The US government will start tracking hospital readmission rates. Why? Because we spend some $15B each year treating returning patients. Many of these would not need to return if they followed instructions — which involve meds, follow up out patient visits, diet, and you get the picture. To be fair, it's sometimes not the patient's fault. They often do not get a proper discharge summary and in some cases they are just not together enough to comply. They may lack transportation, communication skills, or the ability to follow instructions. Doesn't it make sense to figure out those at-risk patients and do something a little extra? It does. No question. And translates to real money and better care, and this is where big data comes in — and it's nice to see some real use cases that do not involve monitoring our behavior to sell something. Turns out — no surprise here — the structured EMR patient record, if one exists, is full of holes and gaps — including missing treatments from other providers, billing history, or indicators of personal behavior — that may provide a clue to readmission potential. The larger picture of information —mostly unstructured —can now be accessed and analyzed, and high-risk patients can have mini workflows or case management apps to be sure they are following instructions. IBM is doing some great work in this area with the analytics engine Watson and partners such as Seton. Take a few minutes to read this article.
We all feel the loss of human connection due to relentless automation, the emerging behavior of Digital Natives (who prefer online interaction to direct human interaction), and the inability of current systems to support “personalization at scale.” So I’ve been wondering whether we will start to see real pushback against the straight-through and self-service procesees we endure daily — what I am calling “faceless” processes. In short, we are starting to see inklings that the pendulum is swinging away from faceless processes and a back toward more personalized human-driven interactions.
There are a few things that seem to point in this direction, such as community banks taking customers from the big guys, or the well-documented hatred of foreign call centers and voicemail hell. An “I’ve had enough” shift is also advanced by more vocal consumer attitudes — witness, for example, the recent consumer pushback on debit card fees. The question is, will we start to see companies start to differentiate based on injecting humans back into the process? Does social have a role to play here? And is there a way to measure whether this is actually happening?
My “Stuck in Cement” research is up on Forrester.com today. I have to say, I really wrestled with the title. It’s just incorrect to say “stuck in cement,” because technically cement is only the active ingredient and needs to be mixed with sand and water to make concrete. So it should be “stuck in concrete,” although somehow this doesn’t quite sound right. But really, who but a chemist would lose sleep over this or even catch the distinction? The real issue is whether packaged apps really are a barrier to innovation at this point — or does our research just reflect the high level of frustration that our clients feel trying to manage technology in a world changing so quickly?
The basic idea is that industry-specific or packaged apps — and these are currently mostly on-premises applications — aligned with organizational silos have worked well for well-defined, highly structured processes where volume, scale, and straight-through processing dominate system design. But these apps are difficult to change, appear increasingly less relevant, and form a barrier to innovation for companies in fast-moving industries like energy, healthcare, and financial services now facing advancing consumer technologies that threaten business as usual.
Kofax is the latest investor in the BPM business (and for Kofax, this means capture-driven BPM). What Kofax has envisioned for more than a year is now reality. The first step will no doubt be to link the Singularity BPM platform with the capture process and lift data that is then filtered and cleansed and move it to straight-through processes. This provides a lighter-weight approach; for some processes, this will bypass the packaged application or ECM platform. Yet more automation leads to more challenging exceptions — and the more we move to STP, the more those exceptions require case management handling and even more serious human intervention. That’s where Singularity’s case management platform will help; Singularity was a Leader in the 2011 Forrester Wave™ for dynamic case management solutions. Overall, there is a lot to like here. Rather then partnering for BPM, building from within, or trying to leverage 170 systems more fit to purpose workflow, this investment shows that Kofax understands that the real customer value is in process transformation rather than in supporting tasks like capture or document management. More tactically, Singularity fits well with existing Kofax SharePoint solutions. But the real synergy is around distribution: Singularity, as a private company based in Ireland with $15 million in annual revenues, suffered from poor recognition in the bigger markets. Now the 700-plus Kofax partners around the world could change that, and quickly, although not all of the partners may be up to the task. Kofax’s recent investment in MobiFlex, which has mobile technology for capturing PDFs and rich media, can also be tied to capture and now case management apps. Overall, there are many positives to this, and I don’t see a lot of conflict with the recent
Lexmark International acquired Netherlands-based Pallas Athena and will combine the company with its recent acquisition of Perceptive Software, a fast-growing ECM provider. Together this is a very complete software unit for the ECM, BPM, and dynamic case management market. Pallas received good reviews well in the recent Forrester Wave™ for dynamic case management solutions and has a strong overall BPM technology. North American exposure, and distribution in general, was the big issue. Perceptive had an easy-to-deploy workflow management solution but lacked case managenent or extension beyond departmental applications. Combining Perceptive and Pallas Athena should should work well. The challenge and potential is to create synergy and focus with Lexmark’s growing managed print services business — which means focusing on office document automation that supports the knowledge worker.
