In this blog post, we’ll flesh out the basics of BPM for healthcare and go over the main game-changers it has in store for care teams.
The BPM definition in the medical sector refers to a systematic approach to optimizing the efficiency of business processes by automating low-value tasks through predetermined IT workflows. Instead of making piecemeal corrections to the system, BPM in healthcare allows to reset the entire technology landscape and transform manual processes into automated input.
According to Fortune Business Insights, the global business process management market is poised to leap from $11.84 billion in 2021 to over $26.18 billion in 2028. Driven by the pandemic and rising healthcare costs, healthcare software development is expected to take the central stage in the industry.
Business audits and research have revealed that reasons like regulatory complexity, industry consolidation, ongoing cost constraints, and shifting patient expectations are the main sector's concerns. Moreover, the transition to outcome-based care puts an additional strain on the US and UK healthcare systems.
The stringent regulatory framework in healthcare includes well-known HIPAA, GDPR, and other guidelines with penalties of up to $50,000 and up to one-year imprisonment. False claims and changes in reimbursement add to the regulatory overload of medical organizations.
Over the last three years, the healthcare industry has been operating under a rising amount of clinical, nonclinical, and non labor expenses. By 2027, US healthcare costs could be $590 billion higher than the projected $5.8 trillion majorly due to inflation.
With the advent of virtual and digital care, customers have grown weary of traditional clinical pathways and expect more speed and efficiency from their providers. Moreover, patients now request more enablement in health care and seamless data sharing with the doctor.
The healthcare industry is a complex, fragmented and expensive one. From the way in which care is delivered to the way in which data is managed, it is clear that healthcare organizations are struggling to keep up with the demands of modern life. This inefficiency has led to negative consequences, including a decline in the quality of care and an increase in healthcare costs.
Manual-intensive data management is among the core reasons for the downfall of care. Traditionally, all patient admissions, charts, billing, and prescriptions were put down manually at each stage, office, and facility. This resulted in a spike in medical errors and greater gaps between patients and doctors.
With the advent of electronic health records, there has been a shift from a paper-based healthcare process to digital records. However, this transition has not been smooth. Many organizations have struggled to natively integrate electronic health records into their systems due to uneven digitalization.
Conversely, BPM in healthcare helps medical organizations, insurers, and other providers go big with their transformational efforts. By leveraging automation, care teams can break free from manual data entry and allocate more time and effort to improving patient outcomes.
In the quest for a patient-centric, data-driven approach, medical facilities and providers invest in more robust information systems. Business process management software is among the pillars of healthcare digitization that pave the way for optimized processes and quality patient care.
One of the largest challenges in medical practice is coordinating patient care as a team from the patient’s arrival to the end of treatment. Workflow and BPM healthcare software solutions are designed specifically to streamline and automate processes across business departments to keep everyone on the same page.
They consolidate the efforts of the collaborating employees, ignite more transparency in patient journey management, and maximize the effort of medical professionals.
Pre-defined form builders, automated approval processes for document evaluation, dynamic assignment to approvers, electronic forms, integrations, and other enablers help generate the default pathway for the patient with little effort from the medical staff. This way, everyone operates to the agreed standard and can look into the previous steps of the patient journey.
According to the study, primary care physicians need 26.7 hours per day for documentation and inbox management. BPM takes over the lion’s share of the administrative burden and allows doctors to streamline their healthcare business processes, including patient registration and appointment scheduling, medical billing and claims processing, electronic health records, and insurance-payer interfaces.
In particular, this software takes away the drudgery of the following tasks:
Being compliant with regulations can be a challenge for companies, especially if they lack the tools to effectively manage their business processes. Business process management software helps businesses comply with regulations by analyzing existing processes for compliance issues and recommending improvements that will reduce risks and improve efficiency.
For example, BPM solutions document the compliance due dates for every process and ISO audit dates. Software owners receive automated alerts for an impending compliance event and ensure that it is attended to by the due date.
The landscape of automation in medicine has been growing exponentially over the last few years. Below, you will find some of the most prominent specimens of business process management in healthcare.
Remote patient monitoring (RPM) refers to the use of technology to collect patient data beyond traditional clinical settings. RPM solutions help monitor a wide variety of patients, including those with chronic conditions, post-operative patients, and clinical trial participants.
RPM solutions typically involve the use of wearable devices, such as fitness trackers, that collect data about the patient’s health. This data is then transmitted to a secure cloud-based platform where it can be accessed by the patient’s care team.
RPM software can help improve the quality of care for patients by allowing care teams to closely monitor their health and identify potential problems early. Typically, these solutions integrate with EHR systems to provide a comprehensive snapshot of a patient's health.
Medical claims management solutions help streamline the end-to-end process of submitting and managing insurance claims. By automating tasks and providing access to real-time data, these solutions can reduce the time and cost associated with claims management. In addition, they improve the accuracy of claim submissions, which reduces the number of denied claims and improves reimbursement rates.
In particular, BPM software can handle the following set of tasks:
These solutions can then gain from EDI data exchange integration that imports claims from multiple insurance carriers. Claims management platforms can also be supplemented with custom web development solutions, such as customer portals, to enable customers to access their claims status online.
Radiofrequency identification (RFID) is a technology based on electromagnetic fields that automatically track tags attached to objects. Thus, instead of manual monitoring, hospitals can delegate inventory monitoring and equipment tracking to easily traceable automated pathways.
RFID tags can be placed on a variety of objects, including OR supplies, prescription medications, and patient belongings. RFID-enabled inventory management systems help healthcare facilities track the locations of these items and to ensure that they are available when needed.
Also, RFID tags can be used to monitor the expiration dates of medications and to track the movement of medical supplies between different departments. Some hospitals have adopted RFID-equipped ankle band systems to ensure infant security within the facility.
The healthcare sector is a resource-intensive and compliance-heavy industry with a data footprint left throughout the entire clinical pathway. Healthcare business process management tools allow healthcare providers to eliminate data silos and share patient data, inventory levels, and other critical information within a single, secure environment. BPM tools also optimize processes within the facility by automating mundane tasks and generating reports for effective decision-making.
CleverDev Software delivers custom automation solutions for global healthcare organizations and insurance providers. Contact us to get an estimate on your BPM project.