Unless you are developing only the simplest applications and require little in the way of customization or connection to existing systems, low-code will always be a better option than no-code.

Low-code development allows for customization using a simple expression language using spreadsheet-like functions. This minimal coding approach enables more skilled power users and SMEs on low-code platforms to customize their application more than a no-code platform. Low code platforms are also good for developing sophisticated applications that can run mission-critical processes. It is also good for building mobile and web apps that require more complex integrations with both external and internal systems.

Three generic types of low-code platforms are emerging. Low-code application platforms (LCAPs) that provide a graphical user interface development experience for citizen developers. LCAPs are a solution to growing application demands from the business and IT budget-related problems. Model Driven Platforms (MDPs) such as BPMS, DMS, and BRMS are low-code technology platforms that implement, manage, and automate business logic, decisions, and processes. MDPs offers visual notations that make them simple enough for citizen developers while being expressive enough for professional developers. Finally, Multiexperience Development Platforms (MXDPs) as Low-code development tools used in multiexperience development platforms. As defined by Gartner, MXDPs use low-code development to increase the productivity of application development in different touchpoints such as web, mobile, wearables, chatbots, augmented reality (AR) and virtual reality (VR).

What is Pro-Code?

Pro-code refers to the use of traditional programming languages such as Java, JavaScript, C#, Python, etc. to create applications. Pro-code allows development of complex prototypes and production systems from the ground up. These applications can build new and existing legacy system connections into the new application and tailor applications to fit precisely within the organization’s architecture. There is no need for the potential compromise sometimes required with low-code and no-code platforms. Since this work is done by IT technology staff, the application structure is thoroughly understood by the development team, and they can easily troubleshoot and correct bugs.

A significant factor in the emergence and growth of low-code/no-code platforms is the result of high demand for new digital applications. Such new apps are part of the wave of digital transformation initiatives in practically every organization. These organizations are turning to low-code/no-code solutions because professional developers are needed on other more complex projects, hard to find, expensive to employ, and because learning traditional programming takes a lot of time and training. LCNC solutions, on the other hand, allow non-technical employees (citizen developers) to assemble application logic even if they don’t know traditional programming languages.

The ability to build applications has historically been designated to professional coders, however, low-code and no-code technology has democratized the skill and ability to build applications such that anyone can do it.
LCNC in Financial Services

LCNC in Financial Services

Some might say that the birth of low-code solutions came with the introduction of spreadsheets, a mainstay of the financial community.

More info on Finance

Going beyond the conventional column and row model of accounting ledgers, spreadsheets offered the ability to write formulas for advanced calculations and later, more and more sophisticated functions far beyond row or column sums and averages. It was the beginning of macro functions and if/then logic processing for non-programmers. This, in turn, led to an explosion of uses for spreadsheets far beyond simple accounting tasks, spawned the proliferation of user-built “applications”, and created a new class of business technologist – the power-user.

Today, with the ever-increasing demand for mobile and online banking services, financial services organizations including retail and commercial banking, insurance, mortgage, investments, etc. need to constantly re-engineer customer offerings just to remain competitive. Several standards groups are providing a way to make transactions and financial processes compatible across many organizations. Examples include MISMO™ (Mortgage Industry Standards Maintenance Organization) and FIBO® (Financial Industry Business Ontology). These standards also help low-code vendors create predefined data structures and templates that citizen developers can use.

In the financial services industry, access to customer and market data and the ability to analyze it and personalize it for specific customers is critical. The needed flexibility and efficiency to create these apps is often not available in legacy systems. Combine that with issues like the fierce war for talent raging in the financial industry, development backlogs for requested and required custom applications, slow IT turnaround times, and programmer burn-out, it is easy to see why financial services businesses are turning to low-code/no-code platforms and citizen development as a way forward.

The nature of much of the financial services world centers around cyclical and mundane tasks, month after month, quarter after quarter and year after year. This takes its toll on application developers and line workers alike. About 0.3% of the world’s population are professional software developers, yet everyone is capable of problem solving. Low-code/no-code solutions put application building and how to code an app in the hands of the people who need to solve the problems, rather than only in the hands of professional software developers. This is a very attractive option for people who want to do meaningful work that utilizes broad skill sets and will help with both recruiting and retaining top-performing people. As citizen developers, finance professionals with an interest or skills in business technology can make an impact and become stand-out employees.

