The hardest part about managing a clinic is keeping everybody up-to-date with the right information. Whether this is simply making sure billing is alerted of a new bill or as complex as managing follow-ups after a referral. There is simply too many documents, emails and schedules for a person to manage. This is the value of workflow to a clinic or hospital- setting the rules regarding who gets to see certain types of documents and ensuring that know about the updated information.
Automating Patient Management with ApplicationXtender Workflow
1. Automating Patient information
routing with OpenText™
ApplicationXtender Workflow
Manager
This white paper explains how ApplicationXtender enables
healthcare organizations to manage their patient document
processing with a low-code approach. Its core functionality
and key features help them streamline and automate
processes, increasing operational efficiency. This white
paper is for both clinical and administrative managers in
organizations that are seeking to streamline and automate
business processes to increase operational efficiency.
2. Contents
Executive summary 3
Introduction 4
The value of automating business processes 4
ApplicationXtender Workflow Manager 4
Use case: Patient information collection 5
ApplicationXtender Workflow Manager—a functional overview 7
Conclusion 9
Automating business processes with OpenText™ ApplicationXtender Workflow Manager 2/9
3. Executive summary
It is no secret that today’s healthcare organization’s face a rapidly growing volume of
information—digital and paper-based. To cope with this information and improve the
many business activities that rely on it, such as managing patient release forms,
claims processing, diagnostic request forms, prescription requests. The move to
digital healthcare administration has proved difficult due to the need for real time
access to documents and images that are currently only available in the physical
world. The reality that documents have a long lifecycle increases costs and introduce
the potential for delays in patient care.
Midsize hospitals and primary care clinics in particular face similar information
and process management challenges—albeit with far smaller budgets. They
often carry extra staff in order to manage inefficient processes that are bound
by the limitations of paper. At the same time, they lack the tools to analyze
processes, identify the bottlenecks that breed inefficiency, and measure
business performance.
ApplicationXtender provides out-of-the-box capabilities that allow organizations to
quickly create a digital hub for information, enabling the capture, organization, and
delivery of images, documents, and reports from any source. As an added value for
organizations with limitations in their IT budget and departments. ApplicationXtender
can handle both patient information and other business-critical information.
Built on a central repository, ApplicationXtender deploys quickly without programming
and is easy to customize. Once deployed, it is simple to monitor and requires no
dedicated IT support. ApplicationXtender provides specific capabilities for high-speed
image capture and storage, enabling information that originates on paper to be digitized
and easily accessed. With ApplicationXtender, administrative and clinical staff can quickly
retrieve information from a variety of sources, gaining greater control over compliance
headaches while enhancing the quality of decisions, streamlining patient administration,
and reducing wasted time looking for notes.
Application is easy to deploy with several options including cloud and manage service
deployments. Administrators can centrally configure and manage application resources
such as templates and repository parameters, storage devices, and business rules.
Remote management and monitoring services offer a central view of the application
environment and related resources.
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4. Introduction
This white paper will focus on the value of automating business
processes that are typical in healthcare but not supported by
EMR systems with high-level functionality of ApplicationXtender
Workflow Manager and outline some of its key features.
The value of automating business processes
For small, rural hospitals and small clinics, administrators must
constantly reconsider and optimize the way they the manage the
business. This means ensuring that information systems and
applications don’t inhibit moving paper and verbal processes as
they evolve to digital processes. Organizations struggle to move
from paper forms to electronic forms for patient information
capture, the foundation of any automated process. This means
that the move to ECM (aka content service platforms) has little
cost savings and in fact see their processes become more
complex as documents move between paper and digital form.
The value of ApplicationXtender is that in addition to simple
workflow it has an integrated forms engine reducing the complexity
of integrating separate IT systems into your workflow.
Furthermore, ApplicationXtender has the modules to capture a
variety of paper and emailed documents. This allows for ensuring
that no matter how advanced allied services and vendors are in
their digital business your own business processes are not
impacted.
Workflow, which encompasses both routing of documents and
extracting of data from documents, ensures that the steps in a
process are handled in the correct order. The automation of
business rules, which is the core value of workflow, capture and
enforce the business requirements of a process such as
approvals, activity queue length and wait time, exceptions and
exception routing, regulatory guidelines, and so forth.
The same technology that enables processes to be automated
via workflow also makes processes auditable. As information is
passed from step to step in a workflow, it creates an audit trail.
Audit trails can be used to analyze process efficiency and prove
compliance with internal guidelines and regulatory mandates.
