Buying Practice Management software is often like buying a new house or a new car: only after a few months of use do you know what you really needed. What sets OD Professional apart from all other solutions is the ease by which you can tailor the application post-production. Changes are easily made, ranging from simple look and feel to complex clinical and administrative workflows.
Because OD Professional is built on Object Technologies, changes are quick and easy to make and can immediately and transparently flow through to everyone. That is, changes flow across all related processes in a single department or office, or across a complete multi-office or large clinical environment. This level of flexibility can speed up implementations since we can implement then tailor rather than striving for the “perfect implementation” first. We also have a future –proofed solution that is poised to embrace change rather then resist it.
Optimizing the process for Optemetric Practice Management
by Glenn Brand and Richard Currier
OD Professional
EMR logic Systems Inc
October 18, 2006
Business Process Optimization
Abstract
Small businesses – at least those beyond the home office – have automated many of the routine business and paperwork processes, such as accounting, billing and operations. However, their systems substantially automate paperwork and processes for “business as usual,” and increasingly “business as usual isn't.” Many believe that small businesses are ripe for new technologies that drive their business to the next dimension of business success, much as large enterprises have moved to these next dimension systems with new I.T. solutions such as those for global supply chains and just in time manufacturing.
Some of the key technologies to “drive to the next dimension of business performance” that are widely deployed in large enterprises include Business Performance Management (BPM), Business Intelligence (BI) , Business Process Automation (BPA), Customer Relationship Management (CRM), and Supply Chain Management (SCM). This paper explores the potential value of Business Process Optimization (BPO) in private Optometry practices in North America, businesses that range from several hundred thousands of dollars in yearly revenue for a single practitioner, to several millions for multi-doc office and multi-office practices. This paper explores the business benefits and challenges in implementing BPO to drive practices to the next dimension of business success as well as the characteristics of effective technology solutions.
While industry analysts have varying (and often conflicting) taxonomies and acronyms for these next dimension of business I.T. solutions, this paper follows one of the popular definitions: Business Process Optimization including Business Performance Measurement and analytics (such as BI, Data Warehouse, dashboards and the like) and Business Process Automation (which includes workflow management, business rules engines, the process management components of large-scale ERP solutions, and the like).
Together BPM, BI and BPA can form a closed loop BPO system. The loop flows from 1) measurement, monitoring and analytics to discover problems or areas ripe for improvement, to 2) process automation to implement and enforce the process change necessary to support the improved actions, and then 3) to continuous measurement and monitoring to ensure compliance and to refine or correct the changed processes as appropriate. While large enterprise can deploy hordes of inside and outside resources (such as McKinsey or Accenture) for BPO activities, the small business needs solutions in a box. In this paper a potential solution in a box system is proposed.
Introduction
This paper describes the optimization of business processes within an Optometric practice, processes between the patients of the practice and processes of suppliers to the practice.
Background
Daily tasks consume time
Much time consuming details must be considered by the employees and doctors of an optometric practice. The most common type of details that employees must track is insurance plans, insurance billings, patient billings, lens and frame orders, recalls, patient appointments, and patient pre-appointments. If a paper system is in use all types of information must be carefully filed away in the current patient's folder. However the current patient's folder is often in process somewhere in the practice. In larger practices there is often enough time wasted finding the patient file to completely occupy a full time staff person. Information is transposed to other forms for purposes of insurance billing or ordering or providing prescriptions. For recalls office assistants search through all relevant patient files each day consuming one to two hours.
Details fall through the cracks
There are many management problems inherent to Optometric Practice Management today. If an insurance plan is not entered prior to the billing the patient could be billed or the wrong insurance plan might be billed. Cash flow is affected when the patient billing is not completed and sent to the insurance carrier. Patient perception of care is impacted if the lenses are not ordered or there are errors in the submitted specifications for the lenses. Re-makes are one of the most costly areas to Optometric practices. Sometimes the extra options that the doctor discussed with the patient in the exam room are forgotten about by the time the patient reaches the dispensary. If the next recall is not set the patient may never be reminded to come back, or even worse a serious health problem like glaucoma may go unnoticed until it is too late.
