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Three recent studies have identified that clinicians – doctors and nurses – are spending less than 50% of their time on direct patient care. Clinicians are spending the other half of their time on administrative work, and this raises the risk of clinician burnout . Those administrative functions include tasks such as faxing documents (in 2019), researching patient benefit eligibility, validating and coordinating benefit coverage with insurance companies, and documenting information in an electronic medical record system for payment from payers. There are solutions that can help alleviate the administrative burden and subsequent burnout.
Today, payers and providers speak different languages and use different tools, which has proven challenging when translating clinical and financial needs. Interoperability platforms, such as InterSystems HealthShare®, provide the ability for payers and providers to translate their partners’ communications in near real-time. They enable the exchange of information automatically as data, not images or faxes. Exchanging information as data allows for greater automation of decision-making, and creates the ability to more efficiently perform administrative tasks like prior authorization, inpatient admissions review, and documentation for claims payment.
This exchange also opens the door to machine learning and other data science advancements. Incorporating artificial intelligence for improved decision-making is part of InterSystems’ new IRIS platform, and will help identify payers and providers address additional administrative inefficiencies in the future.
What is the true value of interoperability?
The administrative constraint on clinical staff time imposed by EHR clinical updates, procedures coding & billing, and external communications applies to a $3.5 Trillion portion of the U.S. economy. While it’s not possible to eradicate all clinical staff time dedicated to administrative work, there is a nearly $2 Trillion medical system capacity argument to be made for automating tasks to free physicians to deliver medical care. Cutting that number in half, thirds, or even eighths would still make an impact. Solving these problems will accrue savings year over year. While this provides macro level value, there is also value at the micro level.
To the physician delivering care, the value is reduced administrative burden, which is directly related to physician burnout and satisfaction. The late nights and tasks that take them away from direct patient care are creating an epidemic of dissatisfaction amongst medical practitioners . This burnout also adds to employer and individual patient costs as the systems attempt to meet payer and provider productivity needs.
To the individual patient, the value of interoperability is medical care delivered where their doctor has a complete picture of their health history. Imagine a world where you walk into a doctor’s office and they already have a complete picture of your health history including chronic conditions and specialists, or a loved one is rushed to the emergency room and those first responders are aware of medicines prescribed or drug allergies. Interoperability can literally save lives through real-time data exchanges.
So, where do we go from here?
Payer and provider organization CIOs spend billions of dollars each year on software and hardware, yet the daily work in both organizations remain heavily reliant on fax machines and phone calls to accomplish tasks. It’s a decades-old problem in which solutions have not improved the outcome of our healthcare system – this includes attracting additional physicians to the profession, medical errors, provider satisfaction and burnout rates, customer satisfaction rates, and the cost of medical care.
In effect it is an act of “will”, not technology, across payer and provider organizations to solve the problem. So where do we begin? Where is the appetite for replacing manual with automated process and open the door to the 21st Century?
Join my colleague, David Braza, Premera’s Executive Vice President, Chief Financial Officer, and Chief Actuary, together with Jeff Rivkin, Research Director for Payer IT Strategies at HIMSS19. They’ll be discussing the future of payer-provider collaboration in the Rosen Center, Salon 10, on Wednesday, Feb. 13, from 12 – 1:30 p.m. More information on the session here.
About the Author
Colt Courtright leads Corporate Data & Analytics at Premera Blue Cross, where he is responsible for strategies that impact its 2.1 million members, 38,000 physician network, and self-insured employers such as Amazon, Microsoft, Starbucks, Expedia, Weyerhaeuser and other household name companies.
Colt brings over 20 years’ experience performing new product innovation, supporting strategic partnerships, and overseeing advanced analytics and data management solutions. Recently this has included initial product deployments for companies such as Landmark, MOBE, Quartet, Vim/BookMD, Collective Medical Technologies, and Cardinal Analytics. Colt has direct responsibility for real-time EMR clinical data exchange, data warehouse, data lake, data science, and business intelligence production environments, along with sales, marketing, clinical, and operational analytic and reporting teams.
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InterSystems blogs are authored by members of the InterSystems team as well as guest bloggers. Our blogs will provide a range of opinions that we hope you will find useful, engaging, informative – and fun to read.