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Automated clinical care pathways: Healthcare’s next frontier

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Any woman who’s ever been pregnant is familiar with the constant doctor visits and the lab tests meant to ensure the health and safety of both mother and child. That’s known as a clinical care pathway, a series of best-practices based on decades of medical experience and expertise. But it has the same weak link any series of best practices does: human error. What if an overworked nurse forgets to schedule a follow up, or a doctor forgets to order a blood test?

That’s why Red Hat is advancing business process model and notation (BPMN), commonly used across a wide range of industries across the world, to the healthcare field.

“The idea behind BPMN is to take that best practice protocol that’s already been written up by some of the leading institutes in the world and create a model that can be automated, which is to say, when somebody goes in for an appointment, the protocol might dictate that within 24 hours, they get a follow up call, or within two weeks, they get more blood drawn. So instead of having somebody who has to remember to do those things, the system just contacts the nurse and says it’s time to follow up with this patient. And the system schedules the next appointment for the blood draw. Those basic type of actions have a huge impact in health care. You’ve reduced the potential for morbidity and adverse effects,” said Ben Cushing, chief technology officer for Federal Health at Red Hat.

In other words, the model dictates what to do next if communication breaks down. And that’s where Red Hat comes in: the engine the model runs in understands contextually how to communicate to the right system to send the right message. The Process Automation Manager is flexible, portable, lightweight and available in enough modalities that it can be adapted to any enterprise.

On top of that, it uses a hybrid cloud approach, allowing health care organizations to scale rapidly for different sized workloads, whereas currently they’re constrained by existing infrastructure.

“For example, you’re using the process automation manager to run clinical trials for the National Cancer Institute, or to run clinical trials for Johns Hopkins,” Cushing said. “Each one of those trials is really just a process, right? It’s a series of things that somebody does, or group of people do on behalf of the patient. The challenge being that you might have five people in a clinical trial, you might have millions of people in a clinical trial, and your engine has to be able to scale rapidly to accommodate that growth.”

On top of that, it’s Red Hat, so of course the whole thing is open source. In fact, Cushing said the rules engine, which dictates the logic and decision making at any given point in the process, is written in an “if … then …” format that’s easy to understand. It can be expressed inside the process automation tool with natural language; no coding skill is required. Effectively, it democratizes the development process around this.

“That’s one of the most exciting things for me, is to watch doctors create these models, which are under the surface, highly technical objects. Developers have a hard time with the models themselves. But when it comes to authoring them, it’s actually very easy,” Cushing said. “You’re essentially taking a process that you understand in your head and putting it down on paper. And we abstract a lot of that complexity away. So that people can actually get these things operational. On top of all this, Red Hat is the open source company, everything we’re doing is transparent. Our process automation engine is open for those who want to peel back the cover and look inside and see how it works. People want to add, subtract, or whatever they need to do to make it better, they can do that.”

Cushing said this type of modeling is already being piloted at the Mayo Clinic, the Cleveland Clinic, and within the Department of Veterans Affairs. He said he’s visited numerous VA hospitals around the country over the past few years, and he saw the same thing in many of them: most existing practices to manage these processes exist in the form of spreadsheets.

“And the person managing the sheet is usually a very highly paid individual who has an advanced education, a lot of qualifications and a lot of requirements placed on them. They’re wasting their valuable time managing these things,” Cushing said. “And what they should be doing, what they want to be doing is spending time with their patients. The very lowest hanging fruit, and the number one way process automation can impact any industry, is it will free up time.”

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