For organizations that deploy it, process automation technology
provides a host of benefits, including:
• Reduced transcription time
• More efficient operations at lower cost
• An integrated view of process information
• Greater accuracy and fewer manual processing errors
• Improved response to compliance and litigation inquiries
ApplicationXtender Workflow Manager
Most business processes involve several departments within an
organization. They may also include parent company subsidiaries
or even third-party participants such as partners and suppliers.
ApplicationXtender Workflow Manager is an advanced workflow
solution that includes the process management and analysis
capabilities necessary to create workflows and improve process
efficiency.
Built on the standard business platforms it can be deployed on
Windows Server and can use a variety of databases for easy
integration with existing medical coding databases, AX
Workflow Manager easily integrates with existing business
applications.
AX Workflow Manager enables organizations to improve
performance and reduce costs within and across functional
business units by automating and optimizing manual, document-
intensive processes such as those found in patient information
capture. With AX Workflow Manager, clinic administrators or
department managers can design, test, implement, analyze, and
manage automated workflows. AX Workflow Manager includes
workflow samples, a user-friendly, graphical process designer,
and built-in reporting and forms support. AX Workflow Manager
enables trained users to:
• Use an intuitive, graphical process designer to discover, analyze,
and design workflow automations without coding or IT support
• Streamline processes by eliminating bottlenecks and
unnecessary or redundant steps
• Test and refine processes before they’re deployed
in a production environment
• Integrate, categorize, and manage processes with AX
Workflow Manager’s Enterprise Console
• Enjoy advanced customization and integration capabilities
using .NET
• Monitor and analyze user and process performance
with built-in reporting capability
• Leverage platform support for the latest database versions
of Microsoft® SQL Server® and Oracle
• Meet compliance requirements with comprehensive audit trails
AX Workflow Manager also features advanced server clustering.
With advanced server clustering, the administrators no longer
have to worry about how to accommodate growth and demand
on a system. Organizations are able to:
• Scale workloads across multiple servers
• Monitor CPU utilization and health
• Distribute work to the least active CPU
The capabilities of AX Workflow Manager boost process efficiency
while reducing staff and operational expense—a significant
contribution to an organization’s competitive strength.
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5. Use case: Patient information collection
Although this white paper focuses on basic patient information
management to illustrate the value of automating business
processes, process automation can be applied to virtually any
transaction as the following table highlights.
Financial Administrative
• Insurance claims • Procurement
• Expense report processing • Contracts management
•Transcription and coding • Schedule management
Human Resources Facilities
• Certifications • Maintenance schedule
• Compliance • Safety reviews
• Approvals • Mobile access
Patient engagement Referrals and diagnostics
• Patient portals • Hand-off note sharing
• Specialty referrals • Digital PACs/DICOM viewing
• Patient appointments • Diagnostic requests
Table 1. Process automation benefits many functional areas
Capturing initial basic patient information is an instructive use case
as it is one of the complex use cases for ECM systems to manage
in just about every organization regardless of size or industry. On
its own, patient information is used across administrative, billing
and clinical departments- yet in different ways and with complicated
rules on how the information can be accessed and shared. In
addition, ingesting and processing paper documents simply
compounds the problem and adds to the cost.
Organizations usually ignore this part of patient management which
causes:
• Complex and time-consuming processes for getting patients into
the care management system
• Require manual data entry and document matching that delays
the payment process
• Increases the chance of errors during referrals, diagnostic orders
and patient scheduling.
Clearly, technology decreases the need for duplication of effort
for inputting patient information processing capability without
increasing headcount can deliver substantial cost savings.
Simplified healthcare administration
with ApplicationXtender and
ApplicationXtender Workflow Manager
ApplicationXtender gives clinical administrators a
comprehensive solution that streamlines all document
processing. It does this in a variety of ways, including a
central repository to capture and store all electronic
information. A central repository would seem an obvious first
step for organizations looking to improve operations.
But as fundamental as a central repository is, ongoing process
improvement requires workflow technology that facilitates timely
routing of invoices for approval, improves the accuracy of data
entry, and feeds key information directly into EMR and financial
systems. ApplicationXtender Workflow Manager addresses this
need to automate and control the processing flow and timeliness
of information being available to the right people.
Patient information forms can be scanned as they are received
either when a new patient arrives or for transfers added to the
system from various methods including Fax, emailed PDF or
completion of an e-form. This can then be added to your master
patient list, specific information extracted, then automatically routed
to appropriate personnel for clinical and billing support. Completed
service and referrals as well as any related documentation are
archived in the ApplicationXtender repository to ensure that both
long term accessibility and archival requirements are met-without
creating duplicates or secondary repositories for staff to search. AX
Workflow Manager deploys rapidly to reduce processing time while
boosting employee productivity and improving information
accuracy.