Computerizing old business practices
Most computer software available to Optometrists today does not provide Business Process Optimization. Dr. Stephen Rothbloom of Atlanta GA recently said “Optometric software sold today is equivalent in capability to a giant pigeonhole board. You can put all kind of details in the system but you can't really make any useful decisions about all the information that you have collected.” In other words legacy software systems are all about just another place to put things albeit electronic.
Once patient data is entered into the database a user has to look it up every time they want to get any information which is time consuming and error prone. It is easy to access the wrong patient with a similar name and then put information on the wrong patient file. Searching for a patient record is similar, although somewhat faster, to searching for a file in a paper filing system.
Navigation in legacy applications programs is managed by menus and function keys that must be memorized by the user at great expense to the practitioner. This is not unlike the myriad of procedures that may be documented in the practice procedures manual. Oftentimes the well trained employee moves on to other employment requiring complete retraining of a replacement position.
The need for consistency of service
It is difficult to provide consistently great service to every patient seen. An optometrist or office manager may define procedures that will ensure a quality patient visit. The difficulty lies in the distractions interacting with the expected performance of multiple steps typical of medical procedures. Oftentimes the front desk person is distracted by patients stopping by or patients phoning for appointments. Whatever work is being done must be temporarily put on hold, opening up an opportunity to forget a step. Perhaps forgetting to get the insurance details, or maybe to place an order, or to check an order, or to include the diagnosis code for the billing. There are many more opportunities for steps to be missed.
Order delays and errors
Information from a computerized system is often printed out and faxed to the lab which retypes the information into another computer system. This consumes a nontrivial amount of time and creates another opportunity for order entry errors. The additional time to enter in data results in an increase in the overall time it takes to deliver the finished product. Errors result in defective lenses and unhappy patients.
Facts are stored but not well organized
In order for a doctor to see a step increase in cash flow he or she must be able to have visibility into the financial details at a very high level. Most software today only provides limited visibility into the financial and operational affairs of the business. Medical procedures may or may not be reimbursed by the insurance carrier at a level that supports the resources required providing the medical service. Insurance carriers routinely adjust down claims so that the practitioner is no longer getting what he needs. But with so many details to manage this information is not visible and becomes a matter of guesswork to ascertain.
Discussion
Business Process Management (BPM)
The term Business Process Management ( BPM ) refers to activities performed by businesses to optimize and adapt their processes.
In addition, a Business Process Management System ( BPMS ) can also monitor the execution of the practice processes, providing doctors of an organization with the means to analyze their performance and make changes to the original processes in real-time. Using a BPMS the modified process can then be merged into the current work flow of the live system.
Process design
This encompasses either the design or capture of existing processes. In addition the processes may be simulated in order to test them. The software support for these activities consists of a graphical editor to document the processes and a database to store the process models. For example a process model might be the steps taken to perform a comprehensive eye exam including confirming the insurance, receiving data from instruments, examining the patient, dispensing the lenses and finally creating the patient and insurance billing. An example of another process model is the steps taken in a contact lens recheck.
An emphasis on getting the design of the process right will logically lead to better results as the flow effect on problems at the design stage logically affects a large number of parts in an integrated system.
Evolution of business processes requires a change to the process design to flow on into the live system. Integrating business process is also a current research area. Integration of software for process design to be used both for creating graphical representations of workflows and implementing and maintaining these workflows makes evolution of business processes less stressful, given that requirements are not as static as legacy information systems.
