Business Process Modeling Notation (BPMN) Tips

Business Process Modeling Notation (BPMN) is a method of illustrating business processes in the form of a diagram similar to a flowchart, which is valuable in helping to contextualize and visualize a process so stakeholders – both business and technical – can refine and understand it together.

After working on BPMN projects in healthcare technology management program, as well as in my internship, there are some suggestions that I think people should keep in mind when designing BPMN.

Detail every step VS. Simpler diagram

At the first hand, I thought that it would be easier for both business and technical to understand a simpler diagram as compared to a complicated one. However, the simpler one would not able to cover all details which may including important details that could lead to reading confused. When my first model came out, I tried to make it as simple as possible. However, as my manager read it, he raised a lot of questions because the model was not details enough to describe the inner working and the logic behind it. In addition, it will be hard to give recommendations when reader don’t fully understand the logic behind the processes.

BPM software

A BPM software should support for BPMN 2.0. There are some free BPM software available online that we could use for practicing or using for a simple model: processon.com, or bmnp.io.

Labeling the flowchart process item

To help a model easier to understand, process items should be named in the action methodology. For example, if action is representing equipment tested, then use the label “test an equipment” to define that action

Criteria for decision

There are criteria come with making a decision before you decide to act on something. These criteria would be very important to understand the inner work. For example, in a decision of keep a medical equipment after having a process of “test an equipment,” we must know what criteria in the test to know the equipment is good to start to refurbish, or bad to let it go. Therefore, when we build a model, we should keep in mind questioning criteria needed for the action before having your decision and making note on it.

There are just a few suggestions which you should consider to make your BPM more effective. These are the tips that I has learned from my experience while working on BPMN projects.

Usability: Medical Devices vs. Users

Usability: Medical Devices vs. Users

A medical device should be used without making use errors which compromise with medical care. A medical device is not expected to be complete error free. However, the designing and manufacturing companies are expected to aggressively seek out potential errors and apply a reasonable effort to mitigate the potential hazard. Therefore, designing and manufacturing medical devices companies must understand an important place of usability or how people interaction with a medical device.

To approach a result of safe and effective use, as well as limiting use error, designing and manufacturing medical devices engineers would consider three major components: device users, device use environments and device user interfaces.

The intended users of a medical device should be able to use the device without making use errors. As a result, maintaining or using medical device must be operated under professional caregivers, such as physicians, nurses, physical therapists; professionals who install and set up the devices and those who clean, maintain, repair, or reprocess them; or non-professionals who are trained to operate devices on themselves to provide self-care or family members. For example, Bridge Disability Ministries medical equipment center is a place where receives donation medical devices, such as commodes, wheelchairs, walkers, hospital bed, etc. The center will clean, repair, test and then reprocess them to others who needed. To make sure an intended users of a medical device should be able to use the device without making use errors. It is important for the center to control quality of a medical device after refurbishing to make sure that the device is fully function as it is. Because there are a lot of volunteers working in the center to help clean, center manager always consider the quality of medical devices by have them tested by himself or employees assigned by the manager before handling them to a customer. In addition, a customer, who is either a person who come to pick up a medical device for his/her relative or for his /her own would be carefully instructed to use the device by an employee who working in the center.

The second component is the environment which a medical device is used. A medical device might be used in clinical environments or non-clinical environments, community settings or moving vehicles. For example, a power scooter is designed to help a user able to mobility access different communities. Therefore, a battery that could able to use for a long distance throughout a day is an important property. A used scooter would be need to test a battery. At Bridge Disability Ministries equipment center, a center employee would give his advises about changing to new batteries depending on user needs and his/her limited pocket. Another property needed for a power scooter is ability to break the scooter into parts, or fold it to an affordable size that fix into a car trunk. This is so important feature that helps the user able to use it in a community center far away from home.

The last component is device user interface which includes all elements of interaction between the user and the device while user setups the device (unpacking, setup, calibration), uses the devices, or performs maintenance on the device (cleaning, replacing a battery, repairing parts). Come back to the example above about a power scooter, to break the scooter into parts or folder it and put into a car trunk, the user would do it without an extra tool needed. The scooter also is designed to have a comfortable seat, adjustable arm rest, a big enough foot rest, easy to maneuver directions etc.

To making the considerations above to be practical, FDA has stringent requirements for testing human factors and usability. The FDA testing will identify areas for design improvements to reduce errors. Therefore understanding the FDA usability standards is very important on the way to design and develop medical devices. Even though there are cost and complexity of incorporating the FDA standards, the process would help avoid the high cost associated with device recalls and making changes to designs late in the development process.

Resources:

1.       Human factors Considerations. Fda.gov. http://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/HumanFactors/ucm124829.htm. Accessed July 25, 2016.

