Tag Archives: referral management

6 Powerful Applications Of Artificial Intelligence In The Healthcare Industry

Artificial Intelligence in Healthcare

Artificial Intelligence has laid the foundation for many stunning innovations that have simplified our lives. The term is used to describe the intelligence demonstrated by machines. AI complements human intelligence in a beautiful way, allowing us to achieve more with the information we have. The implementation of AI in healthcare has changed the way in which patients were treated. The most common implementations of AI in healthcare are medical imaging diagnostics and virtual health assistants.

The following are the six interesting applications of AI in the healthcare industry,

1. Robot doctors are real now

Let’s say you are going to see the doctor. Will you not be taken aback to see a robot attending you? In 2017, a robot passed the medical licensing exam in China. It’s an AI device that automatically captures and analyzes the patient’s information. It can even provide an initial diagnosis, which would help in future treatment. In simple terms, robot doctors can be compared to chatbots that give customer service to people visiting the website. Is this robot ready to go into solo practice? Not quite. The robot will not treat you. But it’s absolutely capable to take care of the first doctor-patient encounter. It takes the patient’s information and processes it. Then it makes logical suggestions to the doctor, so it can help them identify the issue and proceed to adequate treatment. It takes the patient’s information and processes it. Then it makes logical suggestions to the doctor, so it can help them identify the issue and proceed to adequate treatment.

2. Robot dentists can operate alone

The robot doctor in the discussion above won’t replace the actual doctors in the office. But a robot dentist can do much more. It is so real and amazing. In this case, we can safely say that the robot is better than a human dentist. Dental implant operations are problematic and prone to human errors. The robot can avoid such problems and overcome the shortage of dentists in many countries across the world. The hour-long procedure took place in China, in August 2018.
The robot carried out the implant surgery autonomously. The medical staff was present, but they only supervised the process. It must have been really scary for the patient. But the fact that robots can perform dental surgery with a minimal margin of error is impressive. Even more impressive: the teeth that the robot implanted were created with 3D printing technology. We’re getting far, people!

3. Artificial Intelligence has made melanoma detection easier

Melanoma is hard to detect with the human eye. Early detection is primarily important, though. It literally saves lives. Artificial intelligence gives new hope. It has the potential to distinguish benign from malignant moles. The computer program analyzes the patterns of various skin conditions. Through a self-learning system, it will be able to make a difference between various dermatological conditions. This technology is yet to be implemented into diagnostic practices. Still, the researchers are very optimistic about it. AI can outperform human doctors in recognizing skin melanomas, and the technology is likely to get better.

4. AI can reduce non-adherence to medication issues

Non-adherence with prescription medication is a serious healthcare issue. It is the patient’s inability to follow the treatment prescriptions. They may decide not to start treatment, or they may decide to use doses different from the prescribed ones. They may also discontinue the treatment because they decided so.
Artificial intelligence is making a huge difference in this aspect. Healthcare practitioners can use AI to reduce systemic waste by identifying patients who are prone to non-adherence with their prescription drugs. The program analyzes several variables, such as age, gender, payer type, geography, and out-of-pocket costs, so it can predict the possibility for non-adherence.
With this information, they can identify patients who need additional support to follow the recommendations for treatment. They will focus more on communication and they will explain exactly why it’s important for the patient to follow recommendations.

5. Effective Image Analysis with AI

Medical imaging is the foundation of proper diagnostics. Image analysis, however, is time-consuming and tricky for doctors. It can take hours for them to compare 3D medical scans and analyze the changes. It’s a good thing that we’re making progress here. In June 2018, a team of MIT researchers came out with the news that they developed a machine learning algorithm, which analyzes 3D scans up to 1,000 faster than doctors. This is incredibly important, especially for surgeons. Sometimes they have to bring patients back to the operating room if they notice that they haven’t completely removed a tumor after surgery. The ability to read medical images faster is life-saving. With this technology, they can practically study changes in real-time.

6. Robot-assisted surgeries are happening

We are still waiting for the day when large incisions during surgery will be part of history. Thanks to robots, that day is getting close. Da Vinci Si is a surgical robot that’s as minimally invasive as possible. The technology uses information from past surgical experiences to improve its techniques. The robot contains 3D cameras and a variety of surgical instruments, which replicate the movements of the operating surgeon.
With this, the surgeon gets an opportunity to perform complex procedures with greater precision and more control over the instruments. They control the robot’s arms from a computer console positioned near the operating table.

