2.1Business Context
Hospitals are being challenged by lower cost at-home care and ambulatory care services. Reports suggest that there has been a downward demand for hospital beds since 20083. Because of this, the boards of hospital care providers Gloco and LiCO have made a strategic decision to merge the two companies to reduce costs, drive for efficiency, and improve revenue streams. This newly formed entity is called Gloco Healthcare Provider (GlocoHCP).
GlocoHCP inherits legacy systems, which are rigid, monolithic and difficult to update in response to business needs. The patient systems from both companies are incompatible, they are large monolithic architectures that are difficult to understand, hard to change, and are not built for future growth.
GlocoHCP wants to integrate and grow these existing systems without committing to a long-term external vendor partnership. It also needs flexibility to adapt to future needs, initially creating a way to interface with patients who are using the latest technologies for remote-patient monitoring and care (the in-home Healthcare market).
2.1.1Business Problem
The following are the major challenges being faced by the company:
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Revenue losses from a decline in hospital bed occupancy and competition from smaller clinic and ambulatory services.
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Remote patient health monitoring services such as Connected Cardiac Care Program (CCCP) at Massachusetts General Hospital reduced hospital readmissions by 95%4. This trend indicates less revenue for GlocoHCP using its traditional in-hospital model of healthcare.
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The company is a late entry into the in-home healthcare market, delayed by its legacy infrastructure and business model.
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Interfacing the two systems using Service Oriented Architecture (SOA) or Enterprise Service Bus (ESB) is challenging in terms of the cost of a third party system, along with efficiency restrictions imposed by the traditional integration technology relating to scaling and performance.
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The hospital billing system is currently using the International Classification of Diseases – 9 (ICD-9), for submitting medical insurance claims. The compliance date for implementation of ICD-10-CM/PCS5 is October 1, 2015, for all entities under the Health Insurance Portability and Accountability Act (HIPAA)6 - GlocoHCP must comply this.
2.1.2Use Cases -
GlocoHCP will provide an Anywhere Healthcare service to enter the in-home Healthcare market. This is to generate revenue in the in-home market, to increase referrals, and to increase patient retention.
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GlocoHCP will extend medical care after releasing the patient. It is doing this to improve customer loyalty and satisfaction, measured by a customer satisfaction survey.
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GlocoHCP will transform the hospital legacy systems to enable a flexible architecture, in an effort to improve response times to market demands.
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The new system will introduce the concept of a connected patient that will reduce the human errors associated with data capturing during; admission, in service or discharge.
2.2Business Processes
The current business process (AS-IS) has the following steps:
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GlocoHCP starts its activity once the patients arrive at the hospital, as there is no home care services offered. The Information Technology (IT) department offers tools for patient care, and work primarily to keep records for the business. There is no system for innovation improvements being used.
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The patient is registered in the Patient Admission and Billing System (PABS), and directed to either hospital in-patient services or to outpatient services. The system currently interfaces with all major medical insurance providers using ICD-9 system.
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The billing system is initiated and records all transactions relating to the patient.
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A care provider attends updates information in the Electronic Medical Records (EMR) System.
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Each step of the service is recorded in the EMR system; a large monolithic database.
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A script for the patient is registered in a Computerized Patient Order Entry (CPOE) system as the pharmaceutical service receives requests for medication from CPOE. The nursing stations receive patient’s condition from EMR. All medical images are stored in a Picture Archiving and Communication System (PACS) which is managed by a Radiology Information System (RIS). A Laboratory Information System (LIS) is used to manage pathology and laboratory information.
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Once patient care is completed; the patient is discharge, and either the patient or their medical insurance provider is billed.
In the TO-BE process (below), two more overall functional areas are suggested: one to offer flexible services to link with external and internal business processes, and a second to integrate with the legacy monolith systems:
Figure : AS-IS Business Process
Figure : TO-BE Business Process
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In the new process, as before a customer will visit the hospital using the as-is processes. This process starts at G, after releasing the patient from the hospital. It is expected that they will be connected to the hospital patient monitoring system using their choice of devices and their data aggregator services (e.g. Microsoft HealthVault). Patient will be enrolled at this time using the patient enrollment service.
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The hospital’s remote patient monitoring system collects the patient device records at regular intervals depending on the patient type, status, and capacity of monitoring devices via the aggregator services.
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The flexible service receives records, keeping them in local storage, and streams them to long-term storage. All other flexible services utilize this data to perform their functions.
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Data streaming services will broadcast data to long-term storage and other systems.
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It keeps long term patient records for system support and analytics.
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A context aware notification system works in near real time. It utilizes specific physician instructions (rules), and machine-learning methods, to learn the patient’s condition. It will then create alarms based on the rules and knowledge provided to the algorithm. It will route alarms to the patient, clinics or ambulatory care, as well as the hospital.
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Once a clinic is notified to attend to a patient, the clinic will update the system, and attend to that patient. The clinic can call the hospital for any additional support.
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An ambulatory service will receive notifications based on their; availability, geo-location, and distance from the patient. An ambulance will pick up the patient and transport them to the hospital. It is important to note that the system will use the patient’s address for location services and not geo-location from the medical devices.
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While the ambulatory service is in transit, the hospital will be notified to prepare the necessary services. The hospital will receive the patient and follow the AS-IS process.
The proposed solution is not going to change the existing processes of the hospital. It will augment and enhance patient care by better interfacing with external provider systems as well as monitoring devices of the patient. The legacy systems will be used for certain functions until the hospital systems are migrated to the new architecture.
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