This is all great news. McKinsey & Company projects that personalization can lead to 15% revenue growth for companies in the financial services sector. By empowering financial services employees to help create personalized applications, citizen development gives people of all technical abilities the tools to solve business problems using low-code application development. This isn’t just a fad, it’s the future of work.

Trisotech LCNC
in Financial Services

Trisotech is a MISMO™ (Mortgage Industry Standards Maintenance Organization) partner and provides DMN and BPMN technology to that standards group. Trisotech also provides BPMN extended modeling support in the form of no-code drag-and-drop “Accelerators” for the MISMO and FIBO (Financial Industry Business Ontology) standard data structures. Trisotech financial clients include governments, insurance organizations, mortgage finance organizations, loan originators, retail and commercial banks, stock trading exchanges, credit card organizations, real estate brokers, investment brokerage houses and more.

Building low-code financial apps requires access to advanced computational and logical capabilities. Trisotech supports the only international standard expression language perfect for low-code developers – FEEL (Friendly Enough Expression Language) published as part of the DMN (Decision Model and Notation™) from OMG, an international standards body.

LCNC in Healthcare

Whether you believe that “today, all companies are software companies” or that “software is eating the world,” one thing we know for certain is that health and care services are changing, so their IT solutions must change as well.

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LCNC in Healthcare

Healthcare automation needs have become so critical and pervasive that to address these concerns head-on, a community of practice, BPM+ Health, has been created. BPM+ Health was established based on the use of open, standards-based notations including BPMN™ (workflow management) DMN™ (decision management), CMMN™ (case management), and other open IT standards which allows for all types of health organizations, professional societies, and vendors to document their care pathways and workflows, so they are sharable, discoverable, and automatable.

In this age of digital transformations, software is becoming increasingly strategic ad pervasive. Both new care settings and continuously changing medical and pharmaceutical advances are driving an explosion in the demand for new and updated applications yet professional programmers who can build and maintain this software has reached a critical shortage. Other industries are already adopting lowcode and nocode platforms to speed the creation of applications, reduce the backlog, and make application development more affordable. Because professional software developers are an increasingly scarce and expensive resource, everyday employees are stepping up as “citizen developers.” These power users and SMEs already have the domain knowledge needed to rapidly compose their needed applications using low-code tools. The healthcare software revolution is behind the curve and low-code development is rapidly becoming the best option to catch up. However, even as low-code platforms advance, pro-code professional developers will still be needed to create the more complex features and integrations required in healthcare.

Most current Electronic Health Record systems (EHRs) are increasing the burden of work on doctors and other care team members primarily because they are neither agile nor provide for innovation capabilities. Surprisingly, while virtually every other business sector is utilizing these new technologies, little is developed with low-code or no code in healthcare. Low-code solutions would seem to lend themselves to patient portal apps, common patient care apps or even complex back-office systems. Using low-code, care givers and other subject matter experts (SMEs) don’t need to learn a professional programming language to create apps but only need to learn an app where they set configurations in a graphical user environment and sometimes a simple expression language. Low-code app development is therefore faster and far less expensive. Using low-code platforms, developers can use agile methods to test the new and changing needs of providers and patients directly during the development cycle. Since low-code platforms provide simple ways to invoke other applications or components via RESTful API calls, apps can easily integrate with existing IT systems and standards such as HL7®, FHIR®, CDS Hooks™, SMART™, and SMART on FHIR allowing new functionalities to be added to existing systems with little or no disruption to current operations.

A hallmark of the healthcare industry is the diversity and volume of data needed to provide the vast array of clinical, administrative, and insurance services patients and caregivers have come to expect while controlling the costs of those services. Just creating and maintaining a comprehensive data layer accessible to all is a major and ongoing undertaking. Add to that the hundreds, if not thousands, of applications, APIs, and interdependencies, the complexity is nearly overwhelming. Emerging standards like FHIR may help. Still, by using low-code composable apps along with FHIR and other data sources, organizations and their citizen developers may be able to modernize faster and more affordably by assembling their own vendor-neutral digital platforms.