Future of AI

With all the implementations described above, under careful human oversight AI can reduce human errors in healthcare, and make the providers more effective. The good news is that currently, AI is being used under careful human oversight. The day for robots that operate autonomously will probably come. But by then, we’ll be absolutely confident in their capacity. Despite the concerns, the growing implementation of AI in the medical industry is part of the inevitable progress.

Top 6 Reasons Why You Need A Referral Management System Even Though You Have An EMR/EHR

When an organization considers purchasing a patient Referral Management System (RMS), one of the first points management considers is whether or not its existing EMR/EHR can provide the missing functionality with an add-on, or perhaps already does but is not being used.

In general, use cases that are exclusive to employed healthcare providers working within the provider system will favor using an EMR alone. However, once an organization wants to do complex tiering of its networks and/or work with provider resources outside its organization, a Referral Management System becomes critical.

Below, we provide the top 6 reasons a Referral Management System is a necessary tool for a healthcare system in addition to an EHR/EMR.

6. Referral Management Systems Enable Healthy Provider Network Utilization

A healthy referral network should be able to distribute referrals evenly among comparable resources in a given geography. It is essential to maintain active participation among all the providers in the network. Often a favored specialist at the top of the list keeps getting more and more referrals at the expense of others who might be just as qualified. An effective Referral Management System can provide load-balancing algorithms so that referrals are distributed evenly among comparable providers.

5. Referral Management Systems Provide End-to-End Patient Referral Tracking

Part of the clinical opportunity for referral management stems from the fact that referrals typically occur when there is a change of diagnosis or an escalation in care. As such, a referral is often the first indication that a patient will likely trigger significant downstream consumption. A well-implemented patient referral solution enables an organization to track patients in real-time and better guide patients towards high-quality low-cost care settings. Further, the system needs to encourage specialist staff to report appointment attendance or noncompliance, as well as return clinical notes to primary care offices for better patient care and better patient outcomes.

4. Referral Management Systems Facilitate Real-Time Referral Reporting

The ability to report highly granular referral analytics that illustrates referral patterns is essential for any Referral Management System. Organizations taking on risk as well as organizations optimizing referral patterns need to stay vigilant about network performance and network adequacy. Referral analytics should help organizations identify particular areas of concern as well as provide reporting that impacts referral patterns and facilitates change. Furthermore, robust Referral management software should be able to provide this data within the application itself as well as have the ability to export this data in any suitable format.

3. Referral Management Systems Create Dynamic Referral List Based on Location

Many organizations must be able to manage referrals across large geographic areas. Indeed, the Service Level Agreements (SLAs) that many provider organizations enter into with payers as part of risk-sharing arrangements have network requirements that dictate how far away a specialist referral can be for a patient. A patient referral management solution can store the SLAs from the different payers, and then generate a geo-specific list of referral resources that can be based on the primary care provider’s location or the patient’s home.

2. Referral Management Systems Create Dynamic Referral Lists Based on Payer Selection or Plan Design

Referral networks tend to have networks within the network, where different payers or insurance plans have preferences or rules where patients can go for care. A referral management solution can generate a referral list for each patient based on the plan each patient carries.

1. Referral Management Systems Connect Healthcare Clinics Across Different EMRs

Once an organization wants to manage referrals across networks (e.g. among affiliates), chances are high that many offices will be using different EMRs. An effective referral management solution will be able to provide workflow and integration solutions that can work across multiple different EMR/EHR vendors and networks.

How has HealthViewX added value to referring physicians’ patient referral problems?

1) Automating the insurance pre-authorization process

HealthViewX platform has a payer management module that maintains and manages

Different payer details
Modes of prior authorization
Direct authorization procedures
Payer forms
Online portal links
With this information already present, it provides the referral coordinator with the capability to automate
Prior authorization submission
Status checks coupled
Fax integration

It simplifies the process of insurance pre-authorization. The referral coordinator need not waste time on the process anymore.

2) Intelligent Provider Match

Our “Smart Search” feature makes it easy for the referring provider in finding the right provider. It has smart filters and search options that help in narrowing down the specialist based on the requirements.

3) Establishing best practices

After using our HealthViewX Patient Referral Management System, physicians were automatically alerted to

Appointments
Referral status
Patient diagnostic reports
Referral completion

As a result, we can cut down on miscommunications and bridge the gaps between the specialist and the physician community. The system also assembles a patient encounter record from the EMR/EHR and pushes it directly to the physician.

