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Decision Services in Healthcare Case Study

Challenges with clinical guidelines documents such as information overload, varied implementation and difficulty to maintain led this leading healthcare provider to adopt a new approach using decision modeling to develop clinical decision services.

With a decision management approach, the studies and research available could be combined into a single decision model. This could then be used to deploy some standard decision services, available on the enterprise infrastructure, to make decisions whenever and wherever needed.

The organization is a not-for-profit health plan providing a wide range of services, including inpatient, home health, hospitals, hospice, pharmacy, and insurance.  10M+ members, 17,000 doctors and nearly 200,000 total employees.

This project used our standard methodology to:

  • Run discovery workshops involving actual business owners – in this case, heart surgeons and heart transplant specialists –to describe the decisions involved and their business context.
  • Model and refine decision models in DecisionsFirst Modeler, our decision modeling software. This revealed more granular and reusable decisions as well as the input data and knowledge sources involved.
  • Transform decision models into executable decision tables. As the model stabilized, decision tables were added to IBM’s Operational Decision Manager BRMS using the web-based editor and each table was linked to a specific decision in the decision model using our integration between DecisionsFirst Modeler and IBM ODM.
  • Deploy an ODM Decision Service that could be called from processes or from a UI such as that used by the Doctors.

The methodology is available from Decision Management Solutions and is configured to fit with an organization’s other approaches based on experience with a decision modeling effort running in parallel.

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