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Business Rules as a solution to Healthcare problems

This article - IT Could Help Ailing Health Care Systems - led with the statement that "Health care systems across the developed world are struggling to coordinate care and keep patients informed about what their medications do. That's the conclusion of a report released this month by the Commonwealth Fund."

The United States scored markedly worse than other countries in terms of patients' access to health care, financial burdens placed on patients, errors and efficiency, but patients in all countries reported high rates of mistakes, poor care coordination, and otherwise deficient care.

So why have healthcare providers not implemented systems to fix or at least improve some of these problems. Well, of course, many have tried. One of the reasons for failure is, I think, the problems caused by the usual mismatch of IT and the "business". Many projects, in all kinds of industries, suffer from this - the business understands the problem but not the technology used to try and solve it and the IT folks don't really understand the business problem. In healthcare this is much worse - now you have medical folks who understand the drugs, treatments, interactions as well as the people who understand the "business" of healthcare. No system would be allowed to control or even monitor what doctors and nurses do unless the rules within it were driven by medical professionals - and quite rightly. After all, you don't want a programmer deciding which drug you get when you are sick! But however knowledgeable doctors are they make mistakes, they forget things and they cannot be as effective as an information system at profiling a patient, reviewing their history, seeing what other treatments are being prescribed by other doctors etc.

So how to solve this problem? Well, elsewhere on this blog I have talked a lot about how a business rules approach can make it possible for business users to control the business rules within a system while the IT folks focus on the technology and the "plumbing". This approach would also allow Doctors to define the rules, in peace and quiet rather than in the hurly-burly of an ER. A rules-based system could thus close the circle - it would be an information system and so could "remember" everything and cross-compare but it would be informed and driven by rules written by medical professionals.

I was also reminded of this article - PDAs Help Doctors Cut Excessive Antibiotics, also by Monya Baker, where she talks about how automated systems for prescription management and clinical support, especially when delivered to the point of care, can reduce errors both of over-prescription (e.g. of Antibiotics) and of mis-prescription (e.g. caused by failing to remember a potentially dangerous drug interaction).

One example of an organization doing this is Parkview Health who is using the Fair Isaac business rules management system inside IDX Carecast to improve the efficiency and safety of medication ordering and administration. Not only did they improve the medication turnaround time, they also improved patient safety and increased their adoption of best practices. See Parkview Health Uses Fair Isaac's Business Rules Technology With IDX(R) Carecast(TM) to Help Improve Healthcare Services. This is exactly the kind of system these articles identify as a way to improve healthcare delivery.

I have a couple of other articles on decisioning in healthcare here.

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