Healthcare is a core focus area across countries all over the world. Providing and improving healthcare facilities to the population ranks amongst the topmost agenda for governments. However, healthcare industry has grown on beyond the realms of it being solely a state function, especially true for fast-developing countries such as India. While in the developed countries private healthcare has long existed, India was relatively slow to start off, with post-reforms scenario witnessing a rapid growth of large-scale private healthcare providers.
In spite of thriving healthcare industries, whether they exist in developed or developing nations, IT has only had a limited role to play in healthcare companies. As opposed to other industries such as banking, finance, insurance, manufacturing and defense, among several other verticals, that have witnessed paradigm shift in way the business is done, healthcare has had to contend with quick-fix solutions that never really went beyond recording information digitally and managing records. The reason given is that healthcare is an extremely complex industry to really benefit from large-scale enterprise grade solutions; and that the enterprise solutions cannot go beyond automating the administrative and financial functions.
Recent times have seen advent of solutions such as Electronic Medical Records Systems, Healthcare Information Systems, Practice Management Systems and Clinical Decision Support Systems. However, all these systems are still focused towards micromanaging individual functions. The emergence of Business Process Management as an approach to automate, centralize and manage healthcare processes is ringing in unheard operational efficiencies, sweeping productivity gains, greater quality healthcare to patients, and adherence to mandatory compliance regulations.
Challenges in Healthcare
Process automation has been viewed with a lot of skepticism in the healthcare industry, especially for the clinical and operational processes, which directly deal with patient care. However, BPM goes beyond mere automation of processes and can provide robust platform for gains across all categories of healthcare processes, be it clinical, operation, financial, administrative or human resource. Before describing how BPM actually help companies in these areas, a quick look at the challenges puts forth the pain points of the healthcare industry:
o Ensure clinical excellence & improved quality of patient care: Amidst rising number of patients, increased complications and limited resources, providing the best healthcare becomes a daunting task. Each patient's problems are unique, and developing and maintaining clinical excellence by adhering to best practices while catering to distinct individual treatment requirements for every patient is the biggest challenge for healthcare providers.
o Decrease cost of operations & administration: As hospitals grow to become large enterprises, managing functions of their operations, administration and finance departments in themselves become extremely difficult to manage. With individual solution for each of these functions, it becomes cost-and-resource intensive, replete with data redundancies. However, managing them under one umbrella brings its own set of challenges.
o Comprehensive management capabilities: Every organization strives hard to provide complete visibility and control in their processes to processablish. Problems and bottlenecks often remain hidden due to unavailability of tracking information, often leading to uninformed, and at time, costly decisions or indecisions.
o Ensure adherence to regulatory compliance norms: Healthcare industry is one of the foremost industry that has to abide with stringiest of compliance regulations such as HIPAA, OSHA and CLIA. Failing to comply with these regulations could obliterate small players as well as behemoths. Compliance is an intensive and constant exercise that involves extensive documentation to demonstrate compliance to stipulated norms. Without an automated and centralized system, managing compliance becomes nothing short of a nightmare for the organizations.
o Leverage existing investments: Healthcare companies usually have disconnected IT systems working in individual departments. Companies, big or small, always look to extend the value of their investment in their legacy healthcare systems. The enterprise-grade solution must not only be able to bind together distinct legacy systems to coherently work together under one hood but also provide functionalities such as SOA support and Web-based access, monitoring, and administration.
o Acquire & retain quality staff: Talented professionals, especially doctors, are a rare commodity. Equally critical is the good quality support staff. Amidst rising competition, retaining talent is one area companies are always struggling to cope with. Companies, while striving to provide best healthcare (quick and appropriate diagnosis, accurate cure, no erroneous prescriptions, minimal side effects in least time and cost, also have to walk the tightrope of not overburdening their doctors and staff. Without streamlined processes for cure and treatment, Companies are always struggling to balance the oft-conflicting requirements.
Addressing such a diverse set of requirements, with the fulcrum being people care makes BPM for healthcare a unique and complex system. BPM must enable healthcare providers during all the phases namely diagnostics, treatment, and post treatment.
How BPM Helps Healthcare Organizations
With healthcare organizations becoming giant enterprises, they demand constant increase in efficiency and productivity, while minimizing the cost. BPM helps achieve healthcare organizations, big or small, achieve these by managing and impacting all the functional areas, which mainly involve clinical / medical, operations, administration and finance. While clinical function is unique to the healthcare industry, administration and finance are similar to these functions in other industries. Operations also involve distinct needs for health providers.
Clinical / Medical procedures: Often touted as highly complex to handle, clinical procedures form the core of what a healthcare organization offers. It's not just about a standard set of instructions to be strictly followed for curing a patient; rather it involves closely monitoring and making critical decisions at each step of the documented procedure, carefully analyzing the repercussions of prescription / treatment at each step, anticipate drug interactions, derive inferences from patients' medical history, choosing best alternative for cure among many to provide best quality and cost-effective healthcare to patients, while directly impacting the bottom line of the organization. To add to the complexity, the patient might be involved in more than one healthcare process at a time.