Figure 1 ApplicationXtender is organized based on what users are
doing so documents can be found across departments based on
information needs not department
To simplify deployment and reduce time-to-proficiency for
inputting patient details, AX Workflow Manager leverages an easy
to use drag-and-drop process builder to ensure that however
large or small your organization is you can design- and optimize
the patient information process to meet your current and long-
term needs.
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6. Combined with ApplicationXtender’s flexible architecture, AX
Workflow Manager can be tailored to meet the needs of virtually
any organization in any industry. AX Workflow Manager brings
improved speed, accuracy, and efficiency to each of the four key
steps in capturing patient information:
Capture from form
Metadata extraction for search
Routing to ensure awareness
Archive to reduce duplication of documents
Step One: Capture
With ApplicationXtender’s web scanning—and best of all, it’s
integrated seamlessly and natively with AX. The scanning feature
can be used either for a single patient file or as part of a batch scan
that is performed on a weekly, monthly or quarterly basis.
For larger organizations and those that want full automation of
document recognition (Intelligent Capture) ApplicationXtender has
a variety of out-of-the-box integrations into full capture solutions
including Captiva and OpenText Capture Center (OCC).
Figure 2 ApplicationXtender Web scanning can be used to input tags
and metadata that will make the document easier to find later.
Alternatively, for organizations ready to make the move to e-forms,
Workflow manager has a complete drag-and-drop forms building
engine that increases efficiency of the capture process by removing
and need for scanning and document review.
Figure 3 The Forms manager can build a form to automatically fill
known data based on completed information such as Patient ID or
can provide a drop-down of known entities such as accepted insurers.
Forms can also be presented on mobile device for self-service
The captured documents can then be directly routed to
ApplicationXtender Workflow Manager electronically captures
invoices and other paper documents.
Step Two: Metadata extraction
AX Workflow Manager enables cross system codes; internal
patient ID, government insurance IDs, last seen dates, etc to
be imported from existing systems and selected using pull-
down menus. This accelerates data entry and improves
accuracy for your patient support team.
As part of your organizations move to digital it also means that
self-service models for patient form fill-out,appointment
scheduling and other kiosk style activities are flagged and
reviewed by your internal staff for follow-up without making
patients wait for simple tasks to be completed.
Step Three: Routing to ensure awareness
Once patient information has been captured, basic metadata has to
be added to ensure that the document can be found later and
stored with the appropriate security. AX Workflow Manager can
automatically route the document or even just snippets of
information to the appropriate individuals for action. For example,
many small clinics require a basic medical background document to
be completed prior to their first appointment.
If a clinic used a tablet based e-form the information would be
captured, saved in the patient’s file and front desk staff would be
made aware that the patient was ready for their appointment.
Another common process point is ensuring that when diagnostic
results or imaging are completed that the internal staff are aware.
For clinical staff, there will be the need to review and approve that
the patient should be rescheduled for a follow-up appointment. For
Front of the house staff, knowing that results are in- but not being
able to view the results ensures that they can respond to patient
questions while preserving patient privacy with regards to test
results.
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Figure 4 The workflow designer has simple drag-and-drop menu of
items to ensure that stakeholders have a chance to review the
process prior to its implementation
7. ApplicationXtender Workflow Manager delivers end-to-end
visibility and control throughout every step of any process. It
helps managers maximize resource utilization while:
• Reducing process cycle times
• Optimizing both clinical staff time as well as
patient experience
• Streamlining information flow between
document management and enterprise
applications
Step Four: Archival
AX Workflow Manager creates a summary report, which is
attached to the original patient document for storage. An index
record points to the same document for each piece if information
regarding that patient, including patient ID, insurance provider(s),
etc. It can even be attached to payment or billing directives
depending on how integrated you want the workflow to be with
your EMR and financial systems.
The patient information document can be stored securely in the AX
repository, which will enforce the organization’s record-keeping,
information governance, and retention policies. This also ensures
that when the document is updated- or replaced that the
associated information is updated- and vice versa when the EMR
or financial systems are updated, the associated patient
information is flagged and updated.
Where the interconnected document and workflow management
provides true value is in circumstances where a patient has not
been seen in a long time. Often staff will not know if the patient is
in the system or where the most recent document is being kept.
