Question

Model the business process described below using Bonita BPM software. Answer all questions at the end. You can assume that communication with customers, doctors, and insurance companies is done by telephone. This means that you do not need separate pools; focus on the process within the pharmacy. You should make reasonable/sensible assumptions about the information on prescriptions, information about insurance, and information about drugs. Include what you think is necessary for a realistic process.

Consider the following process at a pharmacy.

Customers drop off their prescriptions either in the drive-through counter or in the front counter of the pharmacy. Customers can request that their prescription be filled immediately. In this case, they have to wait between 15 minutes and one hour depending on the current workload. Most customers are not willing to wait that long, so they opt to nominate a pick-up time at a later point during the day. Generally, customers drop their prescriptions in the morning before going to work (or at lunchtime) and they come back to pick up the drugs after work, typically between 5pm and 6pm. When dropping their prescription, a technician asks the customer for the pick-up time and puts the prescription in a box labelled with the hour preceding the pick-up time. For example, if the customer asks to have the prescription be ready at 5pm, the technician will drop it in the box with the label 4pm (there is one box for each hour of the day).

Every hour, one of the pharmacy technicians picks up the prescriptions due to be filled in the current hour. The technician then enters the details of each prescription (e.g. doctor details, patient details and medication details) into the pharmacy system. As soon as the details of a prescription are entered, the pharmacy system performs an automated check called Drug Utilization Review (DUR). This check is meant to determine if the prescription contains any drugs that may be incompatible with other drugs that had been dispensed to the same customer in the past, or drugs that may be inappropriate for the customer taking into account the customer data maintained in the system (e.g. age).

Any alarms raised during the automated DUR are reviewed by a pharmacist who performs a more thorough check. In some cases, the pharmacist even has to call the doctor who issued the prescription in order to confirm it.

After the DUR, the system performs an insurance check in order to determine whether the customer’s insurance policy will pay for part or for the whole cost of the drugs. In most cases, the output of this check is that the insurance company would pay for a certain percentage of the costs, while the customer has to pay for the remaining part (also called the co-payment). The rules for determining how much the insurance company will pay and how much the customer has to pay are very complicated. Every insurance company has different rules. In some cases, the insurance policy does not cover one or several drugs in a prescription, but the drug in question can be replaced by another drug that is covered by the insurance policy. When such cases are detected, the pharmacist generally calls the doctor and/or the patient to determine if it is possible to perform the drug replacement.

Once the prescription passes the insurance check, it is assigned to a technician who collects the drugs from the shelves and puts them in a bag with the prescription stapled to it. After the technician has filled a given prescription, the bag is passed to the pharmacist who double-checks that the prescription has been filled correctly. After this quality check, the pharmacist seals the bag and puts it in the pick-up area. When a customer arrives to pick up a prescription, a technician retrieves the prescription and asks the customer for payment in case the drugs in the prescription are not (fully) covered by the customer’s insurance.

With respect to the above process, consider the following questions:

1. What type of process is the above one: order-to-cash, procure-to-pay or issue-to-resolution?

2. Who are the actors in this process? Who are the customers?

3. What are the tasks of this process?

4. What value does the process deliver to its customers?

5.What are the possible outcomes of this process?

6.Taking the perspective of the customer, what performance measures can be attached to this process?

7.What potential issues do you foresee this process might have? What information would you need to collect in order to analyse these issues?

8.What possible changes do you think could be made to this process in order to address the above issues?

Answer 1

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1. What type of process is the above one: order-to-cash, procure-to-pay or issue-to-resolution?

The process involved in the process above is order to cash.

Order to cash is a business process that follows the following steps given below: -

(i). Customer requirement arises (prescription of drugs).

(ii). Sales order created and reviewed (prescription forms dropped at the pharmacy so that orders can be collected).

(iii). Order confirmation and delivery processing (all medicines collected and insurance reviewed and sealed by pharmacist and kept in pick-up area).

(iv). Posting goods, billing and receiving cash (payment is taken from either insurance company or customer or both).

2. Who are the actors in this process? Who are the customers?

There are various categories of actors:

(i) Human actors.

(ii) Organization actors.

(iii) Software system actors.

(iv) Immaterial object actors.

In the given process, the actors are as follows:

(i) Human actors are the customers, technicians, phamacists, and the doctors(sometimes).

(ii) Organization actor is Insurance company.

(iii) Software system actor is pharmacy system.

(iv) Immaterial object actor is the Insurance policy of the customer.

3. What are the tasks of this process?

The tasks of this process are:

(i). Customers get prescription from doctors.

(ii). Customers drop off their prescriptions at the pharmacy

(iii). Technicians collect the prescriptions and search for the drugs in their system

(iv). Technicians enter the prescription in the system to perform an automated check called Drug Utilization Review (DUR).

(v). Any alarms raised during the automated DUR are reviewed by a pharmacist who performs a more thorough check

(vi). After the DUR, the system performs an insurance check in order to determine whether the customer’s insurance policy will pay for part or for the whole cost of the drugs

(vii). Once the prescription passes the insurance check, it is assigned to a technician who collects the drugs from the shelves and puts them in a bag with the prescription stapled to it

(viii). Then bag is passed to the pharmacist who double-checks that the prescription has been filled correctly

(ix). After this quality check, the pharmacist seals the bag and puts it in the pick-up area

(x). When a customer arrives to pick up a prescription, a technician retrieves the prescription and asks the customer for payment in case the drugs in the prescription are not (fully) covered by the customer’s insurance.

4. What value does the process deliver to its customers?

The process delivers the faster delivery of accurate medicines to the customer.

5.What are the possible outcomes of this process?

The possible outcomes of this process are:

(i). Shorter wait times.

(ii). Quality service.

(iii). Money management.

(iv). Less hassle.

6.Taking the perspective of the customer, what performance measures can be attached to this process?

(i) Result obtained from the system regarding co-payment system may determine the customer satisfaction.

(ii) Higher the customer satisfaction, greater will be the business performance.

(iii) In terms of perspective of the customer, the chief performance measures can be how much time taken to get the drugs ready, the quality, availability and the brand of the prescribed medicines and the amount they must pay out of their pocket matters the most.

7.What potential issues do you foresee this process might have? What information would you need to collect in order to analyse these issues?

Potential issues:

Pickup time might get packed as a lot of pickup takes place between 5-6pm

The automation process might show warning for critical or emergency prescription which may create problems later on.

Information in order to analyse issues:

How many prescriptions are ready in time.

Total number of prescriptions needed to be delivered.

Proper information of importance of the prescriptions.

8.What possible changes do you think could be made to this process in order to address the above issues?

Some of the changes that could be made are:

i. More staffs could be accommodated to interact with the customers.

ii. Wait times could be reduced.

iii. Availability of medicines should be up to date.

iv. Cross checking should be increased to avoid mismatching.