Define the administrative scope
Salesforce Health Cloud includes utilisation-management capabilities for collecting information and supporting care-request review. The starting point is the organisation’s actual process, roles and product configuration. Software supports that process; this guide does not provide clinical decision criteria or a claim of improved patient outcomes.
Salesforce: Health Cloud utilisation management
Identify who submits a request, who checks completeness, who reviews it and who communicates the outcome. Qualified staff remain responsible for the relevant clinical and policy decisions. Do not treat a technically complete record as an approval of care.
Map a request through its exceptions
Document the normal path and the situations that interrupt it: missing information, a duplicate, a reassignment, a changed request or a need for further review. Each state needs an owner and a clear next action.
Use the product’s current care-request configuration and data-model documentation to check the proposed implementation. Confirm the necessary licences, permissions and integrations in the actual environment rather than assuming every Health Cloud installation has the same setup.
Salesforce: care-request configurations
Salesforce Trailhead: utilisation-management data model
| Area | Question for the process owner |
|---|---|
| Intake | What information is required, and how is missing information requested? |
| Assignment | Which authorised role owns the next review? |
| Status | Can staff distinguish waiting, active review and a recorded outcome? |
| Decision record | Where are the accountable reviewer, relevant evidence and decision recorded? |
| Follow-up | How are additional review and communication handed off? |
| Exceptions | Who resolves duplicates, access issues and integration failures? |
Design access around the task
Map the information each role needs and test the actual permissions. Include documents, integration accounts, exports and operational logs, not just the main Salesforce screen. An integration can expand access beyond what a well-configured page appears to allow.
Agree retention and data-exchange requirements with the organisation’s responsible privacy, security and clinical operations owners. A product name or vendor feature does not establish that a particular implementation meets all of the organisation’s obligations.
Make the handoff observable
Staff should be able to see whether a request reached the destination system and who is responsible for it. A failed integration must not appear as a completed handoff. Retain a useful error reference and a recovery route that does not duplicate the request.
If response targets apply, obtain their definitions from the accountable policy owner. Define how the workflow calculates and displays them, including exceptions. This guide does not prescribe clinical urgency, legal deadlines or coverage rules.
Use representative acceptance examples
- A complete request reaches the correct review role.
- An incomplete request stays visible with an assigned next action.
- A reassignment preserves the relevant history.
- An unauthorised user cannot access restricted information.
- A duplicate or failed transfer enters a recoverable exception path.
- A recorded outcome remains distinguishable from a draft or an incomplete review.
Use synthetic data for early demonstrations. Have the responsible staff validate both the routine path and the exceptions before considering a live release. Evaluate administrative measures such as missing information and unowned handoffs separately from any clinical outcome.
What discovery should produce
The useful deliverable is a workflow map, data and access requirements, integration boundaries, acceptance examples and a scoped implementation option. A demonstration alone cannot establish production readiness or compliance.
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Discuss a similar workflow
Bring a description of the process, the systems involved and one example of where work gets stuck. We can use discovery to establish the requirements, dependencies and next step before preparing a solution and estimate. Please leave private customer, applicant and patient records out of the website enquiry.