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API-led approach for “Stakeholder Experience Transformation” in the Healthcare industry

API-led approach for “Stakeholder Experience Transformation” in the Healthcare industry
October 08, 2021

The pandemic had a telling impact on almost all industries. Like many industries, the healthcare industry has undergone various cataclysmic transformations and changes in the last couple of years. Digital transformation plans that had 5-6-year horizons earlier are getting fast-tracked owing to the behavioral changes that the pandemic literally forced upon the world.

Digital transformation is sweeping the healthcare landscape and having growing ramifications across the patient, partner, and agent personas.

From customers displaying utmost app savviness and preferring to book appointments online to an enhanced need to facilitate seamless patient onboarding, to a stratospheric growth seen in the global telehealth market (growing at 17% per annum) and the compelling need for seamless interoperability with payers and partners (given the ballooning claims seen during the pandemic), and finally, the de facto need to have all patient information in one screen for faster support and for an improved agent experience. These trends are sweeping the healthcare landscape and having growing ramifications across the patient, partner, and agent personas.

These ramifications, in turn, manifest themselves as challenges for modern-day healthcare providers that need immediate addressing. Failing which, shall see, rapid customer defection, agent attrition, and payer/partner churn.

The following table outlines some of the key experience-centric challenges for modern healthcare providers.

Table 1: some key experience-centric challenges for modern healthcare providers

Sl.No

Business Challenge

Technology Impediment

Experience Impact

1

Customer calls getting missed in the face of the pandemic traffic load leading to delayed patient scheduling or non-scheduling.

Lack of integration of the Electronic Health Record (EHR) and the Patient Management System with other systems such as phones, websites, and more.

Poor customer experience

2

Very long call times, some running to even 20+ minutes just for bookings and appointments- a result of agents toggling with more than four screens for a single conversation.

Absence of integration and APIs resulting in fragmented customer data that is further exacerbated by the non-availability of a single cloud repository.

Poor agent and customer experience

3

Inability to provide customer referrals within the hospital’s chain of network. This translates to increased customer denials, poor CSAT, and loss of business.

Non-standard, P2P, legacy integrations are limited to systems and location leading to low reusability and no scalability. 

Poor customer experience

4

Delayed data sharing within government health departments and payers resulting in government warnings and delayed insurance settlements.

Absence of a cloud-based healthcare repository leads to inefficiencies. Absence of APIs that expose patient data disallows the payers from making efficient use of patient data.

Poor partner

experience

 

The above challenges are already prodding the CTOs of the healthcare industry to think of quick-fix solutions. However, ‘quick-fix’ is never the right approach for holistic, experience-centric, digital transformation.

Quick-fix solutions such as point-to-point integrations negate the opportunities to scale, reuse, and replicate, thus becoming more an obstacle than a solution to the challenges mentioned above.

API-led Integration is the right approach to alleviating the above challenges as it lends the solution reusability, scalability, composability, and replicability.

Let us take a look how.

healthcare industry

Figure: Three-layered API-led reference architecture for healthcare providers

Conventionally, healthcare enterprises adopt a point-to-point approach to integration. Point-to-point solutions appear attractive for ‘quick-fix’ delivery of a single given project or when there are a limited number of endpoints and the pace of transformation isn’t demanding. However, this approach becomes a liability when used for experience-centric scaled implementations, as the endpoints are simply too many and the expectation is not only to make one hospital branch efficient but scale and replicate this transformation success across all the branches of a hospital chain. This is where API-led integration becomes useful and efficient. APIs provide both a consumable and controlled means of accessing connectivity.

Need for a layered architecture

Large enterprises in general and enterprises in regulated industries such as healthcare have complex interwoven connectivity needs that require multiple API building blocks. In such a scenario, institutionalizing a framework for ordering and structuring these building blocks is crucial. Flexibility and agility can only emerge from a multi-tier architecture containing distinct layers meant to perform distinct activities.

  • The Systems of Record (SoR) layer houses all core sources of data such as Electronic Health Records (EHR), ERP, CRM, Hospital Management System (HMS), Revenue Management System (RMS), and more.  These systems often operate in an isolated, siloed manner with no interaction between them that leads to no holistic interaction of data. The SoR APIs shown in the illustration above provide a means of accessing underlying systems of record and expose that data, often in a canonical format, while lending downstream insulation from any changes to interface or rationalization of those systems.
  • The Systems of Differentiation (SoD) layer effectively insulates and abstracts the business processes that derive their functionalities from the data underneath from the target channels through which that data is to be delivered. For example, to further the agent enablement process, it is logical to house the patient data in the EHR and reporting data that is common across all common ailment types, geographies, and channels in a single service that can then be called by specific API. The SoD APIs shown in the illustration above perform specific functions and provide access to non-central data.
  • The Systems of Innovation (SoI) layer on top orchestrates the consumption of data and data-driven processes across a diverse set of customer-facing, agent-facing, and partner-facing channels with an aim to provide a superior quality omni-channel experience. For example, a customer service representative, a web portal, and a mobile application would all need to access the same patient information fields with a need to be presented in different formats. The SoI APIs help reconfigure the data so that it is most easily consumed by its intended target persona, all from a shared data source, rather than setting up separate point-to-point integrations for each channel.

Solution features to meet the key healthcare challenges

As seen above, there is beauty and essence in equal measure in a layered architecture. The following table outlines a snapshot of the key solution features that a healthcare provider can leverage to uplift the stakeholder experience across patient, agent, and partner personas.

Sl.No.

Strategic Initiatives

Transformation Initiatives

Key Solution Features

1

Next-gen digital platform

  • Adopt a next-gen mobile app and an intuitive web portal
  • Integrate the channels with EHR and HMS
  • Drive analytics
  • Omni-channel experience across channels
  • API-led real-time integration- HL7 and FHIR R4 compliant
  • Event-driven architecture

2

Standardizing integration

  • Enablement of APIs and Microservices
  • Move away from P2P integrations to a  new modern Integration platform
  • New API-led integration platform supporting hybrid deployment model
  • Service/API templates
  • API market place

3

Economize the integration platform

  • Leverage one system for many functions
  • Expand the usage of the integration platform to all branches of the hospital
  • Ensure end-to-end visibility
  • Adopt an integration competency center
  • Move to a cloud-based healthcare repository
  • Establish a new enterprise-wide operating model addressing ‘People-Process-Tools, and Technology’

4

Keep the solution scalable and flexible

  • Leverage reusable and scalable APIs
  • Use layered integration approach (as shown above)
  • Canonical data models
  • Interface standardization
  • Layered integration approach

5

Stakeholder delight

  • Integrate EHR, HMS, agent, and customer interfaces to reflect details in real-time
  • Omni-channel experience across different channels
  • Analytics and NBA

While the API-led approach to integration would transform the experience of the key stakeholders, internal to the enterprise, such an approach will bring in a culture of innovation, encouraging various lines of businesses to self-serve and self-adopt. It will help improve developer productivity by aiding auto-scaling and reducing duplication of efforts. It is composable, customizable, nimble, and flexible, provides predictable digital transformation changes, and aids greater agility through loose coupling of systems.

Conclusion

The healthcare industry is on the cusp of widespread digital transformation, being pushed against the wall owing to the pressures exerted by the pandemic. In a highly regulated and competitive market, appropriate digital interventions can bring together isolated systems, connect the data together to provide vital insights and intelligence to improve holistic stakeholder experience.

In this regard, the API-led layered integration fits perfectly into the scheme of things that can help improve the holy trinity of the patient, agent, and partner experience.