Business Rules and Decision Management in Healthcare

The Mortgage Feature Set (MFS)

For organizations that underwrite and sell mortgages, Trisotech is enhancing its Digital Enterprise Suite (DES) with mortgage industry specific (Regulatory and GSE) extensions.

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The Mortgage Feature Set (MFS) option offers fully integrated features and functions that allow organizations to model and automate their decisions and workflows more efficiently.

Critical GSE and Regulation Z decisions and workflows are made available. These critical rules and supported decisions are gleaned from more than 500 pages of GSE and Federal Regulations.

MFS Sample Models

For mortgage underwriters/creditors that sell their mortgages to Fannie Mae or Freddie Mac, all the critical decisions mandated in Fannie Mae’s Selling Guide and Freddie Mac’s Seller/Server Guide are included for the conventional and HomeReady™ products.

Fannie Mae Sellers Guide Knowledge Models

  • Fannie Mae Conventional Products
  • Fannie Mae HomeReady™ Products

Fannie Mae Sellers Guide Required Decision Models

  • Complete Sellers Guide Decision model for pre-qualification and preclosing
  • B2-1 Loan-to-Value (LTV) Ratios
  • Loan Level Price Adjustment
  • B5-1 High-Balance Mortgage Eligibility and Underwriting
  • B3-5.1 General Requirements for Credit Scores
  • Eligibility Matrix
  • B7-1 Mortgage Insurance Coverage Requirements
  • B3-1 Manual Underwriting

Freddie Mac’s Seller/Servicing Guide Models

  • Complete Sellers Guide Process model for pre-qualification, preclosing, and presales
  • 4603.2 Super Conforming Mortgage Eligibility and Underwriting
  • 4203.2 Loan-to-value (LTV) Ratios (Calculation of LTV Ratio)
  • 5203.1&2 Indicator Score and General Requirements for Credit Scores
  • 4702.1 Mortgage Insurance Coverage Requirements
  • Exhibit 25 Risk Class and/or Minimum Indicator Score Requirements
  • Exhibit 19 Credit Fees

Also included is the important Ability to Repay the decision model from Regulation Z.

Regulation Z

  • Regulation Z decision models
  • 12 CFR 126.43 Ability to repay (ATR) Decision Model
  • 12 CFR 126.43(C)(2)(vi) Monthly debt to income ratio

MFS Knowledge Features

The Mortgage Feature Set provides various common concept models that can be re-used for mortgage model creation. These concepts can be dragged-and-dropped into decision models (DMN), workflow models (BPMN), and case model (CMMN). The concepts can also be linked to any terms in the labels of various model elements. Users can modify the pre-configured entries and create additional entries.

A number of such common concept models include:

Uniform Mortgage Data Program® (UMDP®) Knowledge Entity Model

This Knowledge Entity Model contains concept maps along with definitions of the various concepts associated with Uniform Mortgage Data Program® (UMDP®). The Uniform Mortgage Data Program (UMDP) is an effort undertaken jointly by Fannie Mae and Freddie Mac at the direction of the Federal Housing Finance Agency (FHFA) to enhance mortgage data quality and standardization.

Mortgage Acronyms Knowledge Entity Model

This dictionary of mortgage terms and acronyms was created from the Uniform Services Veterans Mortgage list of mortgage terms and acronyms.

Other concept models are also available in support of provided specific mortgage workflow and decision models.

MFS MISMO Specific Features

The Mortgage Industry Standards Maintenance Organization (MISMO) is a not-for-profit, wholly owned subsidiary of the Mortgage Bankers Association (MBA) responsible for developing standards for exchanging information and conducting business in the U.S. mortgage finance industry.

MISMO Glossary

This Knowledge Entity Model contains a set MISMO related concepts sourced from the MISMO Business Glossary-Term List. Each provided term comes with a definition and source. Focus areas include:

  • Appraisal
  • Closing Disclosure
  • Commercial
  • Data Governance and Management (DGM) Fit For Purpose
  • eMortgage Glossary
  • MISMO Logical Data Dictionary (LDD)
  • Loan Application
  • Loan Delivery
  • MBA Glossary
  • MISMO3.4 iLAD
  • MISMO3.4 ULAD
  • MISMO Approved Acronym
  • MISMO Life of Loan
  • Origination
  • Servicing

Predefined MISMO Data Types

Trisotech provides out-of-the box MISMO aligned data types that can be assigned with one click to elements in Decision models (DMN), Workflow models (BPMN), and Case models (CMMN).