Trisotech LCNC
in Healthcare

Trisotech is a founding member of BPM + Health which includes BPMN, as well as DMN and CMMN, as an integral standards technology. Trisotech healthcare clientele include international and U.S. acute care hospitals, healthcare insurance organizations, HMOs, renowned teaching hospitals, PPOs, and healthcare professional organizations.

The Trisotech Healthcare Feature Set (HFS) is an optional set of advanced low code development functionalities extending the Trisotech Digital Enterprise Suite with healthcare-specific additions. Through a combination of these new features and functions, healthcare organizations can now access FHIR®, SMART™, and SMART on FHIR capabilities as well as AI and Machine Learning (ML) in their modeling and automation of model-driven applications. Predefined FHIR Data types (simple, complex, and special purpose) are provided as no-code reusable drag and drop data structures that can be assigned as data objects in model-driven applications and autogenerated SMART on FHIR webapps can be created from automations stored in the Digital Enterprise Suite (DES) Service Library.

Building low-code healthcare apps requires access to advanced computational and logical capabilities. Trisotech supports the only international standard expression language perfect for low-code developers – FEEL (Friendly Enough Expression Language) published as part of the DMN (Decision Model and Notation™) from OMG, an international standards body.

Another no-code feature is the Attended Tasks extension. The Trisotech Attended Task feature allows for validation and confirmation of the inputs and/or outputs of any automated task by the care provider user or any other designated performer. This feature ensures that a knowledgeable human expert can correct/modify information in real time during apps execution.

Trisotech also provides nearly 1,000 pre-built evidence-based workflow and decision models including care pathways, clinical guidelines, and healthcare calculators using the the BPM+ Health standard. These models can be quickly and easily modified to fit the exact nature of anorganization’s policies and procedures. Healthcare organizations can also create their own apps from scratch with the easily understood visual Workflow Modeler (BPMN) that can be shared by IT, practitioners, SMEs, and business people – LCNC citizen developers.

1,000
free pre-built evidence-based workflow and decision models

Trisotech and LCNC

Digital Enterprise Suite

Many of the well-known low-code development platforms are business process management platforms.

BPM has long supported model-driven development (MDD) as how to build an app — where you first diagram the way the software should work before building it. The most popular process development standard supported by most BPM platforms is BPMN. Trisotech is a world leader in model-driven low-code business automation solutions and an active contributor to the BPMN standard. Trisotech whose Workflow Modeler (BPMN) is known as the reference implementation for BPMN modeling tools, also supports the DMN and CMMN standards with graphical modelers and the Trisotech Business Automation Suite of engines for building and automating low-code applications and packaged business capabilities (PCBs). Trisotech provides the only international standard expression language perfect for low-code developers – FEEL. FEEL (Friendly Enough Expression Language) is published as part of the DMN (Decision Model and Notation™) specification from OMG®, an international standards body. Finally, Trisotech provides free application modeling tools through self-service trial subscriptions.

The Trisotech platform provides no-code, low-code, and pro-code capabilities that your organization can configure and utilize to best fit your needs. By providing a spectrum of developmental options, Trisotech Digital Enterprise Suite can help close the Business-IT divide by creating a collaborative and cross-functional environment where both professional developers and citizen developers can work together to build stunning apps. These applications are quick to develop, cost far less than traditional programming methods, and integrate easily with existing legacy systems and data sources as well as new technologies like Machine Learning (ML), Artificial Intelligence (AI), and industry standards such as MISMO™, FHIR, and CDS clinical decision support.

