Health care is a major focus area across countries around the world. The provision and improvement of health facilities for the population are among the top agendas for governments. However, the healthcare industry has grown beyond the scope of being solely a state function, especially applicable to rapidly developing countries such as India. While in developed countries private healthcare has been around for a long time, India was relatively slow to start with a scenario following reforms that witnessed rapid growth of major private healthcare providers.
Despite the thriving healthcare industries, whether they exist in developed or developing countries, IT has had only a limited role to play in healthcare companies. Unlike other industries, such as banking, finance, insurance, manufacturing and defense, among several other verticals that have witnessed paradigm shifts in the way the business is run, healthcare has had to contend with quick-fix solutions that never really went out. digital registration information and records management. The reason is that healthcare is an extremely complex industry that really benefits big companies in the solution; and that enterprise solutions cannot go beyond automating administrative and financial functions.
Recently, solutions such as electronic medical record systems, healthcare systems, practice management systems and clinical decision support systems have emerged. However, all these systems are still focused on micromanaging individual functions. The emergence of Business Process Management as an approach to automate, centralize and manage healthcare processes calls for unprecedented operational efficiency, sweeps productivity gains, higher quality healthcare for patients, and adherence to mandatory compliance regulations.
Challenges in health care
Process automation has been viewed with a lot of skepticism in the healthcare industry, especially for the clinical and operational processes that directly deal with patient care. However, BPM goes beyond simply automating processes and can provide a robust platform for gains across all categories of healthcare processes, be it clinical, operational, financial, administrative or human resources. Before describing how BPM actually helps companies in these areas, take a quick look at the challenges the pain points of the healthcare industry:
o Provide clinical expertise and improved quality of patient care: Amid increasing numbers of patients, increased complications and limited resources, the best healthcare system provides a daunting task. Each patient’s problems are unique, and it is the greatest challenge for healthcare providers to develop and maintain clinical expertise by adhering to best practices while addressing different individual treatment needs for each patient.
o Reduce operating costs and administration: As hospitals grow to become large companies, managing functions in their operations becomes administration and finance departments in itself extremely difficult to manage. With individual solution for each of these features, it becomes cost and resource intensive, filled with data redundancies. However, dealing with them under one umbrella brings its own set of challenges.
o Comprehensive governance capabilities: Each organization strives hard to provide complete visibility and control in their processes to address stakeholders. Problems and bottlenecks often remain hidden due to unavailability of tracking information, often leading to uninformed and, at times, costly decisions or indecision.
o Ensure compliance with regulatory compliance standards: The healthcare industry is one of the largest industries that must comply with the most stringent compliance rules such as HIPAA, OSHA and CLIA. Failure to comply with these rules could wipe out both small players and behemoths. Compliance is an intensive and constant exercise that involves extensive documentation to demonstrate compliance with set standards. Without an automated and centralized system, compliance management becomes nothing less than a nightmare for organizations.
o Take advantage of existing investments: Healthcare companies usually have disconnected IT systems working in the individual departments. Companies, big or small, always seem to be expanding the value of their investment in their older health care systems. The enterprise quality solution must not only be able to tie different legacy systems together to work together under one hood, but also provide functionalities such as SOA support and web-based access, monitoring and administration.
o Acquire and retain quality staff: talented professionals, especially doctors, are a rare commodity. Good quality support staff is equally critical. In the midst of growing competition, retaining talent is an area that companies always struggle to manage. Companies, while striving to provide the best healthcare (rapid and appropriate diagnosis, accurate cure, no erroneous prescriptions, minimal side effects in minimum time and cost), also need to take the lead in order not to overload their doctors and staff . Without streamlined processes for cure and treatment, companies always struggle to balance the often conflicting requirements.
Meeting such a diverse set of requirements, the focal point of which is that human care makes BPM health care a unique and complex system. BPM must enable healthcare providers at all stages, namely diagnosis, treatment and aftercare.
How BPM helps healthcare organizations
When healthcare organizations become large companies, they require constant increase in efficiency and productivity while minimizing costs. BPM helps reach health organizations, large and small, by achieving these by managing and influencing all functional areas that mainly involve clinical / medical, operations, administration and finance. While clinical function is unique to health care, administration and funding are similar to those of other industries. Operation also involves different needs for health care providers.
Clinical / medical procedures: Often touted as very complex to handle, clinical procedures are at the heart of what a healthcare organization offers. It’s not just about a standard set of instructions that must be followed carefully to cure a patient; rather, it involves closely monitoring and making critical decisions at each stage of the documented procedure, carefully analyzing the effects of prescription / treatment at each stage, anticipating drug interactions, drawing conclusions from patients’ medical history, and choosing the best alternative to cure among many to provide. best quality and cost effective healthcare for patients while directly affecting the bottom line of the organization. To add to the complexity, the patient may be involved in more than one health process at a time.
