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Utilization management is "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision," as defined by the Institute of Medicine [1] Committee on Utilization Management by Third Parties (1989; IOM is now the National ...
In healthcare, the flow of a patient between healthcare professionals is considered as a workflow - with activities that include all kinds of diagnostic or therapeutic treatments. The workflow is considered as a case, and workflow management in healthcare is to handle these cases. Case handling is orthogonal to content-oriented workflows.
Revenue cycle management (RCM) is the process used by healthcare systems in the United States and all over the world to track the revenue from patients, from their initial appointment or encounter with the healthcare system to their final payment of balance. It is a normal part of health administration. The revenue cycle can be defined as, "all ...
Workflow is a generic term for orchestrated and repeatable patterns of activity, enabled by the systematic organization of resources into processes that transform materials, provide services, or process information. [1]
Process denotes the transactions between patients and providers throughout the delivery of healthcare. Finally, outcomes refer to the effects of healthcare on the health status of patients and populations. [2] Avedis Donabedian, a physician and health services researcher at the University of Michigan, developed the original model in 1966. [3]
Process represented in XPDL (healthcare domain example, Hepatitis A immunization) [1] The XML Process Definition Language (XPDL) is a format standardized by the Workflow Management Coalition (WfMC) to interchange business process definitions between different workflow products, i.e. between different modeling tools and management suites.
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