Low-Code/No-Code/Pro-Code

Trisotech
Low-Code No-Code Differentiators

Trisotech’s business automation architecture is built upon SaaS cloud technologies including API-first design which allows for the invocation of services (applications, processes, or packaged business capabilities) from practically any programming language in mobile, cloud, and on-premise server environments. These automated services are scalable with very high-performance. The services and automation engines are also structured to provide full support for today’s complex availability needs including containerization and docker technologies. All low-code no-code application development – modeling and automation – is completely browser based and can be run in any modern browser environment including Chrome, Edge, Safari, Firefox, etc. Automation servers can be hosted by Trisotech, or Clients including on-premises and public/private clouds like AWS, Azure, Google, etc. Advanced configurations allow for 24 X 7 operation, concurrent geographic dispersion and failover, and containerization operating environments.

The Trisotech low-code no-code development and automation platform

provides many meaningful features and capabilities for citizen developers to create an app that other platforms do not.

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Low-code/No-Code/Pro-Code

These include:

  • FEEL expression language from DMN for low-code automation (data mapping, if/then logic, computation functions, and much more)
  • Model-driven graphical drag-and-drop no-code development helps citizen developers think like professional developers
  • Integrated Learning features (BPMN, Quick Guide, BPMN Rule Book, BPMN JIT eLearning)
  • Realtime graphical step-by-step debugger
  • Configurable autogenerated documentation in Word or HTML including overlays on models
  • Model “standards” validation
  • Issue tracking and management by model
  • Lean/Six Sigma analysis
  • Heatmap visualizations
  • Dependency view of re-use and where-used
  • Library of connectors for triggers & operations (Outlook, Google Storage, Excel, OneDrive, CRMs, ERPs, social media, mobile, cloud…)
  • Graphical development with in-line step-by-step debugger allows citizen developers to iterate rapidly
  • Drag & drop re-use by copy and re-use by reference (DEG: Digital Enterprise Graph)
  • Multimedia model animator
  • Threaded collaborative commenting down to element level
  • Versioning of apps (Services)
  • Versioning of models
  • Capture & interrelate W5 (Who, What, When, Where, and Why)
  • Single click deployment to execution library
  • Import of various file formats

OMG®, BPMN™, (Business Process Model and Notation™), Decision Model and Notation™, (DMN™), CMMN™, (Case Management Model and Notation™), FIBO®, and BPM+ Health™ are either registered trademarks or trademarks of Object Management Group, Inc. in the United States and/or other countries. MISMO™ is a registered trademark of Mortgage Industry Standards Maintenance Organization, Inc. HL7®, and FHIR® are the registered trademarks of Health Level Seven International and the use of these trademarks does not constitute an endorsement by HL7.

CDS Hooks™, the CDS Hooks logos, SMART™ and the SMART logos are trademarks of The Children’s Medical Center Corporation.

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Integrating clinical workflows and decisions with FHIR, CDS Hooks and SMART

Presented by
Dr. John Svribely, CMIO at Trisotech
Denis Gagne, CEO & CTO at Trisotech

In this webinar we will introduce the various capabilities and features from the Trisotech healthcare feature Sets (HFS) that enable and accelerate the integration clinical workflows and decisions with FHIR, CDS Hooks and SMART.

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Optimizing Preoperative Assessments

From Rules to Decisions. From Decisions to Value.

Presented by

Dr. John Svribely, CMIO at Trisotech

Denis Gagne, CEO & CTO at Trisotech

A patient undergoing surgery may have to undergo many preoperative assessments, which are often manual and time-consuming. Preauthorization has become synonymous with endless forms and delays and with the occasional denial of care that the provider had deemed appropriate. A payer organization must balance quality of care, reimbursement and patient satisfaction, while being compliant with ever changing rules and regulations.

In an era of digital transformation, it is possible to completely automate low-risk preauthorizations. This can be done using processes and decisions using visual low-code models that are easily changed to meet changing requirements. The same models can be used to risk stratify patients, to prepare dashboards to quickly visualize data and to prepare data for predictive analytics (AI). Automated BPM+ visual models can help to achieve these goals, with SmileCDR providing and collecting the standardized data.

In this session, we will introduce and demonstrate visual modeling and automation for preauthorization based on a set of international open standards called BPM+. We will show how changes to compliance rules can be rapidly and easily traced to modify automation services accordingly, using an example in orthopedic surgery.

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