In this tip, I'd like to share my experiences in engineering a business process platform for healthcare. I'm sure that many of you have already heard the buzzwords eSOA, services, model-driven development etc.
But let's set the technology aspects aside for the moment and start by asking why so many people feel that service-oriented architecture (SOA) and the idea of a Business Process Platform can bring value to the healthcare industry.
In 2006, I had many opportunities to speak to our customers and partners around the globe. We discussed their current challenges, and of course they were eager to know how SAP could help address these.
Here's a random collection of topics I remember from those conversations:
- "We need to (better) integrate the replenishment process into the clinical workflow"
- "We would like to offer an enterprise-wide scheduling system supporting the various departments"
- "We need to integrate our hospital information system with a regional master patient index (MPI)"
- "We would like to offer patient-centric scheduling across institutions or even organizations"
- "We would like to move our organizations from acute care to preventive health management"
As you can see, these examples range widely from rather tactical topics to the more strategic question of how a healthcare provider organization should
In this figure I have tried to classify the examples -- asking the main reason why organizations wanted to do something. I found that basically you could assign all examples to one of the four following goals:
- Increase end-user or overall process efficiency, e.g. integrate the replenishment process into the clinical workflow
- Increase the flexibility of existing processes, e.g. create an admission process variant to be able to connect to the regional MPI
- Create and support new processes within the existing business, e.g. turn the scheduling process around and put the customer into the center
- Innovate the business itself, e.g. create new offerings beside acute care in the area of preventive health management and wellness
Reflecting the past decade that I spent in developing standard software solutions for the healthcare industry globally, I think we can say that standard software packages do a very good job in the area of process efficiency. High efficiency is a must for all those areas where a healthcare provider organization does not distinguish itself from others and cannot achieve a competitive advantage. This is often referred to as context (see Living on the Fault Line by Geoffrey Moore).
However, this does not necessarily mean that the organization can neglect this area -- think of all administrative processes to ensure legal compliance, for example. But it does mean, from an IT perspective, that is not worth investing in home-grown solutions if standard packages offer good support for the context. And because even in the area of context processes not all hospitals world-wide are the same so you'll typically find some flexibility built into the standard package.
Some examples from SAP Patient Management include different methods to handle co-payments, different replenishment strategies or the ability to create different variants for ADT processes, etc.
While configuration techniques in these areas typically provide a certain degree of flexibility, I think we all have noticed that there is a limit sometimes: either the process variant you needed was not foreseen in the product or it is simply too costly to customize the system compared to the expected benefit. So sometimes IT becomes a bottleneck for business process support...
And the more you look into the core -- processes that are likely to give your organization the competitive advantage, real innovation, be it new processes or even a complete new business model for your organization -- the more unlikely it will be that you'll find the process support in an existing standard software package. And why should you -- if the idea is really new and not yet best practice among your peers in the industry it cannot be expected to be supported already, right?
So in these cases, business process experts had basically the following choices:
- Roll in the requirement and convince the standard software package provider to incorporate the new idea into the standard -- I would say this is a valid possibility but typically takes (too much) time
- Recommend purchasing a best-of-breed solution if available -- while this alternative looks very attractive in the beginning, it has hidden cost in the long run as regards integration efforts and produces a very diverse IT landscape
- Build something on their own -- in-house software development can be very risky depending on size of the project and available resources and is typically also regarded as rather expensive
And here is another very important observation: in most cases I have discussed with customers business process innovation is a combination of some real new ideas and process steps re-combined with existing steps -- in other words, Business Process Experts need a tool at hand to unlock the potential of existing IT assets and combine these as easily as possible to create new processes.
Here's where the platform idea kicks in: what if we could provide support for the more stable business processes while at the same time allowing the flexibility to compose new processes on top of the platform?