Durable medical equipment Vs. Medicare coverage

As the elderly population has growth progressively due to the influence of the babyboom generation, there has been an increased need for seniors to purchase home or durable medical equipment. 15% of approximately $100 billion ($15 billion) would paid for directly out-of-pocket of consumers. Therefore, it is important to maximize the assistance the seniors receive from the insurance coverage or minimize their out-of-pocket spending on durable medical equipment.

There are about 55.5 million elderly people covered by Medicare in US. Medicare pays for much of their health care, but not all of it. Medicare covers most acute medical conditions – conditions from which a patient usually recovers. But, Medicare does not cover most care given at home, in assisted living facilities or in nursing homes, for people with chronic disabilities and lengthy illnesses. Through my internship with Bridge Disability Ministries, there are a lot of customers whose relatives are placed in assisted living facilities, in nursing homes, or at home with chronic disabilities and lengthy illnesses. The customers have come to us because they could not afford the renting fee of the durable medical equipment, such as airbeds, commodes, or wheelchair at the healthcare organizations. Our customers often say that the fee for nursing homes is about $7500/month covered by their pocket. This is a big money and will immediately affect to their normal living. When come to the question that “Do Medicare's Benefits Include durable medical equipment?” the short answer is yes. However, it be depended on the type of coverage, and there is a list that Medicare will cover.

Medicare Part A is hospital insurance. It has strict requirements for medical equipment which require individuals must be Homebound. The individuals cannot leave their home without assistance and they must require skilled nursing care. Medicare Part A will pay for 80% of the allowable amount for any specific item, and leaving the 20% responsible and any amount over the allowable limit for the individuals.² However, guest what, the allowable limit for the individuals would run out quickly to cover medical spending needed. In addition, there are many people who even not able to afford the 20% price of expensive equipment, such as power wheelchair, or full electric hospital bed. As a result, they are looking for supports from non-profit organizations where they could come and have the durable medical equipment needed with affordable prices. Bridge Disability Ministries medical equipment center is one kind of the place where people may find a full function power wheelchair for themselves with a price just around 15% of the new one in the market. The money paid would be under the donation form. In addition, the employees in the center would help them to adjust the power wheelchair without charging fee. So, with this supports, the people visiting Bridge Disability Ministries would pay only 15% value of the equipment, with a money that could put in their tax return, and free technical services.

Part B is for outpatient services. Part B pays for durable medical equipment which must be for use in the home or personal care residence such as assisted living but not in a nursing home. Durable medical equipment must be medically necessary and purchased from a Medicare-approved supplier. As same as Medicare Part A, the Part B pays for 80% of the allowable purchase price and the individual is responsible for the remaining 20% and any amount over the allowable limit.²

Part C also called Medicare Advantage, is a combination of Part A and Part B and is sold by private companies instead of provided by the government. Therefore, if one has Medicare Part C, their plan will pay at least 80% of the allowable limit.²

                Beside the type of Medicare coverage, a durable medical equipment is covered or not also depend on if it listed in Medicare coverage. There are a lot of medical equipment needed that will not be covered by the list, such as, bath or shower seat, transfer tub bench, or transfer wheelchair. At Bridge Disability Ministries equipment center, transfer wheelchair is a hot subject with a lot of people come to ask for and, that could in and out the inventory every day. The transfer wheelchair is lighter with smaller wheels comparing to the manual wheelchair. It supports for transferring patient from place to place, and very handling to put it into a car. A transfer wheelchair is cheaper than a manual wheelchair but it is not covered by Medicare. However, the function of a transfer wheelchair is so important for elderly people, especially women, who do not able to lift 40lb of a wheelchair. Without a transfer wheelchair, a lot of people could not able to help their partner or relative visit doctor appointments, or coming to a community center.        

  In conclusion, a durable medical equipment is covered or not by Medicare depending on both the type of coverage, and be in the list of Medicare coverage. However, whatever the type of coverage that an individual is covered, he or she must be responsible for the 20% of the equipment price from the supplier and any amount over the allowable limit. There a lot of people do not able to afford that amount of money and looking for a non-profit charity organization like Bridge Disability Ministries where they could find durable medical equipment needed with affordable prices.

References:

1.      1. How to Pay for Home and Durable Medical Equipment: a Comprehensive Guide. Payingforseniorcare.com. https://www.payingforseniorcare.com/durable-medical-equipment/how-to-pay-home.html. Accessed July 19, 2016.

2.       2. Do Medicare's Benefits Include Home / Durable Medical Equipment? Payingforsenior.com. https://www.payingforseniorcare.com/durable-medical-equipment/medicare.html. Accessed July 20, 2016.