As a response to these problems, the Business Process Management System (BPMS) category of software has evolved, which we have built into ActionManager. ActionManager allows the full business process (as developed in the process design activity) to be defined in a computer language which can be directly executed by the computer. ActionManager will either use services within the application OD Professional to perform business operations (e.g. updating insurance, creating a spectacle lens order, creating a patient invoice) or will send messages to doctors and optometric assistants requesting they perform certain tasks which necessitate a human attribute such as intuition as opposed to an automated process. As the process definition is directly executable, changes in the process can be (in comparison to the traditional approach of application development or maintenance) relatively quickly moved into operation. In order to work effectively a BPMS like ActionManager often requires that the underlying software is constructed according to the principles of a service-oriented architecture . Thus, it is often difficult to make a suite of existing legacy systems fit with a BPMS.
Process monitoring
This monitoring encompasses the tracking of individual processes so that information on their current status can be easily seen and the provision of statistics on the performance of one or more processes. An example of the tracking is that it should be clear that a patient insurance plan has not been updated, or that a recall has not been made, or that the account has not been billed. A further example of the tracking is being able to determine the state of a patient order (e.g. lens order arrived, awaiting delivery, invoice paid) so that problems in its operation can be identified and corrected. All these cases are in fact monitored manually in most practices not using BPM but with the problem of tasks being forgotten. In addition, this information can be used to work with patients and suppliers to improve their connected processes. Examples of the statistics are the generation of measures on how quickly a patient order is processed, how many orders were processed in the last month etc. These measures tend to fit into three categories: cycle time, defect rate (re-makes) and productivity.
Business process automation (BPA)
Business process automation ( BPA) is the process a business uses to contain costs. It consists of integrating applications, cutting labor wherever possible, and using software applications throughout the organization.
Business Process Automation (BPA) vs. Business Process Management (BPM)
An area of discussion exists as to whether BPA is a distinct field of activity in its own right or merely a subset of the wider activity BPM. Given the similarity in terminology it is not surprising that most casual observers would believe them to be closely related if not identical. However, to experts in these areas they carry very distinct meanings, even if they are ultimately complementary concepts. To explain this further it is necessary to summarize the views of each camp:
The BPM camp asserts that before any process can be automated, it is necessary to define (often at a very strategic level or enterprise-wide) all of the business processes running inside an organization. From this the processes can be re-defined and where necessary optimized (BPO), including automation.
The BPA camp states that until a process is automated, there is no real value in analyzing and defining it, and that the cycle of business change is so rapid that there simply isn't time to define every process before choosing which ones to address with automation, and that delivering immediate benefits creates more value.
There is no consensus amongst which view will prevail, however it can be seen that both perspectives are at least complementary to some extent. Process improvement methodologies such as those of ActionManager appear to align well with the BPA view of the world, as it constantly looks for incremental opportunities to make processes more efficient and reduce defects, however these methodologies can also be used downstream of a BPM deployment.
ActionManager
The software component called ActionManager of OD Professional is capable of providing BPM and BPA. ActionManager is a workflow system that is rules based management software that directs, coordinates, and monitors execution of interrelated sets of tasks arranged to form a business process. ActionManager provides end users with tracking, routing, document imaging, and other capabilities designed to improve business processes.
OD Professional
OD Professional™ is a comprehensive software solution designed from the core to provide the necessary services that support Business Process Management and Business Process Automation. With unique and powerful capabilities such as Action Manager, the CACHÉ ™ database, DATAlink and IMAGElink, OD Professional™ allows an optometric practice to focus on key success factors: quality patient care, improved cash flow and a reduction in the hours required to provide quality service.
Business intelligence (BI)
Business intelligence (BI) has two basic different meanings related to the use of the term intelligence . The primary, less frequently, is the human intelligence capacity applied in business affairs /activities. Intelligence of Business is a new field of the investigation of the application of human cognitive faculties and artificial intelligence technologies to the management and decision support in different business problems.
The second meaning, the subject of this paper, relates to the intelligence as information valued for its currency and relevance . It is expert information, knowledge and technologies efficient in the management of organizational and individual businesses. Therefore, in this sense, business intelligence is a broad category of applications and technologies for gathering, providing access to, and analyzing data for the purpose of helping enterprise users make better business decisions. The term implies having a comprehensive knowledge of all of the factors that affect the business. It is imperative to business managers to have an in depth knowledge about factors such as their patients, competitors, business partners, economic environment, and internal operations to make effective and good quality business decisions. Business intelligence enables managers to make these kinds of decisions.
