Go to Top

RPA in Healthcare – Healing the Healthcare Industry with RPA




Medical science has advanced rapidly, allowing life expectancy to increase globally, but as lifespans increase, healthcare systems face rising demands for services, rising costs, and a workforce that cannot meet patient needs.Spending on healthcare simply isn’t keeping up. The healthcare system will not be sustainable without significant structural and technological changes. Health systems need a larger workforce, but despite the economy creating 40 million new jobs in the health sector by 2030, there could be a 9.9 million physician, nurse, and midwife shortage in the global health sector over the same period, according to the World Health Organization. Hence we need to ensure their time is used where it adds most value—caring for patients. The Healthcare Industry is managed by highly skilled professionals and their time is extremely valuable. However approx. 40% of experts’ time is spent on non-value added activities. Enters Robotic Process Automation in Healthcare

RPA in Healthcare can help automate most of these monotonous, non-value added tasks and free up your healthcare professionals on more important activities – taking care of us!

Processes that can be automated in Healthcare using RPA with high accuracy, quality and in a timely manner. Medical science has advanced rapidly, allowing life expectancy to increase globally, but as lifespans increase, healthcare systems face rising demands for services, rising costs, and a workforce that cannot meet patient needs.

McKinsey & Company reports that “By 2050, one in four people in Europe and North America will be over the age of 65—this means the health systems will have to deal with more patients with complex needs. Managing such patients is expensive and requires systems to shift from an episodic care-based philosophy to one that is much more proactive and focused on long-term care management.

The Healthcare Industry is managed by highly skilled professionals and their time is extremely valuable. However approx. 40% of experts’ time is spent on non-value added activities.

Enters Robotic Process Automation – Automation in Healthcare

RPA in Healthcare can help automate most of these monotonous, non-value added tasks and free up your healthcare professionals on more important activities – taking care of us!

Processes that can be automated in Healthcare using RPA with high accuracy, quality and in a timely manner.

Application of RPA in Healthcare

  • Patient scheduling
  • Insurance claims
  • Case follow-ups
  • Health plan management
  • Staff Management
  • Data Processing
  • Data Entry & Migration
  • Prior Authorization Process
  • Medical Claim Process
  • Appointment Scheduling/ Cancelation/ Change
  • Recording audit and Regulatory Compliance

RPA Use Cases in Healthcare

RPA in healthcare can range from simple tasks like auto-generated email response to supporting single-click installations of complex software systems. Here are a few use cases of RPA in the Healthcare industry:

Use Case 1 – Patient Insurance Eligibility

The organization needed accurate and timely insurance eligibility verification for high volume, 100% manual processes to improve patient access and minimize delays in treatment; enabling clinics to perform the appropriate therapy services within the patient’s health care plan in a timely manner. RPA bots helped automate the manual processes, resulting in 100% reduction in manual errors and 60% decrease in man hours spent on these non-value added tasks.

Use Case 2 -Claim Management

Billing takes time after delivery of healthcare service due to the complexity of claim management tasks. It includes processes such as entering, processing, and evaluating documents and data. Additionally, RPA-led claim management can eliminate human errors in the claims processing process, along with automating time-intensive tasks. It is quite possible to achieve significant gains from automation even with partial automation in reducing cycle times, lowering operational costs, and improving the experience of members and providers.

Use Case 3 – Automating Patient Appointment Scheduling

Appointments are often scheduled online. The registration process requires healthcare institutions to collect personal information, diagnoses, and insurance details. Using patient data to schedule appointments can be tedious. A patient’s appointment must also be coordinated with different doctors’ schedules and their availability in hospitals. The appointment schedule of a pediatrician must be adjusted if the patient has to be diagnosed by him. Furthermore, the hospital staff needs to notify its patients in advance in case any doctors cannot attend to their patients. Scheduling patient appointments can therefore be challenging. RPA in healthcare can alleviate all concerns about scheduling patient appointments. Data collection and processing can be automated with RPA bots. This approach allows RPA bots to optimize patient appointments based on diagnosis, location, doctor availability, and other factors.