The advanced search that includes both scanned and e-forms can
reduce duplication without purging the system.
Figure 6 The search feature can look across all types of information
both inside a document and metadata based on a single search term
ApplicationXtender Workflow Manager– a
functional overview
ApplicationXtender Workflow Manager provides a strong
collaborative platform for designing, executing, managing, and
monitoring automated processes. AX Workflow Manager includes
four modules:
• Process designer
• Forms designer
• Management console
• Workflow analytics
Process designer
AX Workflow Manager’s graphical process designer is a 100-
percent web-based tool similar to Microsoft® Visio® and requires no
client software installation. Business users can employ the process
designer to model simple or complex process flows with drag-and-
drop ease. The process designer also offers wizards to simplify
process modeling and definition for the average user.
AX Workflow Manager follows industry standards such as Business
Process Modeling Notation (BPMN), ensuring that process models
are interoperable and easily understood. Processes can be
created, modified, and maintained throughout the process lifecycle
in the process designer environment. AX Workflow Manager offers
a superior platform for developers and knowledge workers to
collaborate on highly complex applications. Developers can also
enhance AX Workflow Manager’s capabilities by creating custom
activities they can share with knowledge workers when desired.
Human workflow capabilities
AX Workflow Manager’s modeling environment allows creation of
interactive human workflows right out of the box. It provides
comprehensive support for more than 40 patterns of work
allocation and task performance. Tasks can be assigned directly
to users, Active Directory® groups or roles, to a custom user
directory, or via business rules associated with a task.
Users can perform tasks on the web (through SMS, instant
message systems, and mobile devices) and, on or offline, with
Microsoft desktop applications such as Outlook®. In addition, AX
Workflow Manager supports group-based task allocation for help
desks and sales teams and allows varying levels of automated task
allocation based on business rules.
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Figure 5 The build screen includes the tools to connect databases add
email routing as well as escalations as part of the process build
without complex coding
8. Queue management
AX Workflow Manager also provides queue management, which
allows groups of users to be identified as a common pool for task
allocation. AX Workflow Manager queue management has the
following features:
• Support for push-pull patterns
• Classification of participants by role or user
• Definition of access rights
• Queue level escalation
• Automated or manual allocation of tasks
Forms designer
Custom forms are integral to process workflows. They capture
critical information, facilitate collaboration and approvals, and often
trigger new workflows. The AX Workflow Manager forms designer
helps users achieve a better fit between their needs and the
business purpose of a form. Like process designer, forms designer
is 100-percent web -based.
It is a WYSIWYG editor that enables rapid design of even complex
forms and provides a range of design controls including text input,
Boolean inputs, drop-down menus, grids, panels, and tabs. In
addition, a form can display any document that resides in the AX
repository. With forms designer, it is easy to link forms to processes
and even call forms from within workflows. Forms designer can also
apply validation rules to form fields to eliminate data entry errors.
Management console
ApplicationXtender Workflow Manager offers centralized
process management through a unified console and enables
administrators to group processes via multi-level categories.
The management console functions as a repository for all
process types— ApplicationXtender processes, manual
processes, and other automated processes.
Figure 8 The Workflow manager has several administrative consoles
for both IT and business managers to simplify both system and
process management
Through the console’s task list interface, managers can also
coordinate tasks assigned to teams. In addition, the console
provides:
• Customizable process documentation templates
• A consolidated view of all process attributes such
as implementation status and process owner
• Version control, tracking, and auditing for process changes
• Workflows for process automation requests
Workflow analytics
ApplicationXtender Workflow Manager provides a number of
workflow analytic tools including activity monitoring, dashboard
views, trending reports, and user defined key performance
indicators (KPIs). Workflow analytics allow organizations to keep
a pulse on their workflows and business processes to ensure all
are optimized and running flawlessly to maximize operational
efficiencies.
Business activity monitoring
AX Workflow Manager’s business activity monitoring capabilities
deliver powerful analytical tools for process optimization. With
these tools, administrators can control process execution through
real-time notification of exceptions and SLA violations and support
improved business decision-making. They can identify and monitor
process bottlenecks, identify star performers, and dramatically
improve resource allocation.
AX Workflow Manager allows workflow execution to be displayed
in three views—analyst view, process view, and execution view.
BAM reporting features include:
• 3-D graphs with drill-down capabilities
• Comprehensive statistics on process performance
• Detailed productivity and trend analyses
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Figure 7 In addition to the drag and drop features, the forms
designer has the ability to auto-fill from other databases like the
EMR, ERP system or even custom databases