My medical records manifesto: A bridge between payers and providers

ECM-VNA-3

While I was visiting one of our largest payer customers, we talked for some time about how long their organization has been using our product and what challenges they were looking to overcome with it in the future. We also talked about automating the usual suspects: Claims, enrollments, provider credentialing and other hot spots.

Then, someone casually said, “But medical records are the real nightmare.”

I asked if they could tell me a little about how their process worked.

Today’s medical records process

“For a variety of reasons, we need a medical record,” she said. “Sometimes, we need them for pre- or post-pay claim reviews, appeals, medical reviews or other reasons. That’s when the fun begins.”

I noted a touch of irony. She continued, detailing the payer’s process today:

  • Start the process by completing an eform. The form goes through a fairly streamlined workflow management process and results in the mailroom printing and mailing the medical record request letter.
  • The hospital receives the letter in their mailroom. They slice, open, prep, batch the letters together, scan and index them. The hospital then routes the letter electronically to the Release of Information (ROI) department.
  • The ROI team works its queues, entering the information into the EMR solution. In this case, the solution is a combination of Epic and OnBase. Ultimately, the team creates a medical record document that is automatically routed to the mailroom where it is printed, then mailed, overnighted or couriered back to the health plan. The file can be hundreds or thousands of pages.
  • When it comes back to the health plan, the paper dance begins again. The mailroom slices, opens, preps, batches, scans and indexes them back into a workflow and routes it the original requestor, usually a nurse or doctor.

Really?

I was more than a bit surprised. This was in 2013. And we were still pushing paper around the country? Enterprise content management was optimizing process for payers and providers individually, but there was no bridge to allow them to communicate effectively.

Unfortunately, this scene is repeated millions of times daily in U.S. health plans and hospitals. Not only is it a slow process, it is very expensive for all involved. Nobody likes it.

And, most importantly, it doesn’t provide good information to the nurse or doctor at the health plan who need it to answer the original question: Should I pay this claim?

This is always followed by two sentiments. One, “We need a better solution.” And two, “We need a bridge between payers and providers.”

The new medical record – my manifesto

Luckily, the future is here. Following is my medical record manifesto. It is a public declaration that we can do better.

Here’s how:

  • Never paper, never fax: Information from Electronic Medical Records (EMR) should NEVER revert to paper or fax. Never.
  • Secure: EMRs are secure. If they can encrypt my iPhone so that the police can’t get in it, then I think we can secure a medical record.
  • Complete: Shared EMRs should contain everything that should be in the record. That includes admission documents, EKGs, consents, lab reports, x-rays, MRIs, scopes, surgical… you name it. Everything regarding that member/patient for that date of service. In addition to documents, the medical record should contain all appropriate and applicable medical data associated with the member/patient. In this way, the health plan can use the data to actually coordinate care with the provider and member/patient.
  • Searchable: Medical records should be completely searchable. That nurse at the end of the process should be able to find and answer the question in seconds, not days or hours. He or she should ask questions and quickly find the correct, complete answer.
  • Collaborative: A medical record should be an opportunity for the hospital and health plan to collaborate on the care of the member/patient. It should allow a conversation between the nurse at the hospital and the nurse at the plan that focuses on the wellness of that individual. Things like sticky notes, voice notes and real-time chats should be a part of the record.

We live in the information age. I am tired of my medical information printed on dead trees. I am done with my most absolutely, most sensitive personal information being shipped across town or the entire country in a format that can be read by anyone with bifocals.

It’s time for a change. We need a bridge between payers and providers. I’m mad as heck and I’m not going to take it anymore! Are you?

The solution: A health information management bridge

(Deep breath.)

In my last post, I mentioned a project at that will change the way healthcare organizations share medical information. Our project, Mackinac, is that bridge for our payer and provider customers.

Mackinac will replace paper, faxes and emails with instant, secure workflows to improve collaboration, communication and coordination of care between payers and providers, improving the member or patient experience.

Get ready. Mackinac is coming.

Mike Hurley

Mike Hurley is the industry manager for Health Insurance at Hyland, helping health insurance organizations transform business processes that drive value for members, providers and employees. Mike works with current and prospective customers to use our award-winning product, OnBase, to drive business transformation. He is also responsible for our high-value, high-impact health insurance solutions, the like Mobile Medicare Enrollment Solution for OnBase. Prior to joining Hyland, he was the founder and president of Swim Lane Software, LLC. Hurley founded Swim Lane in 2007 to create a solution that leveraged Software as a Service (SaaS) technology to automate the processing and adjudication of Medicare Claims through unique use Business Process Management (BPM) and Business Rules Management Systems (BRMS) technologies. Preceding Swim Lane, he founded Green Square in 1997 as a national consulting practice that connected technology with business strategy. As a boutique services firm, Green Square was aimed at driving stakeholder value at over 25 BlueCross BlueShield plans in the U.S. Prior to Green Square, Hurley founded Avalon Technologies, Inc., an award-winning systems integrator focused on Enterprise Content Management (ECM), workflow and Optical Character Recognition (OCR) technologies.

Leave a Reply

Your email address will not be published. Required fields are marked *

You may also like...