by Peter B. Nichol

Robotic process automation for healthcare

Jun 15, 2016
AnalyticsEmerging TechnologyEnterprise Applications

Autonomics and multi-agent systems will be applied in healthcare to definable, repeatable, and rule-based processes. Robotic process automation will be a competitive advantage, not replacing humans but enabling them.

Autonomics ultimately aims to develop computer systems capable of self-management and was started by IBM in 2001. These self-regulating autonomic components are driving the research of multi-agent systems (MAS). MAS are computerized systems composed of multiple interacting intelligent agents within an environment. Robotic process automation (RPA) is capable of automating activities (by creating software agents) that once required human judgment. This is the evolution of automation: the automation of automation.

Transactional to analytical

In 1990, traditional onshore labor was the norm. By 2000 offshore labor was ripping through every industry including healthcare. Huge cost savings were realized shifting from the traditional onshore model to an offshore model. The next revolution of digital labor is called “no shore.” This robotic process automation is autonomic, self-learning, and self-healing system.

The Institute for Robotic Process Automation (IRPA) published an excellent report highlighting the top ten benefits of robotic process automation that cross industries.

1. Decreased operational costs – no shore models (digital software agents)

2. Improved data analytics – task executed by robots allow for analysis

3. Increased regulatory compliance – steps are tracked, traceable, and documented

4. Increased efficiency – software robots never need time off

5. Higher employee productivity – software agents address repetitive activities, freeing workers to participate in more value-added activities

6. Improved accuracy – employees are human, and all humans make mistakes

7. Increased customer satisfaction – decreased errors build deeper customer relationships, improving retention and customer happiness

8. IT support and management – it’s easier to scale software than it is people

9. Logistical upside – minimize or eliminate complications with offshore labor

10. RPA and business processors – presentation-layer automation software, mimicking the steps of rules-based non-subjective processes

Automation process cycle

When do labor efficiencies become labor elimination? To better understand how RPA can enable your organization we first need to identify the five phases of the automation process cycle:

1. Manual execution – one off, no repeatable processes

2. Scripting – linear tasks, standard and repeatable

3. Orchestration – activities that are complex, standard, and multi-scripted

4. Autonomics – dynamic processes that are non-standard, contextual, and inference based

5. Cognitive – self-aware systems, that are predictive, self-learning, and self-healing

If we want our employees engaged in activities that involve personal interactions, problem-solving, and decision-making we need first to get them out of the tedious and repetitive activities.

What if you were told there will be a new team member joining your team. You’re not sure where they are geographically located, but you managed to get some intel from your colleague. You are told they never complain, didn’t want a desk, never need coaching, and love daily performance reviews. This is the resume of the modern robot, a leader in process automation. The competition just got stiffer.

Multi-agent systems

Robotic process automation begins with an understanding of agents. Typically, multi-agent systems refer to software agents, but these systems could equally be robots or hybrid robot and human teams.

There are three primary types of agents: passive agents (simple – agents without goals), active agents (advanced – agents with simple goals, and cognitive agendas (complex – with complex calculations and activities). Agent environments where these types of agents reside can be divided into three environments: virtual environment, discrete environment, and the continuous environment. Also, each agent environment has one or more associative properties:

1. Accessibility – when possible to gather complete information about the environment

2. Determinism – if an action performed in the environment causes a definite effect

3. Dynamics – how many entities influence the environment at the moment

4. Discreteness – whether the number of possible actions in the environment is finite

5. Episodicity – whether agent actions in certain time periods influence other periods

6. Dimensionality – whether spatial characteristics are important factors of the environment and the agent considers space in its decision-making

RPA applied to healthcare

Transparency Market Research, predicts that the global IT robotic automation market to be worth USD $4.98 billion by 2020. Robotic automation is a powerful alternative to offshore outsourcing. It is curious how these processes managed to escape automation. Regardless, there are many areas where RPA can be applied to healthcare including account management, claims processing, underwriter support, customer support, billing, collections, reconciliation, and reporting and analytics consolidation.

The HfS Blueprint Report helps us identify precisely where RPA can be applied within the healthcare ecosystem.

1. Claims administration – claims adjudication and processing, payment integrity complaints, and appeals

2. Member management – account setup, eligibility, and enrollment, billing, benefit management, and customer service

3. Provider management – provider credentialing, provider data management, contracting audits, and network management

4. Health & care management – population health and wellness, utilization management, care coordination and case management, and remote monitoring

5. Administration – finance, accounting, and training

Intelligent automation is entering the business world, and CFOs are happy because RPA is delivering the promised cost savings. However, cost-only value propositions are no longer attractive to top executives. They are looking for cost-plus value propositions (transactional plus judgement-intensive plus analytics). Global labor arbitrage, the disintegration of barriers to international trade or moving to where costs of doing business are low, is no longer sufficient. In this quest for greater cost-plus value propositions, technology plays a critical role.

Start by getting to understand where repetitive task hurt your organization. First, identify the opportunity, second validate the opportunity, third design the mode, and fourth deploy a pilot. Health plans and providers are discovering software agents as a cost-effective alternative to enhancing or replacing platforms.

The conversation has expanded beyond cost reduction to quality, engagement, and innovation. This new phase of sourcing will engage and manage resources to shift workers from the mundane task to activities with deeper customer interactions.

Health innovators are using robotics process automation to drive the next stage of transformation – at affordable costs. Robotic process automation isn’t coming soon; it’s here.