Trisotech Telemedicine Webinars Series Telemedicine is the practice of medicine using technology to deliver care at a distance. While telemedicine and its use are not new, widespread adoption beyond simple telephone exchanges has been relatively slow. However, the current pandemic has forced rethinking of how health care is delivered, while new developments in technology have made remote care more accessible. In this webinar series we will explore the application of the BPM+ Health set of standards to Telemedicine and the benefits that can be expected. More specifically, we will explore how automation of telemedicine can improve efficiency, improve care, and reduce risk. Webinar 2: Process Automation in Telemedicine: Improving care. Over the years home care has been extended to a wide range of conditions, such as drug infusions, blood transfusions and nutritional support. Receiving hospital care at home is even being discussed. A patient at home is largely outside the scope of traditional healthcare. This webinar will explore the automation of an early warning score identify a patient with sepsis associated with home parenteral nutrition. Presented by: John Svirbely, CMIO Trisotech Denis Gagne, CEO & CTO Trisotech

1. Trisotech.com
Process Automation in Telemedicine:
Improving Patient Care
With the support of
With the participation of
John Svirbely, MD
Chief Medical Informatics Officer (CMIO),
jsvirbely@Trisotech.com
Denis Gagne
Chief Executive Officer (CEO),
dgagne@Trisotech.com

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Abstract
Trisotech Telemedicine Webinars Series
Telemedicine is the practice of medicine using technology to deliver care at a distance. While telemedicine and its use are
not new, widespread adoption beyond simple telephone exchanges has been relatively slow. However, the current
pandemic has forced rethinking of how health care is delivered, while new developments in technology have made remote
care more accessible.
In this webinar series we will explore the application of the BPM+ Health set of standards to Telemedicine and the benefits
that can be expected. More specifically, we will explore how automation of telemedicine can improve efficiency, improve
care, and reduce risk.
Webinar 2: Process Automation in Telemedicine: Improving care.
Over the years home care has been extended to a wide range of conditions, such as drug infusions, blood transfusions
and nutritional support. Receiving hospital care at home is even being discussed. A patient at home is largely outside the
scope of traditional healthcare. This webinar will explore the automation of an early warning score identify a patient with
sepsis associated with home parenteral nutrition.
Presented by:
John Svirbely, CMIO Trisotech
Denis Gagne, CEO & CTO Trisotech
PROCESS AUTOMATION IN TELEMEDICINE: IMPROVINGPATIENTCARE

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Introduction

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Telemedicine Series Recap
In Webinar 1 of the series, we discussed Efficiency Improvements in Telemedicine
o We introduced some telemedicine concepts
• Well-structured protocols are ideal for automation
o We introduced the BPM+ Health open standards
• Introduced a methodology to go from a protocol narrative to an executable model
• BPM+ Health models are both human readable and machine automatable
o Presented and demoed a model of Nurse Teletriage of the Ill-Appearing Infant that
improves efficiency
• Not giving up control for the sake of efficiency through the use of attended tasks
PROCESS AUTOMATION IN TELEMEDICINE: IMPROVING PATIENT CARE
Recording and slides of Webinar 1 are available here:
https://www.trisotech.com/process-automation-in-telemedicine-improving-efficiency/

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Today we want to address Patient Care Improvement using Telemedicine
PROCESS AUTOMATION IN TELEMEDICINE: IMPROVING PATIENT CARE

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Telemedicine Context
Healthcare leaders
expect patient demand
for digital services to
continue rising
— even after the COVID-19 crisis subsides.
Trisotech is the leader in Clinical Workflow and Decision
Automation with its one click deployment of automated services
How will you meet this
increasing telehealth
demand while improving
care provided?
The answer:
Clinical Workflow and
Decision Automation
PROCESS AUTOMATION IN TELEMEDICINE: IMPROVING PATIENT CARE

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Classifications of Telemedicine
Telemedicine can be classified in several ways:
 By Function (management of a chronic condition, routine care, acute interventional, etc)
 By Specialty (general practice, dermatology, surgery, etc)
 By Communicators
PROCESS AUTOMATION IN TELEMEDICINE: IMPROVING PATIENT CARE
Communicator 1 Communicator 2
Role of Communicator
2
Equivalent to
Provider Provider Specialist B2B
Patient Provider Specialist C2B
Patient Provider Primary Care C2B
Patient Provider Nurse C2B
Patient Patient Support group, Family C2C

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Home Care for Vulnerable Populations

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Some examples of vulnerable patient populations
 Home parenteral nutrition
 Post-chemotherapy
 Heart failure patient with history of frequent admissions
 COPD patient with frequent exacerbations
 Pediatric patient with congenital malformations
PROCESS AUTOMATION IN TELEMEDICINE: IMPROVING PATIENT CARE

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Home Care for Vulnerable Populations
PROCESS AUTOMATION IN TELEMEDICINE: IMPROVING PATIENT CARE
Background:
• In the future more healthcare will be provided at home
• A vulnerable patient at home may be at risk for deterioration
• Deterioration can go on for some time before the patient comes to
the attention of the provider
• The sooner the patient is identified, the sooner therapy can be
started and the better the outcome

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Home Care for Vulnerable Populations
PROCESS AUTOMATION IN TELEMEDICINE: IMPROVING PATIENT CARE
Tenets:
• Telemedicine may be stand-alone but is much more useful when
integrated into the patient’s overall care.
• Monitoring at home gives eyes and ears on how the patient is doing,
allowing for early problem detection.

