January 28, 2013

BPM and Health Care:  Can We Do It Without Breaking The Bank?

By  Michael D. Shaw

Last week’s piece, which exposed some of the hidden flaws in health care IT, generated a fair amount of reader response. Some who contacted me were surprised to discover the extent of regulatory paperwork (or these days, “digitalwork”) that is forced on health care providers. Others told me that they finally “got it,” regarding the heavy influence of Medicare on supposedly non-Medicare medical administrative issues.

And, most were dismayed regarding the exaggerated promise of electronic health records. However, notwithstanding reforms and allowances which will very likely occur in 2014, the leviathan of massively regulated health care moves ever forward.

It is quite ironic that health care is the only place where the introduction of high tech has raised costs, instead of significantly lowering them. There are good reasons for this:

1.     Patients have an expectation of receiving the best care, and have been taught that the “best” is also the most high tech. Thus, if every patient presenting with a headache is referred out for an MRI, costs will skyrocket.

2.     Being a highly regulated industry—perhaps THE most regulated industry—reporting requirements are prodigious. Perversely, though, because this reporting can now be “easily” accomplished via computer, the reporting mandates continue to expand.

3.     Given the realm in which they operate, providers are forced to increase their overhead significantly, by investing in the latest and greatest hardware and software. Unfortunately for them, most providers are unable to pass these costs along to the patient—thus increasing the squeeze even more. Not to mention making them more susceptible to the siren song of adding yet more high tech to add efficiency and save money. Talk about a vicious circle.

As such, providers—of all sizes—are best advised to optimize their hardware and software to the greatest possible extent.

I got some good insight, during an extensive interview with Jesse Shiah, CEO and founder of AgilePoint, Inc., based in Mountain View, CA. AgilePoint is an industry leader in the field of Business Process Management (BPM) solutions. The company has special expertise in regulated and professional service industries—which is a pretty fair description of health care these days.

Jesse minces no words:

“Most forms of BPM software do little to alleviate health care administrative costs. If anything, expenses rise and technical complications ensue because, by their very design, the majority of BPM products and services quickly become obsolete. Health care organizations then have to make a painful decision: Spend more money and upgrade to the latest version of a particular brand of BPM software currently in use, or switch to a competitor with the same technical challenges.”

“This lose-lose proposition is one of many reasons why health care organizations do not have a successful series of business processes, which could—and should—reduce expenditures without compromising quality.”

Jesse notes that LOB (line-of-business) applications—in health care, and everywhere else for that matter—are mostly proprietary in nature, and are difficult to customize, or as he puts it “align with intent.” If you do wish to customize, it becomes expensive to both acquire and support.

Enterprise software guru and blogger Alara Rogers speaks of the three technical spheres of health care—Knowledge, Collaboration, and Security—and that addressing all of them is necessary for successful IT implementation.

She notes, though, that “They don’t play well with each other. In particular, Security and Collaboration are oppositional forces—the entities within IT that promote the sharing of information and the entities that promote maintaining close control of information have goals that are almost entirely at odds with each other.”

Both Alara and Jesse are strong proponents of Microsoft SharePoint, now the leading platform for enterprise collaboration. Jesse emphasizes that unlike many software vendors who endeavor to be as proprietary as possible, AgilePoint enables organizations to leverage their existing Microsoft assets (Visio, SharePoint, Outlook, InfoPath etc.) and skill sets, thus minimizing re-training, and facilitating quicker user acceptance. A user can create, modify, and deploy process models using BPM-enabled Visio shapes and connectors. Business logic can be built into the graphic process model directly.

Many industry insiders believe that there is a major trend in health care IT away from proprietary software, and toward solutions built on much more accessible platforms. The recent history of business software roll-out in other fields would certainly support this opinion.