The MISMO Accelerator

The MISMO Accelerator is a comprehensive set of predefined MISMO element structures provided as reusable drag and drop data structures. Simply drag the desired MISMO element to a Decision (DMN), Workflow (BPMN) or Case (CMMN) modeling canvas to obtain an element of that type.

MFS Additional FEEL Functions Features

A complementary library of FEEL functions is included in the Mortgage Feature Set to make the development of financial analysis logic more efficient. Examples of functions added with the Mortgage Feature Set option include:

  • annual interest rate
  • annual nominal interest rate
  • asset depreciation
  • cumulative interest payments
  • cumulative principal payment
  • decimal fraction to decimal number
  • decimal number to decimal fraction
  • depreciation for accounting period
  • discount as percentage
  • effective annual rate
  • first coupon date after settlement
  • fixed rate declining balance asset depreciation
  • future Value
  • future value schedule
  • installments interest
  • interest payment
  • internal rate of return
  • last coupon date before settlement
  • modified internal rate
  • net present value
  • number of coupon dates between settlement and maturity date
  • number of coupon days in coupon containing settlement date
  • number of days from settlement date to first next coupon date
  • number of days in coupon from beginning to settlement date
  • number of periods
  • particular payment
  • payment
  • present value

Mortgage Feature Set (MFS)

Mortgage Feature Set (MFS) is an option of the Digital Enterprise Suite

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From Laws and Regulations to Decision Automation

Providing complete traceability and accountability.

Presented By
Tom DeBevoise
Simon Ringuette
Description

Regulations are a set of obligations that apply to corporations and individuals. They can be established through laws or under the authority of a governing body. Regulations may explicitly define processes and rules, but often they prescribe outcomes or performances without detailing how to achieve them.

When an organization must comply with a regulation, it aligns its operations with the obligations specified in the regulation. Compliance is the action of ensuring this alignment. However, demonstrating compliance can be a challenge because organizations must be able to trace their implementation back to the regulation.

To create traceability, a knowledge entity model (KEM) is developed. This model represents the regulation using vocabulary, concept maps, and business rules. The KEM is derived from the text of the regulation, breaking it down into vocabulary terms, concept connections, and business rules.

Using the KEM, an automated solution can be created using decision automation and business process automation (DMN and BPMN). This solution links the business rules to the decision or process as a knowledge source, creating a traceable solution.

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What is Low-Code/No-Code/Pro-Code?

Low-Code No-Code (LCNC), or low code no code as it is sometimes written, refers to how to make an app – computer and mobile applications – that doesn’t require traditional programming skills (Pro-Code.)

Conceptually, using no code platforms, anyone can figure out how to create an app using a few clicks. With low-code solutions, power users and subject matter experts (citizen developers) can build applications using a business-friendly expression language, and, of course, pro-code solutions utilize programming languages like JavaScript, Java, Python and C# where professional development teams are the app creator.

Simply put:

No-Code

=

drag-and-drop and clicks

Low-Code

=

business friendly expression languages

Pro-Code

=

programming languages

Low-code/no-code adoption is a very rapidly growing pillar of the digital transformation movement. With the growing shortage of professional developers, and the increasing requirements for business agility, application leaders are setting up environments where anyone can be a developer. According to Forrester, low-code platforms have the potential to make the software development process up to 10 times faster than traditional development methods.

What is No-Code?

A No Code app builder enables citizen developers, sometimes called business technologists, to create applications without using a programming language. Gartner defines a citizen developer as “a user who creates new business applications for consumption by others using development and runtime environments sanctioned by corporate IT”. Citizen developers can drag-and-drop reusable components, connect them together, and create applications.

A no-code approach empowers citizen developers. No-code platforms are designed to help non-programmers create applications with no coding at all and are often used to replace, or even enhance, what would otherwise have been achieved using a spreadsheet. They are also used for simple websites.

