Problem Statement

A healthcare company specializing in prescription recommendations faced significant challenges in automating and scaling their clinical decision processes. Their system analyzed patients' clinical histories and personal details to provide health assessments, medication recommendations, and dosage guidelines. The company's operations involved:

1. Complex Clinical Rule Management: Applying intricate medical guidelines to personalize prescriptions based on patient data.
2. Data Integration Difficulties: Utilizing their own MongoDB databases alongside third-party lab vendors' data to generate accurate recommendations.
3. Resource Constraints: The process required extensive involvement from both business analysts and the tech team, leading to prolonged implementation times.
4. Limited Feedback Loop: The inability to quickly iterate on clinical rules hindered responsiveness to new medical insights and patient feedback.
5. Data Security and Compliance: Handling sensitive patient information necessitated strict adherence to healthcare regulations and data protection standards.

These challenges resulted in:

1. Extended Implementation Times: Developing and updating the prescription recommendation system took 2-3 months, delaying patient care improvements.
2. High Resource Consumption: Significant bandwidth from business analysts and tech teams was consumed, reducing overall operational efficiency.
3. Slow Adaptation to New Data: Limited ability to quickly incorporate new clinical data or research findings into the recommendation system.
4. Risk of Non-Compliance: Potential vulnerabilities in data security could lead to non-compliance with healthcare regulations.

Solution

The company partnered with Nected to transform their prescription recommendation process using Nected's low-code/no-code rule engine and workflow automation platform. The collaboration led to:‍

1. ‍Integration of Key Data Sources and Health Insurance Modules: Within a single day, the company connected their existing MongoDB patient records and third-party laboratory data to Nected using no-code API integrations. This comprehensive data pool now included not only detailed clinical history and real-time lab results but also coverage-related information from health insurance systems. By incorporating payer policies, prescription formularies, and eligibility checks for tiered medication coverage, the company ensured that each recommendation considered both medical necessity and insurance constraints.‍
2. Sophisticated Calculations Using Nected’s Formula Editor: With Nected’s intuitive Formula Editor, business analysts were able to create complex calculation models without writing a single line of code. They tailored dosing recommendations based on patient-specific parameters—such as weight, comorbidities, and adherence history—while factoring in insurance-related variables like formulary tiers, prior authorization requirements, and copay structures. These advanced calculations helped determine the most cost-effective and clinically appropriate medication regimens for each patient, improving both care quality and financial outcomes.‍
3. Automated Decision-Making with Nected’s Decision Table: Nected’s Decision Table feature empowered the team to codify intricate clinical and insurance criteria into clear, maintainable rules. By mapping patient health indicators, coverage eligibility, and payer guidelines directly into these decision tables, the company effortlessly generated personalized prescriptions and dosing schedules. Scenarios that previously required months of technical effort were now managed and iterated upon by non-technical staff within hours, ensuring that prescription recommendations stayed current with evolving clinical research and insurance policies.‍
4. Real-Time Workflow Automation and Feedback Loops: The company utilized Nected’s Workflow Automation to streamline the end-to-end prescription recommendation journey. As soon as patient data, coverage details, or medical guidelines changed, the workflows automatically recalculated recommendations and triggered alerts for any exceptions. This immediate feedback loop allowed the clinical and operational teams to adapt promptly to new insurer guidelines, incorporate emerging medication options, or respond to changes in patient conditions. The ability to rapidly test and deploy rule adjustments ensured that the system remained both up-to-date and highly responsive.‍
5. Self-Hosted Deployment for Security and Compliance: Given the sensitive nature of patient health information and the stringent regulatory environment of healthcare, the company opted for Nected’s self-hosted solution. By maintaining all patient and insurance data within a secure, controlled environment, they upheld strict data privacy standards and adhered to healthcare regulations (such as HIPAA) without compromising on system scalability or performance.

By leveraging Nected's platform, the company significantly improved operational efficiency, reduced implementation times, and enhanced their ability to provide personalized patient care.

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