Design Patterns for Case Management

Designing a business process management (BPM) application to address your organization's document processing challenges can be overwhelming. Using a "case management" construct as an organizing principle can often simplify the challenges associated with complex decision-intensive processes.  The theory and practice of case management can be applied to every industry. Claims processing—whether for insurance or for health care—makes this point particularly well.

The case management approach offers several important features:

• A virtual case file aggregates diverse assets into a single entity that can be acted on as a unit. This structure simplifies tracking and processing the dozens of documents and data points associated with each case. For example, the question of when a document can be removed from the archive can be resolved by applying a retention policy to the case, which eliminates the requirement and time of manually tracking and purging each record;
• The ability to enable and track the asynchronous, parallel activities of multiple actors on a case. The amount of time saved on this improvement, compared to a linear workflow, will provide a tangible return on investment; and
• The flexibility to manage all three models of automation: straight-through processing (STP); process worker orchestration; and knowledge worker guidance. Claims weren't suited to the STP systems of yesterday, because the process is too decision-intensive. There is a common pattern to processing a claim, but each claim is unique and may incorporate unanticipated complexities that aren't known until the case work commences.

Claims-processing applications are inherently complex, because they must accommodate the various decisions that information workers make. This complexity makes the development of such applications an excellent candidate for using design patterns rather than starting with a blank canvas or using out-of-the-box applications or templates. The lack of a strong blueprint at the onset of application design can lead to poor architectural and usability decisions. Design patterns simplify the development process, because people in related industries have thought through the myriad permutations of each process step. For example, designing the case initiation step for new claim submissions requires thinking about:

• What constitutes a valid submission;
• What criteria would cause an initiation to fail; and
• What data must exist to move to the next stage of the life cycle?

These questions are similar to those within cases managed by social services within the public sector or loan originations within financial services organizations. Assembling applications from pre-built components according to design patterns provides best practices across industries and the flexibility to fit a single process within a single organization.

This flexibility means that there's a bit of work to go from a design to a running application, but case management development platforms such as EMC Documentum xCelerated Composition Platform (xCP) provide both the business-level solutions patterns that help organizations map their case process and the supporting design patterns that specify the method of implementation. Here is an example:

When designing a virtual case file for claims, there are known patterns around how to define and apply policies. To identify those relevant patterns, you need to consider a series of questions concerning who, what, where, when and how. The answers to each of these questions can be directly associated with a set of design patterns, which show you exactly how to assemble this part of the application.

• Who has access to the case's information;
• Which milestones define when a case can progress to a new phase; and
• How can case workers seek assistance or delegate tasks to other workers?

These patterns can also address more technical aspects of application design, including:

• How can the system interact with external databases; and
• How can claims be initiated from smart phones?

Partners have proven the success of this methodology by building solutions that assemble and configure pre-built components according to the relevant solution patterns for claims processing. For example, Paragon Solutions scans paper documents, captures information from claim forms, validates the data against information contained in external systems and routes the claim to the appropriate processor—all without manual intervention. By using solution patterns as a case management recipe book, your organization can also model and build a claims-processing application that incorporates best practices and enforces policies while maintaining the flexibility to reflect an organization's unique pattern of work and culture.

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You can see the design patterns that support these questions at EMC's online community at community.emc.com/go/xcp.