We are seeing firms migrating away from traditional IT-centric approaches. Why? They have to: Customers are now empowered — and companies are not. So you have to ask yourself a few questions:
How long will packaged apps survive?
How long will it take before customer engagement wins out over the desire to control?
How do enterprises prepare to move to a federated deployment approach to meet process goals?
Federated deployments grab best-of-breed functions from the app Internet and SaaS-based solutions and use emerging technologies like dynamic case management, analytics, and collaboration. Figuring out how to implement these types of deployments to meet the business process needs companies will have in 2020 requires Big Thinking — and we will be addressing this as one of the main topics of discussion at Forrester’s Business Process Forum next week in Boston.
Electronic signatures are gaining momentum and becoming an increasingly popular topic of discussion among Forrester clients. In retrospect, today’s e-signature users will be seen as early adopters. And in 10 years, the dominant form of signature will be digital, with adoption driven by rampant uptake in consumer technology — particularly mobile applications with embedded signing authority. It’s a vision that helped push this SaaS-based acquisition — but it’s only part of the story. Today, many vendors integrate with Adobe LiveCycle, which has a digital signature available in its Forms product. Adobe Forms has a strong signing capability, but did not provide a well-integrated platform for handling documents or executing agreements, including such functionality as hierarchical signing, embedded PKI support, separate forms management, adding fields at the time of signing, or electronic evidence. These had to be developed with other LiveCycle components, such as BPM, or with other e-signature solutions such as those from Silanis, DocuSign, and ARX. As it’s Monday morning, I’ll make it simple. Until the EchoSign acquisition, Adobe allowed you to send a form for signing — but had limited signing applications out of the box. Further, EchoSign is a hard-charging company with a SaaS solution that emphasizes simplicity, but it did not focus on IT buyers and had fewer authentication options. This acquisition is a great fit for both: Adobe will provide more solutions capability and IT focus and gets a full e-signature application. Initially, EchoSign will be part of Adobe’s online document exchange services platform and be integrated with Adobe’s SendNow for FormsCentral for form creation.
OpenText is at it again — and another independent BPM provider is gone. This time it’s Global 360. But Global 360 was more than BPM; it had done a good — no, great — job revitalizing what was at its core an ECM rollup of midrange and questionable solutions (remember Kodak, Keyfile — I actually met an original Keyfile developer there — and ViewStar?). But it nurtured this account base well and built a fast-growing BPM and case management business. It’s now been purchased by the ultimate ECM rollup, OpenText. (It would be interesting, although not partcularly productive, to count the number of original products that OpenText now has — perhaps 500?) Global 360 also created a strong case management platform (you may want to consult our Forrester Wave™ on the subject, where Global 360 was a Leader), with an integrated suite to address the mix of complex unstructured and structured processes that organizations face. Global 360 continued to focus on content-centric casemanagement applications — a strong fit with OpenText’s transaction management assets — and provided an innovative process vision based on a “persona” approach that focuses on the needs of case workers and stakeholders and leveraging emergent design principles. In short, this should really help OpenText in the emerging case management market, and OpenText will be able to put more meat behind Global 360’s focus on the SharePoint ecosystem.
WaterWare will add more software development and consulting services to Xerox which is always a good thing but more importantly, WaterWare has the Aquifer EHR electronic records system that helps convert paper records to electronic data. Added to Xerox's broad document services and global reach the combination gives Xerox strong capability in electronic health records capture and management. Health Care Reform = as we know- is pushing providers to meet “meaningful use” guidleines which boil down to turning massive quantities of unstructured content into structured data -allowing better monitoting of patient outcomes, better access to health data for consumers, and lower administrative costs. Could there be a stronger core competency for this company – and this combination. I also like WaterWare as a launching point for broader Dynamic Case Management solutions they can extend Xerox capability, using DocuShare foundation BPM and ECM components in verticals like pharmacy and order automation. Combining WaterWare with DocuShare makes sense to boost professional services and system integration, but also to provide some luster to a strong product that has been a bit buried in the larger Xerox. So, a nice pick up.
Forrester is conducting a deep dive into dynamic case management usage by interviewing 50 companies implementing these solutions and evaluating 10 dynamic case management (DCM) platforms for an upcoming Forrester Wave. Enterprises are using DCM solutions to tackle untamed processes that service a myriad of customer and citizen requests, automate and track "incidents" related to investigations, and meet new compliance demands from a growing number of ever-more-scrupulous regulators. And with an eye to the future, business process professionals report that DCM offers great potential to align process outcomes with organizational goals, leverage unique expertise of I-workers, and improve agility for case workers, business managers, and IT.
But one aspect of this is interesting in the way DCM may change existing management approaches. The new generation of case management platforms allow for more rapid change by the case worker, business process pros, and IT. But this ability only matters if aligned with organizational agility, i.e., allows rules, such as dollar approval limits, to be approved by management in the same time frame. Approving a new rule or wording change in a communication can take weeks at some enterprises today. So management will have to decentralize decision-making to the case worker.