To some of us, the COVID epidemic feels like it happened a long time ago. To others, it still feels like it was just yesterday. Whatever your recollection of that time, the pandemic undoubtedly changed both our personal and professional lives forever.
Background
In March 2020, I worked in the business process automation space, specifically with workflow orchestration and rules engines using no-code tools. Later in 2020, I had the opportunity to start my own small consulting firm with a former colleague. We focused on using lower cost, no-code tools to rapidly build applications for a variety of industries, delivering savings on licensing and development costs with a shortened time to market. Maintenance costs were lower, too, since non-technical people could easily take over and manage the tools we built. Today, at DecisionRules, I see this same pattern repeat across healthcare.
We helped one such business that handled COVID test reporting for all 50 states in the US. Various labs would perform tests, then report those results to the state health authority. As you can imagine, 50 states have 50 different formats. Manually translating each lab’s (which often operated across multiple states) format to the correct state format would be a time-consuming nightmare; coding a solution would probably take even longer with heavy technical debt.
The Use Case
This was before I joined DecisionRules, and the tool we used was not ours. What matters is the pattern, because I have since seen it repeat across healthcare organisations.
So what did the client turn to? A no-code rules engine. A rules engine provided an easy way to take in an input, like, “M,” “Man”, “m,” or other similar marker in a large healthcare report and transform it to the appropriate gender token for the state, which might require “Male”, “M,” or “m,” depending on the state. Submissions in the incorrect format would be rejected, so these transformations, as minuscule as they seem, were essential. For example:
| Text contains | State | Transform to | |
|---|---|---|---|
| “M” or “male” | VA | "m" | |
| “m” or “man” | SC | “male” | |
| “m”, “M”, “man”, or “Male” | NY | “male” |
Why a rules engine though? This marker for gender was one of 100s of markers that all had a particular format and valid values for each state. Building an application from scratch would take 10,000s of lines of code vs. simple tables that could be built by a lay-person and maintained as requirements changed. Markers for gender, age, ethnicity, diagnosis, treatment, and other values could be quickly sorted through Excel-like, visual tables.
Through the implementation of a rules engine, the business saved over $200,000 in engineering costs and lost revenues by quickly onboarding new labs.
Oftentimes, we who work with computers disassociate from the real-world applications of our work. We’re typing on computers while the doctor is actually treating patients. In this case, however, it was easy to see how, even from behind a screen, this agility was helping save lives by providing states with the most up-to-date data so they could respond quickly.
This is just one simple example of a rules engine application in healthcare. In my years of experience working with rules engines, I’ve also seen how they can transform several other areas in the industry.
Clinical Trials
My mom recently recovered after a difficult bout with cancer. Taking her to daily treatments, I was astounded by the hospital’s innovation and technology. I thought back to my time working with a global drug manufacturer in Switzerland. The development of new drugs and therapeutics (especially for cancer) depends on clinical trials to prove those treatments are safe and effective, and these clinical trials are notoriously expensive and rigorous.
Firstly, the clinical trials had to recruit people from many different parts of the world with different demographics, so they relied on labs locally in many countries. The issue? Every lab had a different reporting framework (similar to the COVID reporting). The solution? A rules engine can act as a massive accelerator for patient recruitment by translating the results to a standard format.
Secondly, the trials had to recruit people who matched rigorous demographic and clinical eligibility criteria.
With a rules engine, researchers can fill cohorts in weeks rather than months by instantly translating records and cross-referencing patient records against complex eligibility criteria.
This speed translates to massive financial gains; when a drug launch is delayed, companies can lose millions in daily revenue. According to a 2020 JMIR study, trial delays cost between $600K and $8M a day.
More importantly, by automating these protocols, organizations stop burning cash on manual data sorting and start getting life-saving treatments to market faster, to patients like my mom.
Want a real world example? Download this template in a free trial.
Care pathways
What’s the first question a lot of people ask me during the evaluation of a business rules engine? “How are you using AI?”
This contrasts sharply with what one general counsel of a major healthcare provider network recently told me: “We see value in AI - but the moment it makes a treatment decision based on a best guess - we’re opening a legal Pandora’s box.”
Don’t get me wrong - AI is opening a world of possibilities, but in clinical settings, rules engines serve as a digital safety net for evidence-based medicine (and DecisionRules does leverage an AI Assistant to help build the deterministic rules that are important in the high-stakes environment of a hospital, as well as a bunch of other cool features).
They turn static medical guidelines into "living" pathways that guide doctors through the best possible treatment steps in real-time - deterministic, repeatable, auditable rules - and not probabilistic guesses based on AI.
The ROI here is found in the reduction of clinical variation - essentially ensuring every patient gets the "gold standard" of care. This doesn't just save lives; it slashes costs by reducing hospital readmissions and shortening patient stays. When protocols change, administrators can update the rules globally in minutes, avoiding the logistical nightmares.
Want to see it in action? Check out this Care Pathways template.
Insurance
Once, I worked with a third-party payer out of Minnesota that had 1000+ rules on prior authorization and eligibility in SQL stored procedures. Their issue was every time the rules changed for a certain provider, it took nearly a month to update, test, and deploy a new rule. The current reality drifted from the hard-coded rules, leading to billing errors and unhappy customers.
In the world of insurance, rules engines can be the engines of "straight-through processing" that have minimal tech debt. Traditionally, claims and prior authorizations involve a mountain of paperwork and human intervention, costing payers a fortune in administrative overhead.
By automating these decisions with a rules engine instead of hard-coded rules, companies can process the vast majority of claims instantly and accurately - and make updates in days, not weeks or months. The result is a dual win: the insurer slashes the cost per claim and patients get billed the correct amount, each time.
What does this work like in action? Take a look at this Insurance template.
The Future of Healthcare Agility
Whether it’s streamlining data across 50 states during a pandemic or accelerating the next breakthrough in drug development, the common thread is agility. Rules engines bridge the gap between complex logic and human execution, allowing organizations to pivot instantly without the weight of technical debt.
Business people can own logic while technical people still run the integrations and deployment. Both teams can test and pull audit trails for compliance.
Ready to Build for What’s Next?
Don't let rigid codebases and manual processes slow your impact. If you're looking to reduce engineering overhead and bring much-needed speed to your healthcare decisions, let’s talk about how a rules engine can transform your operations. I’m happy to share what I’ve seen over the years.
Bracey Parr is a DecisionRules Expert, where he works closely with organizations to design, implement, and optimize scalable decision automation systems. He has nearly 10 years of experience in transforming complex, hard-coded business workflows into high-performing, transparent rule engines, enabling companies to decouple their operational logic from legacy software and move at the speed of modern business.