Following this procedure, which is adapted to the individual patient’s healing plan and variations, it is a vigorous exercise and requires much more than access to patient records and data.
Using the BPM’s interactive interface, the process could be quickly designed / modeled and modified according to the requirements. These processes are designed as pets for the defined workflow with stakeholders for each step of the workflow. Built-in rules embedded in the BPM engine provide warnings and reminders if a drug is recommended that has potential negative interactions within the prescribed cure process. Similarly, time-bound actions, if not completed on time, can be raised as alarms. Process stakeholders (usually a senior physician) can immediately determine the bottlenecks that impede the process, and consequently remodel and redistribute work so as not to affect overall procedural efficiency. This is required because important resources such as doctors could be allocated to more than one process. In addition, users of processes can provide their comments on a particular processing stage. Since everyone can see changes right away, the information is immediately communicated in an unambiguous way to everyone. Detailed analysis allows process stakeholders to develop a more efficient and effective process in the future.
Therefore, healthcare organizations can greatly benefit from such a system which has a comprehensive and relevant regulatory engine at heart. Such a system not only helps to make timely and informed decisions, but also enables effective collaboration and comprehensive analysis. The power of BPM lies in its ability to be used effectively by hospital staff who have no knowledge of coding. Process design is as simple as dragging and dropping items on the screen. Also, no code customization is required for redesigned processes. Simulation gives process owners the flexibility to analyze the real situation in advance.
operations: The health of a healthcare organization (read topline / bottom line) is a direct measure of the number of patients treated in the shortest possible time. This largely depends on streamlined operations involving timely and accurate action in favor of patient departments, switching patients to different departments, ensuring optimal supply of medicine and equipment, ideal use of surgical equipment and cost equipment, maintaining operating room clear for expected cases, ensuring clear and inexpensive communication among several other similar tasks. BPM manages all these functions under clearly defined processes, which are interwoven with other processes to ensure maximum productivity and efficiency.
Administration: The administration is responsible for keeping the organizations in good health. BPM provides comprehensive opportunities for large healthcare companies to keep infrastructure running to enable organizations to deliver healthcare services in the most efficient manner.
financing: Funding is the lifeblood of any organization and is no different for healthcare organizations. BPM provides immediate and pervasive benefits across all financial functions such as accounts payable, accounts receivable, audits, budget management, payroll, risk management, billing, tax calculation, contract management, cash flow management, financial reports, etc.
Research and development: Research and development is a critical but cost-intensive area for companies in the healthcare industry, especially pharmaceutical companies. BPM helps define processes for the development of new drug molecules, better operating methods, application of new technology in prevailing procedures, improvement of existing drugs and efficacy of drugs with minor side effects, etc. By providing comprehensive and immediate access to data from various sources, analysis of comprehensive tests, documenting results for posterity and shortening research time. With BPM, R&D witnesses are shortening cycle times and better resource utilization.
The benefits that health and pharmaceutical companies achieve are tangible and intangible. On the one hand, lower costs, improved efficiency, improved productivity and swell bottom line provide good numbers; on the other hand, help to keep compliance, create innovation, apply best practices, mitigate risks and gain greater credibility.
Some of the major benefits are as follows:
Much improved patient care: BPM makes healthcare companies agile in achieving their goal of providing best healthcare at the least cost and in the least amount of time to patients. With streamlined processes – spread across the company and working towards one goal – patients result in increased individual focus and faster cure.
Lower costs and improved bottom line: With BPM influencing all aspects of the functioning of healthcare companies, weaving them seamlessly under an umbrella allows cutting costs from every single activity. With well-known implementation methods such as breakthrough methodology, the benefits of the bottom line can be quickly achieved.
compliance: Ensuring compliance with ever-evolving regulations is an important feature for global businesses operating in various business environments worldwide. BPM helps companies comply with compliance requirements and apply best practices without sacrificing their corporate policies. With a compliance solution in place, companies also build effective risk assessment, management and mitigation options.
diversification: The rapid growth in health care has led clean healthcare providers to go beyond offering simple services and individualized care and diversifying into allied Life Sciences areas such as biotechnology, bioinformatics, genetic engineering and molecular medicine. Having a BPM in place enables such organizations to effectively manage new ventures by providing complete visibility and rigorous monitoring of new processes while making use of existing business investment.
In addition, there are several other equally important benefits such as retaining talent, leveraging existing investments and drastic improvements in quality and time to market.
BPM is therefore much more than a blow to the healthcare and pharmaceutical industries. For those organizations that are ready to adopt it wholeheartedly, it brings tangible and measurable benefits; thereby ensuring that companies have the opportunity to follow a high growth path.