Spreadsheets, while powerful, don’t lend themselves to creating an application with a rich user interface. But no-code applications can create an attractive user interface using forms for an application on top of a backend powered by a spreadsheet or a database.

Some of the primary reasons organizations utilize low-code platforms are that: they can build applications 6 to 10 times faster, they can build apps without pro-developers (a scarce and expensive resource), and, the production of no-code applications become up to ten times more affordable.

What is Low-Code?

Low-code and no-code both provide drag-and-drop functionality through an easily navigable graphical user interface (GUI) that pro and citizen developers can use to create applications without having to write thousands of lines of code. Unless you are developing only the simplest applications and require little in the way of customization or connection to existing systems, low-code will always be a better option than no-code.

Low-code development allows for customization using a simple expression language using spreadsheet-like functions. This minimal coding approach enables more skilled power users and SMEs on low-code platforms to customize their application more than a no-code platform. Low code platforms are also good for developing sophisticated applications that can run mission-critical processes. It is also good for building mobile and web apps that require more complex integrations with both external and internal systems.

Three generic types of low-code platforms are emerging. Low-code application platforms (LCAPs) that provide a graphical user interface development experience for citizen developers. LCAPs are a solution to growing application demands from the business and IT budget-related problems. Model Driven Platforms (MDPs) such as BPMS, DMS, and BRMS are low-code technology platforms that implement, manage, and automate business logic, decisions, and processes. MDPs offers visual notations that make them simple enough for citizen developers while being expressive enough for professional developers. Finally, Multiexperience Development Platforms (MXDPs) as Low-code development tools used in multiexperience development platforms. As defined by Gartner, MXDPs use low-code development to increase the productivity of application development in different touchpoints such as web, mobile, wearables, chatbots, augmented reality (AR) and virtual reality (VR).

What is Pro-Code?

Pro-code refers to the use of traditional programming languages such as Java, JavaScript, C#, Python, etc. to create applications. Pro-code allows development of complex prototypes and production systems from the ground up. These applications can build new and existing legacy system connections into the new application and tailor applications to fit precisely within the organization’s architecture. There is no need for the potential compromise sometimes required with low-code and no-code platforms. Since this work is done by IT technology staff, the application structure is thoroughly understood by the development team, and they can easily troubleshoot and correct bugs.

A significant factor in the emergence and growth of low-code/no-code platforms is the result of high demand for new digital applications. Such new apps are part of the wave of digital transformation initiatives in practically every organization. These organizations are turning to low-code/no-code solutions because professional developers are needed on other more complex projects, hard to find, expensive to employ, and because learning traditional programming takes a lot of time and training. LCNC solutions, on the other hand, allow non-technical employees (citizen developers) to assemble application logic even if they don’t know traditional programming languages.

The ability to build applications has historically been designated to professional coders, however, low-code and no-code technology has democratized the skill and ability to build applications such that anyone can do it.
LCNC in Financial Services

LCNC in Financial Services

Some might say that the birth of low-code solutions came with the introduction of spreadsheets, a mainstay of the financial community.

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Going beyond the conventional column and row model of accounting ledgers, spreadsheets offered the ability to write formulas for advanced calculations and later, more and more sophisticated functions far beyond row or column sums and averages. It was the beginning of macro functions and if/then logic processing for non-programmers. This, in turn, led to an explosion of uses for spreadsheets far beyond simple accounting tasks, spawned the proliferation of user-built “applications”, and created a new class of business technologist – the power-user.

Today, with the ever-increasing demand for mobile and online banking services, financial services organizations including retail and commercial banking, insurance, mortgage, investments, etc. need to constantly re-engineer customer offerings just to remain competitive. Several standards groups are providing a way to make transactions and financial processes compatible across many organizations. Examples include MISMO™ (Mortgage Industry Standards Maintenance Organization) and FIBO® (Financial Industry Business Ontology). These standards also help low-code vendors create predefined data structures and templates that citizen developers can use.

In the financial services industry, access to customer and market data and the ability to analyze it and personalize it for specific customers is critical. The needed flexibility and efficiency to create these apps is often not available in legacy systems. Combine that with issues like the fierce war for talent raging in the financial industry, development backlogs for requested and required custom applications, slow IT turnaround times, and programmer burn-out, it is easy to see why financial services businesses are turning to low-code/no-code platforms and citizen development as a way forward.

