BPM in Healthcare

This contribution is courtesy of BPM-C member Robert Lario from VisumPoint.

I recently attended the OMG’s working group meeting in Costa Rica and found it interesting that there seemed to be an underlying theme to many of the conversations: healthcare. Don’t get me wrong, I was very pleased with all the questions and side conversations because my company, visumpoint, LLC, is focused on the healthcare industry. There was a lot of talk about the Obama Administration’s Recovery Act (www.recovery.gov) and the reform of healthcare that is a result of the HITECH Act (www.hitechanswers.net/about). Moreover when you throw hundreds of billions of dollars at a problem you’re bound to get a lot of attention.  So now, everyone is trying to figure out how to get a piece of the pie; how to become part of this new world order of healthcare.

When you look at the problems within healthcare, you find fragmented information and processes across the country as well as within the Care Delivery Organizations (CDO) themselves. Everyone is interested in healthcare at a national level, but we need to understand that the problems must be addressed at a micro level within the CDO. CDOs have numerous disparate systems with different data representation, different applications running on them, managed by different departments. The quality of patient care is significantly impacted by this convoluted environment when physicians do not have an accurate, timely and complete view of a patient’s record.  In an attempt to unify patient records, improve quality of care and reduce costs, the government is mandating that CDOs implement Electronic Medical Records (EMRs) or Electronic Health Records (EHR) by 2014.  This has left many providers scratching their heads given their patient information is fragmented across multiple systems, organizations, and care delivery systems.

And this is just the tip of the iceberg, there is also a strong movement a foot to replace the traditional fee-for-service approach.  In the this approach you go to the doctor, they provide service and the physician is reimbursed regardless of the outcome or quality of care.  But medical issues are not generally episodes that occur momentarily but by their very nature span a period of time.  As such, CDOs need to be emboldened to manage care across a longer period of time; viewing the episode as continuous care.  Within a continuous care solution, CDOs are reimbursed based upon the outcome and quality of their services.  If there is a favorable outcome they will receive full reimbursement, if there is a substandard outcome or a readmission the hospital will receive a reduced payment.

To support the continuous care model, the patient data concerning the specific incident must be managed over a longer time horizon, perhaps 90 days after the initial visit.  To operate within this new payment model, CDOs will have to manage the treatment process and patient data over a longer time interval and across multiple CDOs.   Remember that patient information is spread across systems, across departments, across organizations, and across the country. And the success of the continuous model is entirely dependent upon accurate and complete information about the patient. Therein lies the problem – there is no consolidated, complete, accurate picture of the patient at a hospital level let alone at a national level.

So why write about this in this blog?  Any guesses?  These problems scream BPM and SOA.  These are the exact kinds of problems that BPM and SOA solve.   While BPM and SOA won’t solve all the problems in healthcare, it can address many of the ones facing us today. Data fragmentation, disconnected processes – these healthcare issues are practically begging for BPM and SOA!

With a BPM and SOA strategy, enterprises can begin to inventory their existing systems, expose data from the siloed systems and create atomic services.  These services can be orchestrated with workflow creating richer enterprise services.  This alone creates tremendous value within the CDO and ultimately results in improved care for the patient.  In addition, these services can be shared across multiple CDOs, creating a rich tapestry of choreographed services addressing the complexity of issues around the continuous care model.  By exposing this information through services and exposing data, we can use a common vocabulary that can map data from different systems.  Through the use of open standards like C32 and X12 that play a role in the process, they can create and support interoperability both on a data level and a process level.

The Recovery Act is creating the momentum and the push to change; it provides the mega fuel to drive healthcare to modernize their systems to address these issues. If you are skeptical about the amount of money being pumped into healthcare consider this: By 2030, about 25 percent of the G.D.P. will be spent on healthcare, it will be “the driving force in the economy,” just as railroads drove the economy at the start of the 20th century, predicts Robert W. Fogel, a Nobel laureate at the University of Chicago Graduate School of Business,  And this is just what we spend to keep ourselves healthy.  It doesn’t take into account for the hundreds of billions of dollars that are being pumped in to the healthcare industry to incentivize them to modernize.  I know I am certainly incented.   In a paper published in The Quarterly Journal of Economics, Dr. Hall and Charles I. Jones of the University of California, Berkeley, write: “As we get older and richer, which is more valuable: a third car, yet another television, more clothing — or an extra year of life?”   And what’s going to make all this possible? BPM and SOA!. The only way to address the disparate disconnected heterogeneous environments within healthcare is with the flexibility and extendibility that is offered through a BPM strategy!

You can find more information about VisumPoint at their website: http://www.visumpoint.com/

For more discussion on BPM and SOA - please join us at our upcoming meeting in San Antonio, TX on September 15 and 16.  You can find the agenda here: http://www.omg.org/news/meetings/tc/tx/special-events/SOA-BPM.htm

Comments

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