RPA in healthcare: use cases, benefits, and challenges

Insurance claims management is a process that hospitals have to deal with daily, and as the number of patients grows, the staff often struggles to handle hundreds of claims in time.

Instead of manually transferring information between the insurer’s website and a revenue cycle management system, RPA bots can streamline this tedious, rule-based process, automatically accessing external systems, processing claim data, and updating the hospital’s RCM solution or any other applicable system. Empowering most of the claim processing steps with RPA, healthcare organizations can save up to 30%, according to McKinsey.

Upon discharge, patients need to fill prescriptions and follow discharge instructions. Ensuring that the patient follows post-discharge guidelines is a critical yet cumbersome task for healthcare providers. For example, people often suffer from various surgery side-effects ranging from headaches to nausea, which calls for the prescription of specific medications and follow-up appointments. 

RPA robots can ensure that discharge guidelines are followed as intended and remind patients about upcoming appointments and prescription pick-ups. Such approaches to post-discharge management have proven to be useful for HCAHPS score improvement and an overall enhanced patient experience.

RPA in healthcare is also useful for carrying out compliance-related tasks. For example, at AstraZeneca, a dedicated team follows up with healthcare professionals to understand how the medicines they produce impact patient care. To substitute manual handling of paper documents for adverse event (AE) report creation, AstraZeneca delivered an RPA-based solution for AE management. As a result, the company increased its productivity 20 times, enhanced employee satisfaction, and improved response rates from healthcare professionals.

RPA can also be used for compliance audits. Every action of a bot is recorded, providing transparency for auditors and leaving structured data for further analysis. RPA bots can also be configured to automatically create reports and route them to appropriate managers and departments.

Since in-hospital check-in is still essential to many healthcare providers, some hospitals turn to RPA-enabled self-service kiosks. Upon arrival, people can input their information into a self-service kiosk for further triage by front-desk employees.

With more sophisticated RPA software, the basic triage using patients’ conditions and statuses can also be done by bots. This way, front-desk employees receive a list of patients organized by priority, significantly reducing check-in times.

Apart from reducing friction and improving patient experience, self-service kiosk integration is a significant step towards more optimized data collection.

Clinicians heavily rely on medical records in making decisions. However, hospitals still struggle to keep data updated across all healthcare systems and departments, and manual data transfer between different applications leaves room for mistakes and data breaches.

For example, lab employees usually transfer medical test results from the lab’s system to a patient’s profile by hand. Instead, an RPA bot can automatically put the results into any relevant system. This ensures 100% information accuracy, decreases data breach risks, frees employees from doing mundane work, and keeps patient records synced and updated.

Additionally, RPA helps strengthen data security as the software stores only bot-related activity reports while keeping patient information confidential.

Achieving appropriate staffing levels every day is a complex task for hospitals that have to prevent personnel burnout and understaffing while meeting their budget.

RPA can help hospital administrators coordinate schedules, manage attendance, and monitor employee performance between different systems. Bots synchronize data across all staff-related systems to obtain performance, payroll, FTE, and other related metrics.

Healthcare providers deal with numerous bills and payments, including those for doctor visits, tests, medicines, hospital stays, etc. To settle payment or receive reimbursement from insurance companies, healthcare providers also aggregate and use various data types, such as disease codes, prescriptions, and information from medical records, all from different sources.

RPA bots can be used to streamline the complicated billing process by automatically creating invoices based on the services a patient received, significantly speeding up billing, making pricing transparent for customers, and preventing errors.

Nurses can spend a lot of time searching for lost hospital equipment. In addition to nurse work inefficiency, equipment misplacement can cause delays in treatment delivery, including emergency cases.

Hospitals can combine RPA software with digital sensors to help staff locate devices, check inventory, and monitor equipment condition. The same RPA-based tracking strategy can be applied to locating organs intended for transplantation, allowing more precise surgery planning and seamless operation.

With vast amounts of useful data on their hands, healthcare organizations streamline internal research by employing RPA tools. Bots can be programmed to input patient data and prepare it for analysis to help healthcare professionals make more accurate diagnoses and offer individual treatment for each patient.

To ensure medical aid consistency for returning patients, healthcare providers should keep clear and easily-accessible records of their previous visits and treatments. Manually digging in multiple registers or looking for an Excel sheet with old data requires too much time and effort and does not always turn out successful.

RPA tools can record patient data from the moment of registration and save all further patient information, enabling hospital staff to access and extract necessary data in just a few minutes. Based on RPA-enabled reports, physicians can track medical case histories and offer personalized treatment plans for different patients.