Transforming Healthcare At Maccabi With webMethods And ARIS

Israel has a mandatory but mostly privatized healthcare system, and Maccabi Healthcare Services is the country’s second largest and fastest growing health maintenance organization (HMO), with about 1.9 million members using the services of 5,000 physicians. Maccabi’s chief enterprise architect, Irena Kurman, gave a presentation in the Integration and Automation breakout track at Innovation World on how they are putting the model-to-execution message into practice to improve their processes and integrate their legacy systems better.

She talked about three case studies – medical referral follow-up, doctor visit management, and pregnancy tracking – that highlighted the challenges that they had with multiple systems and data sources, as well as uncontrolled and non-standardized processes. For example, their x-ray results process had point-to-point links between 14 different systems, making it very little to understand what was happening, much less consider modifications to the process. When something went wrong, there was no single process owner, and no visibility into the end-to-end process.

They started with webMethods for integration and SOA governance, then have more recently started to model their processes using ARIS and automate some of these processes using webMethods BPMS. That original spaghetti x-ray process still has those same source systems, but now uses an ESB middleware layer, with the BPMS (as well as external partners) accessing the legacy systems via services: changes to the process are made in the BPMS, not by rewiring the legacy systems.

The results in the case studies are pretty striking. In the medical referral follow-up process, they now have the ability to capture life-threatening cases in near real time, and since the entire process is linked and monitored, test samples can’t go missing without notice. For doctor visit management, payments to doctors are more accurate and are calculated in a transparent manner, improving relationships between Maccabi and their physicians. And for pregnancy tracking, a mobile application provides the patient with access to information relevant to her pregnancy stage, as well as view results such as recorded ultrasound video from anywhere.

Along the way, they’ve developed a model for approaching process and integration projects:

  • Start by modeling the business processes with ARIS
  • Integrate systems with webMethods Integration Platform
  • Execute and monitor processes with webMethods BPMS
  • Enable flexibility with the rules engine
  • Manage software services with CentraSite and Insight

Kurman feels that they’ve just started on their journey to process excellence, but it looks like they have a good roadmap on how they’re going to get there.

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