Following this procedure customized to individual patient's cure plan and variations is a humungous exercise, and requires much more beyond access to patient records and data.
Using BPM's interactive interface, process could be quickly designed / modeled and changed as per the requirements. These processes are designed as pet the defined workflow with neighbors for every stage of the workflow. Built-in rules embedded in BPM engine provide alerts 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, could be raised as alarms. Process stakeholder (usually a senior doctor) can immediately determine the bottlenecks hindering the process, and accordingly remodel and redistribute work so as not to impact the overall procedural effectiveness. This is required because important resources like doctors could be allocated to more than one process. In addition, processes users can provide their comments for particular stage of treatment. Since everyone can view changes immediately, the information is immediately communicated in an unambiguous manner to everyone. Detailed analytics enable process to to evolve a more efficient and effective process in future.
Therefore, healthcare organizations can greatly benefit from such a system, which has a comprehensive and relevant rules engine at its heart. Such as system not only helps making timely and informed decisions but also enables effective collaboration and extensive analytics. The power of BPM lies in its ability to be used effectively by hospital staff having no knowledge of coding. Process designing is as simple as dragging and dropping elements on the screen. Also, no customization of code for re-designed processes is required. Simulation provides process owners flexibility to analyze the real-life situation beforehand.
Operations: A Healthcare organization's health (read topline / bottomline) is a direct measure of number of patients successfully treated in the shortest possible time. This depends largely to streamlined operations, which involve timely and accurate action for allocating wards to patients, shifting patients to different wards, ensuring optimal supply of medicines and equipments, ideal use of surgical and high-cost equipments, maintaining operation theaters ready for anticipated cases , ensuring clear and low-cost communication, among several other similar tasks. BPM manages all these functions under clearly defined processes, which weave together with other processes to ensure maximum productivity and efficiency.
Administration: Administration is responsible for keeping the organizations in good health. BPM provides comprehensive capabilities for large healthcare enterprises to keep the infrastructure running smoothly in order to enable organizations to provide healthcare in most effective manner.
Finance: Finance is the lifeblood of any organizations, and is no different for Healthcare organizations too. BPM provides immediate and pervasive benefits across all the finance functions such as accounts payable, accounts receivable, audits, budget administration, payroll, risk management, billing, tax calculations, contract administration, cash flow administration, financial reports, etc.
Research and development : Research and development is a critical but cost-intensive area for companies in Health industry, especially Pharmaceutical companies. BPM helps define processes for developing new drug molecules, better operating techniques, employing new technology in prevalent procedures, improving effectiveness of existing drugs and medicines with lesser side effects, etc., by providing comprehensive and immediate access to data from various sources, analysis of extensive tests, documenting results for posterity, and shortening research time. With BPM, R&D witnesses shortened cycle times and better resource utilization.
The benefits, which healthcare and pharmaceutical companies obtain, are both tangible and intangible. On one hand, lower costs, improved efficiency, enhanced productivity, and bulging bottom line make for good numbers; While on the other hand, helps conforming to compliance, fostering innovation, employing best practices, mitigating risks and achieving higher credibility.
Some of the major benefits are as follows:
Highly improved patient care: BPM makes healthcare companies agile in achieving their goal of providing best healthcare at the least cost and in minimum time to patients. With streamlined processes – spread across the enterprise and working towards the single goal – results in patients getting increased individual focus and faster cure.
Lower Costs & improved bottomline: With BPM affecting all the aspects of functioning of Healthcare companies, weaving them seamlessly under one umbrella, enables cutting costs from every single activity. With proven implementation methodologies like Breakthrough Methodology, the bottomline benefits can be increased obtained.
Compliance: Ensuring compliance with ever-evolving regulations is a vital function for the global companies operating in different business environments across the world. BPM helps companies conform to compliance needs and employ best practices, without sacrificing their corporate policies. Also, with compliance-solution in place, companies build effective risk assessment, management and mitigation capabilities.
Diversification: The rapid growth of Healthcare industry has resulted in pure Healthcare providers going beyond providing mere services and individualized care, and diversify into allied Life Sciences domains such as biotechnology, bioinformatics, genetic engineering and molecular medicine, among others. Having a BPM in place enables such organizations to effectively manage new ventures by providing complete visibility and tight monitoring for new processes while leveraging existing investments in business.
In addition to these, there are multiple other equally important benefits such as retaining talent, leveraging existing investments and drastic improvements in quality and time-to-market.
BPM, therefore, is much more than a mere fad for the Healthcare and Pharmaceutical industry. To the organizations prepared to adopt it whole-heartedly, it brings tangible and measurable benefits; thus ensuring companies can set off on a high growth path.