RPA in Action

Prior Authorization Process for Insurance Claims
Problem RPA Solution
1.Nurse enters the order/ prescription into an order entry system. 1.The bot will log-in into the EMR and navigate through a list of patients with prescriptions or procedures that have been requested by their doctors.
2.The nurse then identifies the patient and his/her insurance provider and validates if prior authorisation is required for the requested prescription or procedure. 2. The bot will review each patient request and then log into the insurance providers on-line portal to validate from the list of prescriptions and procedures if prior authorisation is required or not
3.The nurse accesses the insurance providers online portal and browses the list of prescriptions and procedures to determine whether prior authorisation is required. 3.If Prior authorisation is not required the bot will leave a notification that the prior authorisation is not required and move on to the next patient
4.If prior authorization is required then the nurse will begin collecting the required patient information from various healthcare provider systems to populate the prior authorization request. 4.If prior authorization is required, then the Bot will navigate to the prior authorization request form within the insurance providers online portal.

5.After completion, the prior authorization form is submitted to the insurance provider.

5.Populate prior authorization request form with the required patient information and submit.
Recording Audit Procedures
Problem RPA Solution
The auditing procedure involves multiple tasks for risk assessment. Such processes and their results need to be recorded to generate reports. These reports are sent to concerned parties for verification and approval. Such audits can be done for multiple objectives such as patient safety or quality of services. The reports generated during healthcare audits are necessary for regulatory compliance. Hence, collecting and evaluating multiple reports from different auditing tasks and collaborating with several concerned parties can be tedious. Also, errors in these reports can result in non-compliance of regulations. Audit procedures can be easily optimized by utilizing RPA in healthcare services. RPA bots can record data and generate reports during audits. The reports can be automatically shared with concerned parties for evaluation and approval. With RPA software, hospital staff can monitor the progress of these reports and check which personnel are pending to approve the reports. With this approach, RPA software can help healthcare institutions ensure accountability for different auditing procedures. In case of non-compliance, the person who approved the reports can be quickly identified using an RPA software.

Benefits of RPA in healthcare

Healthcare organizations that want to serve more patients and improve patient outcomes can use robotic process automation without significant expenditures or significant employee effort. We have compiled a list of RPA’s healthcare benefits that early adopters have reported:

A 2019 McKinsey Report highlights Robotic Process Automation as an emerging automation technology that’d completely revamp the current healthcare system. The same report speculates that timely RPA implementation would increase the annual revenue(to-be) between $350Bn to $410Bn by 2025.

Some of the benefits of RPA in the Healthcare industry are:

1. Increased Appointment Turnover : Healthcare facilities suffer substantial losses due to a huge majority of their patients not showing up or canceling the appointments last minute. Thanks to RPA, this can be significantly reduced by automation of patient scheduling and setting up appointment reminders by RPA bots. With such reminders, patients are less likely to forget their appointments. It inevitably enables the doctors and healthcare to provide better care to more patients and increase productivity and efficiency.

2. Enhanced Patient Experience : Enabling positive patient experience is extremely crucial for healthcare providers. Effective RPA implementation in Healthcare helps healthcare providers automate mundane, rule-based, repetitive tasks with RPA bots, automating and streamlining tasks like data-entry, appointment, patient tracking, insurance claims, etc. This automation allows for better patient dealing and enables them to offer a higher quality customer service.

3.Increased Employee Satisfaction : Assigning tedious, and mechanical tasks to your workforce can impact your employees’ satisfaction negatively and can lead to higher employee turnover. RPA bots enable healthcare workers to focus their time and energy on high-priority, discerning tasks, through automation of tedious and repetitive tasks.

4.Streamlined Workflow: There are several key aspects shared by healthcare providers and patients alike. These tasks include population wellness, case utilization management, and remote monitoring. The common theme amongst these tasks is that they all involve time-consuming and repetitive processes- a prime area for Robotic Process Automation.

A pioneer in the transition of healthcare to a digital industry, Craig Richardville argues that higher job satisfaction directly relates to better patient care as well as greater ROI for companies.

Contact Us