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Secure Structured Messaging: The New Healthcare Workflow Platform

As part of a five-part series on task and workflow interoperability for a health IT publication, one particular area of healthcare IT caught my eye: structured messaging. Many individuals and companies contacted me to say they agreed with my vision and to explain how their products and services were helping to realize it.

I’ve been meaning to drill down on the current state of structured messaging in healthcare for some time. In a series of blog posts, I’ll be examining the roots of structured messaging and its relation to workflow, a detailed examination of a leading secure structured messaging product for healthcare, and how structured messaging fits into the future of task and workflow interoperability.

I have what is whimsically called an ABD (All-But-Dissertation) in computational linguistics. I took twenty courses in linguistics, artificial intelligence, and natural language processing, but never got around to completing requirements for the Ph.D. (That's OK. I still have two Masters degrees, one in Industrial Engineering and one in Intelligent Systems.) Structured messages, usually between humans, is exactly what linguists study. Sounds have structure. Words have structure. Sentences and conversations have structure. And all this "structure" is used to generate messages we humans exchange to communicated, collaborate, and coordinate accomplishment of common goals, including common clinical goals. That is why I am so intrigued with the rise of "structured messaging" in healthcare.

I first encountered the concept of structured messaging in graduate school, as part of a course on human-computer interaction. At the time I was also learning about workflow and workflow technology. Structured messaging is part of a family of technologies that at the time were called Computer-Supported Cooperative Work, including email, group scheduling, structured messaging, computer conferencing, workgroup computing, and workflow systems. This general area came to be referred by the shorter designation “groupware.”

Several years ago “clinical groupware” became a much hyped term that came and went, a victim of its own marketing. However, the basic idea of groupware is both sound and of enormous significance and relevance to healthcare IT today. In fact, over the next five years, the largest and most active area of health IT investment and development will be modern day reincarnations of the groupware ideas and technologies I encountered in graduate school almost three decades ago.

What is structured messaging? To a healthcare informatics ear, one almost automatically thinks structured messaging must be about structured data. We hear so much about how to deal with unstructured data versus structured data that this cannot be helped. However, if you look at structured messaging research, “structured” really refers to interactions among people and machines. The most obvious and evident means to “structure” workflows among collaborating agents, human or otherwise, is to impose structure on the data in the user interface, in what are almost universally referred to as “forms.”

Forms, something healthcare workers are already exquisitely familiar with during day-to-day work, contain structured data. More importantly, the structure of a form is driven by, and in turn drives (through interative design) structured workflows. It is this combination of structured user interfaces and structured sequences of task communication and accomplishment that is the fundamental underpinning of structured messaging.

I have long been an advocate of technologies lending themselves to facilitating structured workflows. These include workflow management systems, business process management, and what academics generally refer to as “process-aware” information systems. y central concern while researching my task and interoperability series was finding a practical migration path forward toward workflow interoperability across healthcare organizations. I tackled this by proposing the idea of task interoperability, out of which workflow interoperability can evolve and diffuse throughout healthcare. The central tenet of task interoperability is task visibility and actionability within teams to collaborating health IT users. Looking around at candidate technologies today, rapidly growing in the health IT space, the most obvious candidate to me appears to be structured messaging.

In my next post I will go into more details about structured messaging in healthcare and highlight a specific secure structured messaging vendor (Telmediq). In my third and final post in this series I’ll extrapolate into the future, a future in which secure structured messaging may very well become the dominant healthcare workflow platform.

Charles Webster, MD, is a Google Glass Explorer with degrees in accountancy, industrial engineering, artificial intelligence and medicine. He designed the first undergraduate program in medical informatics, was CMIO for an EHR vendor and wrote three successful applications for the HIMSS Davies Award for EHR Ambulatory Excellence. Chuck opines about healthcare workflow and other topics from @wareFLO.

blog, Clinical Workflow, Technology