The patient enrollment process across different systems was not unified. Each system had a different approach to enroll patients. This caused a problem with migrating patients between systems. Having an approach using a standardized API would streamline the enrollment process and enable patient records to be quickly migrated across systems. An API with a robust error handling mechanism would be necessary to receive data from different systems and manage patient data in Salesforce.
When a patient initially comes to a pharmacy/hospital with a prescription, they will either fill out information on a physical enrollment form, log the information in a front-end application or provide the information via phone on the IVR. The logged information contains the details of the patient, doctor, hospital, insurance and drug prescribed. The API should be able to read the patient information from these systems and enroll the patient successfully in the Salesforce system. On successful enrollment, the patient will be able to order the required prescription, this process is for patient eligibility.
Data segregation is performed and allocated to different objects in real time based on the system where we are loading the data and the nature of the system mapping.
Develop a generic API using MuleSoft that can read the patient information from different systems and convert it to a JSON request. The API performs data validation, logs the information into Salesforce, and completes the enrollment process (provided the patient information meets all criteria defined in the Salesforce system.) The API is reusable for different drugs and supports different processes such as new enrollment, updates to an existing enrollment, re-enrollment, and cancellation.
An API was developed using MuleSoft that can accommodate the varying business rules and mapping changes between the JSON request and Salesforce objects. The API is configurable in the MuleSoft application and can accommodate different programs. The Mule API configured in the backend of the source systems that receive the patient requests are automatically triggered once the information is submitted. The API then applies business rules specified in the config file which sends back a failure message to the client system in case of inconsistent data. If all business rules are successful, the mule application prepares the payload and logs the information to different objects in Salesforce. After the case passes through all the defined rules, it is successfully enrolled in Salesforce and a success response is sent. API can be reused with minimal changes for other projects.
- Since the system was completely configurable and reusable, coding was reduced for future implementations.
- The quality of the data was improved through communication with the client system.