Performance, Scalability and Maintenance: An Experimental Study of RPA vs. Autonomous Agents in the Healthcare Domain

Robotic Process Automation (RPA) is widely used to reduce administrative burden in United States hospitals, yet an estimated 30-50% of RPA initiatives underperform because processes are selected informally, without a repeatable method to catalogue candidates, prioritize them, match each to an automation tier -- a Python bot, an open-source orchestrator such as n8n, or an enterprise platform such as UiPath -- and forecast financial return before committing resources. We propose a four-module, data-driven framework unifying these decisions: a Process Taxonomy of twenty recurring hospital processes across five value streams; a Prioritization module deriving an Automation Suitability Index from an Analytic Hierarchy Process matrix with an explicit consistency check; a Tool-Tier Selection module recommending the least-cost technology sufficient for a process complexity, integration, and compliance profile; and a Return-on-Investment module quantifying labor savings, error-cost avoidance, payback, and net present value. Applied to a synthetic portfolio spanning all twenty processes, plus a reference data-flow architecture linking it to hospital EHR/payer/ERP systems: 12 of 20 clear the prioritization threshold; the ranking is robust to +/-20% weight perturbation (Spearman correlation 0.83, top-5 set preserved 97.7%, 2,000 Monte Carlo trials); an Automation Risk Index flags four qualifying processes as Critical risk; a budget-constrained portfolio optimization shows diminishing marginal NPV as spend scales from $400K to$1.03M; and a second Monte Carlo analysis shows portfolio NPV stays positive at its 5th percentile. The framework is a conceptual synthesis of the literature rather than an instrument calibrated on primary hospital data; we discuss HIPAA governance and a research agenda for empirical validation. A supplementary Python implementation accompanies the paper.

End-to-end automation of realistic healthcare operations stresses three capabilities underrepresented in current benchmarks: policy density, decisions must be grounded in a large library of medical, insurance, and operational rules; Multi-role composition: a single task requires the agent to play multiple roles with handoffs; and multilateral interaction: intermediate workflow steps are multi-turn dialogs, such as peer-to-peer review and patient outreach. We introduce $χ$-Bench, a benchmark of long-horizon healthcare workflows across three domains: provider prior authorization, payer utilization management, and care management. Each task hands the agent a clinical case in a high-fidelity simulator of 20 healthcare apps exposed via 87 MCP tools, which it must drive to a terminal status through tool calls and writing the role's artifacts, guided by a 1,290+ document managed-care operations handbook skill. Across 30 agent harness/models configurations, the best agent resolves only 28.0% of tasks, no agent clears 20% on strict pass^3, and executing all tasks in a single session slumps the performance to 3.8%. These results raise the hypothesis that similar gaps are likely to surface in other policy-dense, role-composed, irreversible enterprise domains.

Large Language Model (LLM) based agents have demonstrated proficiency in multi-step interactions with graphical user interfaces (GUIs). While most research focuses on improving single-task performance, practical scenarios often involve repetitive GUI tasks for which invoking LLM reasoning repeatedly, i.e., the ReAct paradigm, is inefficient. Prior to LLMs, traditional Robotic Process Automation (RPA) offers runtime efficiency but demands significant manual effort to develop and maintain. To bridge this gap, we propose AutoRPA, a framework that automatically distills the decision logic of ReAct-style agents into robust RPA functions. AutoRPA introduces two core innovations: (1) A translator-builder pipeline, where a translator agent converts hard-coded ReAct actions into soft-coded procedures, and a builder agent synthesizes robust RPA functions via retrieval-augmented generation over multiple trajectories; (2) A hybrid repair strategy during code verification, combining RPA execution with ReAct-based fallback for iterative refinement. Experiments across multiple GUI environments demonstrate that RPA functions generated by AutoRPA successfully solve similar tasks while reducing token usage by 82% to 96%, significantly improving runtime efficiency and reusability.