An Essential Intelligent Framework for Regulatory Compliance Management in the Public Sector: The Case of Healthcare Insurance in Egypt

Abstract

In process-centric public enterprises, the business process (BP) is at the center of value-delivery of public services to the citizens. Governing public enterprise BPs requires the ability to control and guide BP activities according to applied laws. Ensuring compliance of processes with legal regulations becomes a critical government requirement. This paper proposes an ontology-based framework for regulatory-compliance management that provides an integrated view of the law architecture model, public enterprise model, and BP lifecycle to enable the design of compliance solutions that cover the full business process compliance lifecycle, i.e., design time, runtime, and offline monitoring and analysis. The proposed framework is based on an integrated semantic model representing the business process model and administrative laws concepts which provide a shared conceptualization of the BP activities and the related legal rules. This work seeks to lay down the requirements of an integrated architecture for semantic regulatory-compliance management in the context of the BP management lifecycle. The focus of this paper is the design-time compliance approach. Our proposed design-time compliance solution was validated using a running example from the Universal Health Insurance program of Egypt.