The nature of much of the financial services world centers around cyclical and mundane tasks, month after month, quarter after quarter and year after year. This takes its toll on application developers and line workers alike. About 0.3% of the world’s population are professional software developers, yet everyone is capable of problem solving. Low-code/no-code solutions put application building and how to code an app in the hands of the people who need to solve the problems, rather than only in the hands of professional software developers. This is a very attractive option for people who want to do meaningful work that utilizes broad skill sets and will help with both recruiting and retaining top-performing people. As citizen developers, finance professionals with an interest or skills in business technology can make an impact and become stand-out employees.

This is all great news. McKinsey & Company projects that personalization can lead to 15% revenue growth for companies in the financial services sector. By empowering financial services employees to help create personalized applications, citizen development gives people of all technical abilities the tools to solve business problems using low-code application development. This isn’t just a fad, it’s the future of work.

Trisotech LCNC
in Financial Services

Trisotech is a MISMO™ (Mortgage Industry Standards Maintenance Organization) partner and provides DMN and BPMN technology to that standards group. Trisotech also provides BPMN extended modeling support in the form of no-code drag-and-drop “Accelerators” for the MISMO and FIBO (Financial Industry Business Ontology) standard data structures. Trisotech financial clients include governments, insurance organizations, mortgage finance organizations, loan originators, retail and commercial banks, stock trading exchanges, credit card organizations, real estate brokers, investment brokerage houses and more.

Building low-code financial apps requires access to advanced computational and logical capabilities. Trisotech supports the only international standard expression language perfect for low-code developers – FEEL (Friendly Enough Expression Language) published as part of the DMN (Decision Model and Notation™) from OMG, an international standards body.

LCNC in Healthcare

Whether you believe that “today, all companies are software companies” or that “software is eating the world,” one thing we know for certain is that health and care services are changing, so their IT solutions must change as well.

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LCNC in Healthcare

Healthcare automation needs have become so critical and pervasive that to address these concerns head-on, a community of practice, BPM+ Health, has been created. BPM+ Health was established based on the use of open, standards-based notations including BPMN™ (workflow management) DMN™ (decision management), CMMN™ (case management), and other open IT standards which allows for all types of health organizations, professional societies, and vendors to document their care pathways and workflows, so they are sharable, discoverable, and automatable.

In this age of digital transformations, software is becoming increasingly strategic ad pervasive. Both new care settings and continuously changing medical and pharmaceutical advances are driving an explosion in the demand for new and updated applications yet professional programmers who can build and maintain this software has reached a critical shortage. Other industries are already adopting lowcode and nocode platforms to speed the creation of applications, reduce the backlog, and make application development more affordable. Because professional software developers are an increasingly scarce and expensive resource, everyday employees are stepping up as “citizen developers.” These power users and SMEs already have the domain knowledge needed to rapidly compose their needed applications using low-code tools. The healthcare software revolution is behind the curve and low-code development is rapidly becoming the best option to catch up. However, even as low-code platforms advance, pro-code professional developers will still be needed to create the more complex features and integrations required in healthcare.

Most current Electronic Health Record systems (EHRs) are increasing the burden of work on doctors and other care team members primarily because they are neither agile nor provide for innovation capabilities. Surprisingly, while virtually every other business sector is utilizing these new technologies, little is developed with low-code or no code in healthcare. Low-code solutions would seem to lend themselves to patient portal apps, common patient care apps or even complex back-office systems. Using low-code, care givers and other subject matter experts (SMEs) don’t need to learn a professional programming language to create apps but only need to learn an app where they set configurations in a graphical user environment and sometimes a simple expression language. Low-code app development is therefore faster and far less expensive. Using low-code platforms, developers can use agile methods to test the new and changing needs of providers and patients directly during the development cycle. Since low-code platforms provide simple ways to invoke other applications or components via RESTful API calls, apps can easily integrate with existing IT systems and standards such as HL7®, FHIR®, CDS Hooks™, SMART™, and SMART on FHIR allowing new functionalities to be added to existing systems with little or no disruption to current operations.

