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BPM gets kicked up a notch with business event processing

Tom Brady, CIO of a clinical network for administering chronic biologic drugs, explains how business event processing allows his firm to coordinate the distribution and administration of meds to patients in real time and at substantial cost savings.

BOSTON -- Ready for some football analogies? CIO Tom Brady showed up in Boston this week, the day after the other Tom Brady was pronounced disabled on arrival -- and showed why technology is a game changer. CIO Brady was a featured player at an IBM seminar on business event processing (BEP), a no-huddle variation on business process management.

CIO Brady runs information technology at ActiveCare Network LLC (ACN), a 5-year-old startup that bills itself as the largest nationally integrated clinical network for administering chronic biologic drugs -- vaccines, insulin and other injected and infused medicines. The Bannockburn, Ill.-based company schedules people who need those injections at an appropriate location, clinic, in their home or, increasingly, on the road at the nearest drugstore pharmacy. And -- here's the game changer -- it also captures and manages the many events that impinge on that transaction.

The company started on the assumption that there was a shortage of health care providers and facilities to administer the drugs, Brady said. It turns out capacity isn't the big problem -- underutilization of the network of providers is, with big consequences for health care costs and patient safety.

According to Brady, much of the cost associated with drugs stems from how they are administered to patients. About 70% of chronic biologic drugs prescribed require clinical oversight; 30% require training for self-administration, he said.

The push in the insurance industry is to reduce costs of services associated with giving the drugs. When physicians are not reimbursed for giving shots, however, their response has been to either not write the prescription or to send patients to another caregiver, an outpatient clinic or a hospital, where the cost of that needle prick then includes a $900 room rate, Brady said.

Meanwhile the trend in biologic chronic drugs is away from single syringe doses to multvial shots. Home health care providers -- never mind patients who are instructed to stick themselves -- are often insufficiently trained to administer the new drugs. The result is that a lot of expensive medicine ends up literally on the floor, Brady said. He related the experience of the spouse of a company employee who, after years of using a single-dose treatment for rheumatoid arthritis, was sent a multidose prescription with no training. It took several times and something like $2,500 worth of medicine to get it right. But even patients with medicines that come shipped with excellent DVDs fail, it seems, because -- doh! -- it takes practice to learn to heal thyself.

Other factors inflate costs. Many drugs are perishable, but tracking when the prescription was sent out, if it arrived, or if it arrived with instructions to put it in a refrigerator has fallen far short of UPS- or FedEx-style levels of accountability. And the unaccountability costs more then money, Brady said, recounting a story of a kid who experienced an hypoglycemic reaction when he was prescribed a follow-up maintenance dose of a growth hormone because the doctor was not informed the patient never received the first prescribed dose.

"Here's where ActiveCare Network comes in," Brady said. And IBM.

ActiveCare's proprietary system, AccessPoint, uses IBM's WebSphere Business Events to coordinate the distribution and administration of biologic medicines to patients at some 10,0000 locations in the 38 states where pharmacists can give injections, at substantial cost savings. The company works with the facilities, using downtime to train nurses on procedures. Its online scheduling directs patients to locations nearest them at the time they can get treatment. Drugs can be tracked from prescription and delivery to administration with feedback to the prescribing physician. And, yeah, it saves money.

Company literature says that depending on the service, treatment fees are discounted 50% to 90% compared with treatment outside ACN's network.

"This is made possible because ACN leverages a health plan's negotiated specialty drug discount, eliminating drug markups, and provides services at a consistent and affordable rate, preventing costly hospital outpatient service fees," the company states.

Business activity monitoring technology and interactive dashboards is a big change coming.

Michele Cantara, analyst, Gartner Inc.

None of this would be possible without business event processing -- technology that can automatically track and analyze business conditions in real time and execute on that information.

Business event processing involves complex mathematics based on algorithms that produced many a Ph.D. thesis in the 1990s, and that are employed first and foremost by Wall Street trading firms to make an even bigger killing in the casino we call the stock exchange.

But even businesses whose profits do not depend on making a trade a tiny fraction of a second faster than the player down the road will likely have to come to terms with business event processing, as digital business information from email, voicemail, radio frequency identification and other sources explodes. IBM estimates that there are now up to 72 quadrillion unique business events generated each day.

IBM claims to have a lock on BEP, with some 3,800 customers and 63.8% of the market. But it's not the only company that thinks BEP is the next big thing. The explosion in business events from internal and external is pushing a shift from what Gartner Inc. analyst Janelle Hill calls enterprise computing to global-class computing.

In the opening session at Gartner's BPM Summit this week in Washington, D.C., Hill and colleague Michele Cantara laid out the differences between business process management in the age of enterprise computing and global computing. The handmade, rock-solid, built-to-last computing of enterprise days is just not up to the constant change businesses must deal with today. CIOs need to build lightweight, open, outward-facing, good-enough solutions that can monitor and handle process change. And a component of those systems will be technology that captures and monitors business activity in real time, correlates the events and adjusts course accordingly.

"Business activity monitoring technology and interactive dashboards is a big change coming," Cantara said.

Let us know what you think about the story; email Linda Tucci, Senior News Writer.

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