Toward a Healthcare Business-Process Reference Model

• Published in: IT professional Vol. 13; no. 3; pp. 38 - 47
• Main Authors: Brown, Paul, Kelly, John, Querusio, David
• Format: Journal Article
• Language: English
• Published: Washington IEEE 01.05.2011; IEEE Computer Society
• Subjects: Biomedical computing; Business; Business models; business process; Business process reengineering; Computer applications; Computer interfaces; Electronic data interchange; Health care; Health care industry; Health care policy; Health Insurance Portability & Accountability Act 1996-US; healthcare; Information systems; Information technology; Interfaces; Medical information systems; Medical services; reference architecture; reference model; Response time; Roles; Software; Standardization
• ISSN: 1520-9202; 1941-045X
• DOI: 10.1109/MITP.2010.65

Standardizing processes in an effort to develop a full-scale healthcare business-process reference model could enable flexible business models without requiring custom interfaces and help track transactions to improve response times and quality of care. The structure of the healthcare industry is in flux. In seeking more cost-effective solutions, enterprises are constantly experimenting with different business models and trying various combinations of roles: risk holder, care provider, plan manager, and plan administrator. Health plans are also becoming more complex. Comprehensive plans often aggregate smaller plans, each covering a different benefits category with a different business model for providing and administering care. From both a business and information systems perspective, the result is expensive and chaotic.