Reasons for Business Intelligence
Business Intelligence enables organizations to make well informed business decisions and thus can be the source of competitive advantages. This is especially true when a manager is able to extrapolate information from indicators in the external environment and make accurate forecasts about future trends or economic conditions. A manager can make decisions proactively that benefit the organization, once business intelligence is gathered effectively and used, such as focusing on medical procedures that pay at a rate commensurate with the resource expended.
The ultimate objective of business intelligence is to improve the timeliness and quality of information. Timely and good quality information is like having a crystal ball that can give the manager an indication of what's the best course to take. Business intelligence reveals:
• The position of the practice as in comparison to other practices
• Changes in patient behavior and spending patterns
• The capabilities of the practice
• Market conditions, future trends, demographic and economic information
Managers can then deduce from the information gathered what adjustments need to be made.
Doctors realize that in this very competitive, fast paced and ever-changing business environment, a key competitive quality is how quickly they respond and adapt to change. Business intelligence enables them to use information gathered to quickly and constantly respond to changes.
Benefits of BI
BI provides many benefits to practices utilizing it. It can eliminate a lot of the guesswork within an organization, enhance communication among departments while coordinating activities, and enable practices to respond quickly to changes in financial conditions, patient preferences, and supply chain operations. BI improves the overall performance of the practice using it.
Information is often regarded as the second most important resource a practice has (a practice's most valuable assets are its people). So when a practice can make decisions based on timely and accurate information, the practice can improve its performance. BI also expedites decision-making, as acting quickly and correctly on information before competing businesses do can often result in competitively superior performance. It can also improve patient experience, allowing for the timely and appropriate response to patient problems and priorities.
Speedminer
An example of BI is Speedminer DW and BPM. Speedminer is one the most comprehensive and fully integrated sets of data warehouse, business intelligence and business performance management solution available. Speedminer not only assists the manager in uncovering the wealth of information in the practice to build the best Business Intelligence platform, but also to manage the performance of the practice so that the practice will always stay ahead of competition and excel. Database from various sources in a variety of formats are integrated into one common platform for managers to access, analyze and share information to understand how their practice is performing at any moment in time. The relevant information is distributed across the organization to improve decision-making and to reduce the time between insights gained to action. Business Performance Management provides enterprise with business intelligence plus business rules, business content and business processes that support collaboration across the organization and a unified approach to managing and improving financial and operational performance.
Business Process Optimization (BPO)
Together BPM, BI and BPA can form a closed loop BPO system. The loop flows from (1) measurement, monitoring and analytics to discover problems or areas ripe for improvement, to (2) process automation to implement and enforce the process change necessary to support the improved actions, and then (3) to continuous measurement and monitoring to ensure compliance and to refine or correct the changed processes as appropriate.
Conclusion
Adoption of software capable of delivering Business Process Optimization is a key factor in the success of practitioners in the Optometric industry. Optometric Practices as a result will see a step increase in cash flow, doctors will be able to spend less time providing quality services to patient, and practices in the end will be more valuable when they are sold at retirement.
Recommendations
It seems vitally important that practitioners wishing to advance their practices ought to investigate the capabilities of Business Process Optimization and those software systems capable of delivering on BPO. Although the concept appears to be somewhat new it is in fact an automated version of the manual analysis that currently is used by most practitioners today. However the powerful capabilities of BPO are far more effective than a manual system.
Sources for This Document
Principles of Information Systems, Sixth Edition (MIS) (Hardcover)
by Ralph Stair (Author)
Wikipedia, the free encyclopedia
Richard Currier, go-to market consultant that participated in the success of many market leaders such as microsoft, peoplesoft, j.d. edwards, intersystems and hewlitt packard.
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