A hallmark of the healthcare industry is the diversity and volume of data needed to provide the vast array of clinical, administrative, and insurance services patients and caregivers have come to expect while controlling the costs of those services. Just creating and maintaining a comprehensive data layer accessible to all is a major and ongoing undertaking. Add to that the hundreds, if not thousands, of applications, APIs, and interdependencies, the complexity is nearly overwhelming. Emerging standards like FHIR may help. Still, by using low-code composable apps along with FHIR and other data sources, organizations and their citizen developers may be able to modernize faster and more affordably by assembling their own vendor-neutral digital platforms.

Trisotech LCNC
in Healthcare

Trisotech is a founding member of BPM + Health which includes BPMN, as well as DMN and CMMN, as an integral standards technology. Trisotech healthcare clientele include international and U.S. acute care hospitals, healthcare insurance organizations, HMOs, renowned teaching hospitals, PPOs, and healthcare professional organizations.

The Trisotech Healthcare Feature Set (HFS) is an optional set of advanced low code development functionalities extending the Trisotech Digital Enterprise Suite with healthcare-specific additions. Through a combination of these new features and functions, healthcare organizations can now access FHIR®, SMART™, and SMART on FHIR capabilities as well as AI and Machine Learning (ML) in their modeling and automation of model-driven applications. Predefined FHIR Data types (simple, complex, and special purpose) are provided as no-code reusable drag and drop data structures that can be assigned as data objects in model-driven applications and autogenerated SMART on FHIR webapps can be created from automations stored in the Digital Enterprise Suite (DES) Service Library.

Building low-code healthcare apps requires access to advanced computational and logical capabilities. Trisotech supports the only international standard expression language perfect for low-code developers – FEEL (Friendly Enough Expression Language) published as part of the DMN (Decision Model and Notation™) from OMG, an international standards body.

Another no-code feature is the Attended Tasks extension. The Trisotech Attended Task feature allows for validation and confirmation of the inputs and/or outputs of any automated task by the care provider user or any other designated performer. This feature ensures that a knowledgeable human expert can correct/modify information in real time during apps execution.

Trisotech also provides nearly 1,000 pre-built evidence-based workflow and decision models including care pathways, clinical guidelines, and healthcare calculators using the the BPM+ Health standard. These models can be quickly and easily modified to fit the exact nature of anorganization’s policies and procedures. Healthcare organizations can also create their own apps from scratch with the easily understood visual Workflow Modeler (BPMN) that can be shared by IT, practitioners, SMEs, and business people – LCNC citizen developers.

1,000
free pre-built evidence-based workflow and decision models

Trisotech and LCNC

Digital Enterprise Suite

Many of the well-known low-code development platforms are business process management platforms.

BPM has long supported model-driven development (MDD) as how to build an app — where you first diagram the way the software should work before building it. The most popular process development standard supported by most BPM platforms is BPMN. Trisotech is a world leader in model-driven low-code business automation solutions and an active contributor to the BPMN standard. Trisotech whose Workflow Modeler (BPMN) is known as the reference implementation for BPMN modeling tools, also supports the DMN and CMMN standards with graphical modelers and the Trisotech Business Automation Suite of engines for building and automating low-code applications and packaged business capabilities (PCBs). Trisotech provides the only international standard expression language perfect for low-code developers – FEEL. FEEL (Friendly Enough Expression Language) is published as part of the DMN (Decision Model and Notation™) specification from OMG®, an international standards body. Finally, Trisotech provides free application modeling tools through self-service trial subscriptions.

The Trisotech platform provides no-code, low-code, and pro-code capabilities that your organization can configure and utilize to best fit your needs. By providing a spectrum of developmental options, Trisotech Digital Enterprise Suite can help close the Business-IT divide by creating a collaborative and cross-functional environment where both professional developers and citizen developers can work together to build stunning apps. These applications are quick to develop, cost far less than traditional programming methods, and integrate easily with existing legacy systems and data sources as well as new technologies like Machine Learning (ML), Artificial Intelligence (AI), and industry standards such as MISMO™, FHIR, and CDS clinical decision support.