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Home Care for Vulnerable Populations
PROCESS AUTOMATION IN TELEMEDICINE: IMPROVING PATIENT CARE
Our Goals Today:
• Demonstrate how (a) remote data monitoring a patient at home plus
early waring score and (b) access to telemedicine can avoid serious
outcomes.
• Show the benefits of a Knowledge Entity Model supporting a
Workflow and Decision models.

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Introduction to Business
Process Automation

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PROCESS AUTOMATION IN TELEMEDICINE: IMPROVING PATIENT CARE
© 2020 Object Management Group
Established to foster the sharing and
promulgation of best-practices around
modeling and sharing:
• shareable pathways,
• clinical pathways,
• automatable clinical guidelines, and
• other healthcare knowledge
A robust and thriving community-of-
practice of healthcare institutions,
professional societies, and vendors
www.BPM-Plus.org

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Setting some Basic Terminology
Workflow
Automation
Decision
Automation
Open Standards
DMN
(DECISION MODEL AND NOTATION)
Decision tables and logical expressions
BPMN
(BUSINESS PROCESS MODEL AND NOTATION)
Prescriptive sequence of activities
CMMN
(CASE MANAGEMENT MODEL AND NOTATION)
Declarative unstructured event-condition-action
Technology enabled
orchestration of activities, able
to react to business events.
Both may have humans in the loop or not.
(Referred to as Knowledge Workers.)
Technology enabled decisions,
returning answers given some
inputs.
PROCESS AUTOMATION IN TELEMEDICINE: IMPROVING PATIENT CARE

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PROCESS AUTOMATION IN TELEMEDICINE: IMPROVING PATIENT CARE
BPM+ Value Add
Data
Intelligent
Healthcare
Automation
Computable Data
Aggregated Data
Data Automation
Information Automation
Orchestration of knowledge
Workflow and Decision Automation
Data in clinical context
• EMR 1
• EMR 2
• Devices
• Wearables
• Diagnostics
• Claims
• Common schema
• Identity resolution
• Medical resources
• Metadata
• Context
• Events awareness
• Tasks and activities
• Roles and responsibilities
• Decisioning
• Case management
• Event orchestration
• AI and ML

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Home Parenteral Nutritional
Support
Total Parenteral Nutrition (TPN)

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What is Parenteral Nutrition?
PROCESS AUTOMATION IN TELEMEDICINE: IMPROVING PATIENT CARE
Infusion of sterile solutions of nutrients (lipids, proteins,
carbohydrates, etc) through an intravascular catheter
Used when feeding using the gastrointestinal (GI) tract (enteral)
nutrition is insufficient to meet all of the patient’s nutritional needs
May be partial or total, the latter referred to as TPN (Total
Parenteral Nutrition)

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What are some potential complications with TPN?
 Thrombosis
o occurs when blood clots block your blood vessels
 CLABSI (central line associated bloodstream infection)
o a serious infection that occurs when germs (usually bacteria or viruses) enter the bloodstream
through the central line which can lead to sepsis
 Pneumothorax
o an abnormal collection of air in the space between the thin layer of tissue that covers the lungs
and the chest cavity
 Mediastinitis
o swelling and irritation (inflammation) of the chest area between the lungs (mediastinum)
PROCESS AUTOMATION IN TELEMEDICINE: IMPROVING PATIENT CARE

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Knowledge Entity Model (KEM)
PROCESS AUTOMATION IN TELEMEDICINE: IMPROVING PATIENT CARE
Concept Map – shows relationships between concepts

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Knowledge Entity Model (KEM)
PROCESS AUTOMATION IN TELEMEDICINE: IMPROVING PATIENT CARE
Concept terminology and definition

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Knowledge Entity Model (KEM)
PROCESS AUTOMATION IN TELEMEDICINE: IMPROVING PATIENT CARE
Rules

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Knowledge Entity Model (KEM)
PROCESS AUTOMATION IN TELEMEDICINE: IMPROVING PATIENT CARE
Referenced within a Decision Model

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Demo - Early detection of
catheter-related
bloodstream infection

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Conclusions
We hope that we have demonstrated how:
 Home care of vulnerable populations may expose a patient to significant
risks such as CLABSI.
 Remote monitoring of devices combined with early warning scores can
detect a problem before clinical deterioration.
o Accumulated data from monitoring devices can easily be
represented in dashboards for trend analysis
 Knowledge Entity Models can enhance workflow and decision models
by disambiguating terms.
 Telemedicine can improve patient care and enhance patient safety.
PROCESS AUTOMATION IN TELEMEDICINE: IMPROVING PATIENT CARE

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Any questions?
THANKS!
John Svirbely, MD
Chief Medical Informatics Officer (CMIO),
jsvirbely@Trisotech.com
Denis Gagne
Chief Executive Officer (CEO),
dgagne@Trisotech.com