A long time ago in a land far, far away, data was stored in flat files and managed in code by application programmers. First with hierarchical databases and then with relational databases, the management of data was externalized. There are many advantages to this model including security, backup, change control, access control, and the ability for multiple applications to access the same data. This includes making some data available to business users for reporting or updating through user-friendly tools. The DBMS model is one we take for granted today—no one would think of writing their own DBMS or managing data directly in code.
At last week’s Microsoft Enterprise Developer and Industry Solutions Conference, Steve Aylward, General Manager US-Healthcare Management for Microsoft, talked about the many challenges in the healthcare industry http://entdevcon.istreamplanet.com/video.asp?v=6 . He highlighted the unbalance of investment with health results: the United States is #1 in healthcare spending, but #29 in life expectancy and #38 in overall health quality. Steve did a great job acknowledging that while information technology can help, it can’t cure what ails the healthcare system. Even electronic medical records (EMR)—which Microsoft is investing heavily in, with its HealthVault solution—can’t save the day on its own.
Steve highlighted that while there are some technology standards in healthcare, there were no standards around interoperability of systems or processes: technology can best help the healthcare system by liberating data, empowering people to access data and connecting systems.
I don’t disagree that bringing information and systems together to provide a more unified view of a patient or billing cycle or drug efficacy would bring enormous benefit. But I do think it addresses only half the problem, as it doesn’t address the problem of non-standard processes. Within any process, there are multiple decision points: some simple, some complex; some static, many dynamic. Attendees testified that you can ask multiple systems the same question and get a different answer from every one. That’s a problem whether the system is addressing clinical care or payer issues!
By externalizing complex or frequently changing decision logic, healthcare organizations can ensure the consistency of key decision logic. They can empower subject matter experts to maintain it so that it’s always up to date. And multiple applications on multiple platforms can call that decision logic, ensuring that all applications give the same answer to the same question, using the most recently updated logic.
Our session http://entdevcon.istreamplanet.com/video.asp?v=30 highlighted a number of ways business rule technology can make healthcare decisions easier from health plan underwriting to population management to poison control center triage to claims verification and processing. Underlying all these systems is the idea that decision logic is an enterprise asset that should be managed outside of application code, with appropriate controls, the ability to share this asset across systems, and the ability for business users to access and update this logic as appropriate. One of our clients reduced reimbursement times for providers by 81%!
One of my first jobs was working with a new technology called a Relational Database Management System, specifically DB2 V1.2. In all industries, but particularly in U.S. healthcare today, I see the same opportunity for Business Rule Technology to change how we manage decision logic. And I’m glad that, increasingly, the idea of writing your own business rule management system seems as ridiculous as writing your own DBMS.