Low-Code/No-Code/Pro-Code

Trisotech
Low-Code No-Code Differentiators

Trisotech’s business automation architecture is built upon SaaS cloud technologies including API-first design which allows for the invocation of services (applications, processes, or packaged business capabilities) from practically any programming language in mobile, cloud, and on-premise server environments. These automated services are scalable with very high-performance. The services and automation engines are also structured to provide full support for today’s complex availability needs including containerization and docker technologies. All low-code no-code application development – modeling and automation – is completely browser based and can be run in any modern browser environment including Chrome, Edge, Safari, Firefox, etc. Automation servers can be hosted by Trisotech, or Clients including on-premises and public/private clouds like AWS, Azure, Google, etc. Advanced configurations allow for 24 X 7 operation, concurrent geographic dispersion and failover, and containerization operating environments.

The Trisotech low-code no-code development and automation platform

provides many meaningful features and capabilities for citizen developers to create an app that other platforms do not.

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Low-code/No-Code/Pro-Code

These include:

OMG®, BPMN™, (Business Process Model and Notation™), Decision Model and Notation™, (DMN™), CMMN™, (Case Management Model and Notation™), FIBO®, and BPM+ Health™ are either registered trademarks or trademarks of Object Management Group, Inc. in the United States and/or other countries. MISMO™ is a registered trademark of Mortgage Industry Standards Maintenance Organization, Inc. HL7®, and FHIR® are the registered trademarks of Health Level Seven International and the use of these trademarks does not constitute an endorsement by HL7.

CDS Hooks™, the CDS Hooks logos, SMART™ and the SMART logos are trademarks of The Children’s Medical Center Corporation.

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What Are Business Rules and Decision Management?

To meet the demand for enterprise automation over the last few decades, computer programs have become larger and more complex.

To simplify the building and maintenance of those programs, new programming paradigms have evolved. One central method of simplification has been to extract and standardize common computing tasks from the body of application programming source code. One of the first major abstractions was to replace custom data management in programs with Data Base Management Systems (DBMS). The next big movement replaced the step-by-step embedded procedure logic in individual programs with that of Business Process Management Systems (BPMS). Next came the abstraction of business rules which automated the policies by which organizations operated with Business Rule Management Systems (BRMS). The latest evolution is the replacement of BRMS with Decision Management Systems (DMS).

Business rules systems work on the principle of rules statements – a trigger then action paradigm – typically in the If->Then->Else style and usually defined in a proprietary “language” along with decision tables. Those rules are then processed when the trigger occurs by a Business Rules Engine (BRE). The tools to define the rules, version, deploy, execute, monitor, and manage them plus the engine are normally bundled together in a Business Rules Management System (BRMS). These systems are highly technical in nature and are usually owned and maintained by IT resources. Direct business subject matter expert involvement is usually quite limited. Instead, subject matter experts (SMEs) harvest or mine (discover) business rules from within the organization and define them as requirements specifications. IT then translates those requirements into rules statements.

Decision Management Systems work on the principle of defining business decisions where the decision answers a specific business question providing the result (output) of the decision based on the values of pre-defined input variables to the decision logic – typically in the Input(s)->Decision Logic->Answer (output) style. The most commonly used decision management technique is Decision Model and Notation (DMN) an international standard published and supported by OMG, an international, open membership, not-for profit technology standards consortium. DMN focusses on decisions – higher level business asset artifacts – that are meaningful to business subject matter experts (SMEs). DMN also provides the Friendly Enough Expression Language (FEEL), a simple but powerful way to provide logical, textual, mathematical, list processing, interval, date/time and other functions business people need to make decisions.

Decision Management differs from rules management in significant ways. The most important is that rather than just a collection of rules statements, decisions are specific, reusable business logic modules usually created and maintained by business subject matter experts. The DMN standard utilizes visual models which are standardized, verifiable, and where the model serves as the documentation and as the executable source for the Decision Automation Engine. Visual modeling by SME’s eliminates one of the major sources of business rules errors, the “translation” of SME-defined rules (requirements) to IT-created rules. With DMN both the SMEs and IT personnel are working with the same decision model.

Why Are Business Rules and Decision Management Used?

Busines Rules and Decision Management systems are used to free business people and subject matter experts from needing to know and use complex IT programming languages for creating and maintaining the automated policies and logic used to make operational decisions that run their business. By abstracting these rules and decisions from conventional IT application programs and processes, rules and decision systems allow non-IT personnel to create a reusable “single version of the truth” while working directly with existing systems and IT. This abstraction facilitates not only more direct access by business people but also enhances the separation of concerns by making sure the correct people have access to the organization’s policies while providing IT access to the more technical implementation and integration requirements. Business Rules and Decision Management systems abstraction also provides ways to greatly speed up and simplify the creation of and changes to operational decisions resulting in better business agility.

While Business Rules Management Systems continue to be used, their shortcomings have become more pronounced over time. Among these shortcomings are a lack of standardization which forces customers into IT driven vendor-specific proprietary systems and requires higher cost, difficult to find technical personnel to operate. Most recently the advent of cloud computing and customer personalization requirements has disrupted most businesses causing an explosion of rules that has made rules logic more difficult to understand and maintain and that severely restrict agility. Because large business rules repositories contain many thousands of individual rules, they are notoriously difficult to validate and test so heavy step-by-step IT technology involvement is needed and that continuously widens the gap between IT and business subject matter experts.

Decision Management systems based on the DMN standard are, on the other hand, visual model driven, verifiable, standardized, are easily shared between business subject matter experts and IT personnel. A business decision is a reusable tangible business asset that can be automated directly from the visual model without IT translation. Comprehensive visual models in DMN are readable by both IT and business people, serving as a decision specification, the decision logic, the decision documentation, and the automation code – all in a single visual artifact.

Business Rules and Decision Management in Healthcare

Business Rules and Decision Management in Healthcare

The Healthcare industry is very large and extremely diverse including front-line workers – the caregivers and providers – and multitudes of back-office workers.

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Large-scale healthcare organizations are often linked businesses combining and networking physicians, acute care hospitals, long term care facilities and insurance organizations. All these organizations need secure standards-based software to help them store and retrieve data as well as standardize and centralize workflows and decision making across all parts of their business.

Healthcare is also a highly dynamic sector with constant change being generated from regulatory requirements, new procedures, new medicines, new insurance rules and rapidly evolving technologies. Every healthcare organization must be able to quickly set guidelines and policies associated with their data and tailored to their respective delivery systems and business models against which quality of service, cost containment, and patient satisfaction can be directly measured and continuously improved.

Business rules and decision management systems have been used to improve clinical guidelines, care management, prior authorization, billings and payments, off-label prescription policies, fraud management, actuarial and risk management insurance calculations, call center scripting, incorporating AI/Machine learning into decision making, complex process automation pathing and many other applications. Decision Modeling and automation, in conjunction with clinical decision support (CDS), is being used to deliver real-time clinical decision support (CDS Hooks) for providers during their patient encounters. As a result, the providers are able to consider alternative diagnoses, treatments, and potential cost-saving measures for their patients.

Other examples include hundreds of healthcare calculators like BMI, FEV/1, LACE, PEARL, DECAF, Framingham Diabetes Risk, etc. and outside agency preauthorization requirements like Medicare Home Oxygen reimbursement, conventional insurance pre-authorization for Total Knee Arthroplasty (TKA), and internal organizational policies on off-label drug use evaluation and approval. Models like these require multiple decisions, often needing specific patient data. Some of these decisions are based on preset external requirements like Medicare policies and some are specific to the decision-making organization’s policies. One size does not fit all, so the models, to be effective, must be well documented and easy to change to reflect changing policies. Business rules and decision management system solutions allow healthcare organizations to easily define and deploy these examples and many more solutions tied to evidence-based best practices.

Healthcare automation needs have become so critical and pervasive that to address these concerns head-on a community of practice, BPM+ Health™, has been created. BPM+ Health was established based on the use of open, standards-based notations including DMN (decision management) and other open IT standards which allows for all types of health organizations, professional societies, and vendors to document their care pathways and workflows so that they are sharable, discoverable, and automatable.

Trisotech is a founding member of BPM + Healthcare and Trisotech healthcare clientele include international and U.S. acute care hospitals, healthcare insurance organizations, renowned teaching hospitals, and healthcare professional organizations.

The Trisotech Decision Modeling and the Decision Automation Engine provides healthcare providers with centralized, easy-to-understand and change standard process and decision methodologies. These tools adhere to international standards for building processes and decisions and support other standards like FHIR® (HL-7®) for data storage and retrieval, CDS Hooks for real-time decision support at the point of care and PMML execution for the inclusion of AI and Machine learning into automated decision models.

1,000
free pre-built evidence-based workflow and decision models

Trisotech also provides nearly 1,000 free pre-built evidence-based workflow and decision models including care pathways, clinical guidelines, and healthcare calculators in the BPM+ Health standard that are being put into practice every day. These models are human-readable, machine automatable, and embeddable in most medical encounter systems. Healthcare organizations can use these models, created under the direction of Trisotech CMO John Svirbely, as they are, or quickly and easily modify them to fit the exact nature of their organization’s policies and procedures. Healthcare organizations can also, of course, create their own processes and decisions from scratch since the easily understood visual models can be built and shared by practitioners, IT and business people.

Business Rules and Decision Management in Finance

Business Rules and Decision Management in Finance

The financial industry is facing an accelerating pace of change with Fintech start-ups, increasing regulations, and disruptive new business models.

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Financial institutions need to rapidly adapt to this new reality and accelerate their digital transformation to meet and exceed their clients’ expectations. Those unable to do so will inevitably lose market share to emerging new companies or competitors able to transform more rapidly. For example, incumbent lenders that still use manual and paper-based loan approval procedures have faced a hard stop when their employees were forced to work remotely.

There is widespread use of business rules and decision management systems in finance. Like healthcare, much of the financial industry is highly regulated at both the federal and local levels and requires stringent compliance and reporting. Furthermore, these regulations are frequently changed and differ from place to place. Managing the sheer volume of these requirements is a significant component of business costs.

The use of business rules and decision management systems in finance includes a nearly endless list of key policy and procedure decisions including regulatory compliance, regulatory risk assessment, operational risk assessment, general and specific underwriting, cross selling and up-selling decisions, complex process automation pathing and the utilization of standards such as the Mortgage Industry Standards Maintenance Organization (MISMO), the Financial Industry Business Ontology (FIBO), Real Estate Standards Organization (RESO), and the Association for Cooperative Operations Research and Development (ACORD) standard in the insurance and other industries.

Some common examples of business rules and decision management systems use in the financial sector include pricing decisions, claims handling decisions, complaint handling and mitigation decisions, risk mitigation decisions, product compliance decisions, compensation profit sharing and bonus decisions, and anti-bias decisioning. The use of business rules and decision management systems in controlling complex workflow paths is practically universal and decision management systems incorporating AI and Machine Learning is a very rapidly growing area.

Trisotech financial clients include governments, insurance organizations, mortgage finance organizations, loan originators, banks, stock trading exchanges, credit card organizations, real estate brokers, investment brokerage houses and more.

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Business Rules and Decision Management Offerings

Digital Enterprise Suite

Trisotech is a world leader in providing decision management solutions. Trisotech fully supports the Decision Model and Notation (DMN) standard for modeling and the Trisotech Decision Automation Engine for automating DMN models. This support includes full Conformance Level 3 compliance and supports the very latest version of the standard.

Trisotech’s Digital Automation Suite coupled with the Digital Modeling Suite is a decision management platform superior to any other product on the market. Its modern architecture is built around SaaS cloud technologies including API-first design which allows for the invocation of automated decisions from practically any programming language in mobile, cloud and on-premise server environments. These automated decision services are stateless, atomic and provide scalable high performance straight through processing. The automated decision services and decision automation engine are also structured to provide full support for today’s complex availability needs including containerization and docker technologies. The decision making platform’s modeling and automation is completely browser based and can be run in any modern browser environment including Chrome, Edge, Safari, Firefox, etc. Automation servers can be hosted by Trisotech, or Clients including on-premise and public/private clouds like AWS, Azure, Google, etc. Advanced configurations allow for 24 X 7 operation, concurrent geographic dispersion and failover, and containerization operating environments.

Trisotech has also expanded the decision management platform to include specific support for advanced technologies like AI/Machine learning with the inclusion of PMML models in the modeling environment and a PMML execution engine in the automation environment. Decision model creation, testing, administration and management as well as automation library management, administration, configuration, debugging, simulation and audit logging are all visual and browser based making Trisotech’s offering a complete decision management and automation solution.

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