4) Forming a close-knit of trusted referral receiving centers

Our system helps in strengthening ties with the medical community. From a history referral experiences the PCPs can from a close-knit of referral receiving providers. Physicians can now refer patients to hospitals they can rely on.

HealthViewX Patient Referral Management solution helps the referring physicians in handling and managing their referrals. Are you an inbound referral heavy practice looking for an end-to-end referral management solution? Schedule a demo with us. Our patient referral management experts will guide you through our HIPAA compliant solution.

5 Healthcare Industry Trends To Watch Out For

With every passing day, the healthcare industry is growing and becoming better. In order to keep up with the huge demand for medicine and treatments, researchers are inventing new systems and technologies. So what are the healthcare trends to watch out for in 2019 and beyond?

The number of baby boomers who retire and come under Medicare or Medicaid is increasing every year. At the same time, medical experts are making unbelievable achievements in treatments and medicine. So it is difficult to predict the number of inventions in the future. But one thing we know for sure is that the healthcare industry has a bright future.

Due to the rapid advancement in technology, the healthcare industry has grown quickly to serve a huge number of people across the world. Despite the uncertainty in the future, it is possible to predict by looking at the medical learning centers because that’s where most of the ideas originate.

So, let us go into the top 5 healthcare trends to watch out for!

Electronic Medical Records/Electronic Health Records

Electronic Medical Records (EMRs) are the top of the list. But these are not new so how can it be a trend? Most of the health institutions across the U.S. have adopted the use of electronic medical records and it has positive effects.

According to Assignment Masters, it is necessary to have patients’ records in digital form to not only access these easily but also convenient for medical experts to communicate and share information with other experts in a different area. With these records, any physician can access the patient’s medical history in seconds and this allows him or her to make informed decisions when treating the patient.

Although EMRs have been around for a while, it took some time for health systems across the U.S. to embrace and implement it. Today, most of the health systems use electronic medical records.

In 2019, we can see how technology will continue improving patient care in the long-term. With digital records, the medical expert can devise effective treatment plans anytime.

Smartphones allowed in medical classes

The second trend is all about how technology will not only change systems in hospitals but also in the class. Today, technology has changed how medical experts interact, gather information and make decisions. It has also changed the way medical students are trained. Today, healthcare workers don’t get in trouble for having smartphones and Edugeeksclub in class. In fact, they are encouraged to use these devices to improve their learning methods.

Teachers have also changed their teaching methods. They have reported having an easier time teaching using new equipment and software. It allows them to share important information easily and fast as compared to the traditional lecture which was difficult for the teacher and boring for the student. Students can also collaborate easily through these systems and this gets them prepared for real-life experiences.

Artificial Intelligence

It is impossible to discuss the future of the healthcare industry without thinking about artificial intelligence. Artificial intelligence will change and improve healthcare in many different ways. In general, artificial intelligence will open the avenue for human beings and technology to connect. Through this connection, it is easy to monitor and analyze the activity of human beings all over the world easily.

With artificial intelligence, healthcare providers will have the best tools in their hands to treat patients. For instance, using this technology, healthcare providers can easily offer their services in places where there is a shortage of doctors without being there physically. Some experts are predicting that treatments such as radiology will be enhanced to a point that healthcare providers will not need to take tissue samples from patients.

According to Essay Shark, artificial intelligence in the health care industry will increase by $1.7 billion and this is expected to improve performance and productivity by ten to fifteen percent in the next few years. Artificial intelligence will improve efficiency, save time and money and improve the experience of the patient.

Medical devices

Technology has made it possible for patients to consult their doctors without having to visit them. Today, doctors and patients can video chat any time they want. After communicating with the patient and analyzing his or her records, the healthcare provider can easily make informed decisions. This is good news for patients who are very old or for people who cannot get out of their houses.

With improvements in technology, our healthcare system will also improve. Medical experts have spent a lot of time and energy innovating medical devices that will revolutionize the healthcare industry. With these devices, you don’t have to wait for days or hours to get your results. They are fast and efficient.

These machines are not only convenient for patients but also to health providers. Their quality of service determines health or sickness and frustration.

Improved quality of service

All technological advancements are centered on improving the experience of the patient. In every profession, the experts are paid based on the quality and quantity of service they render. Technology allows healthcare providers to measure their outcomes based on the hours they log in and the health outcomes of their patients.

It also makes it easier for healthcare providers to determine which type of treatment works best and how to get the best outcome out of them. Tests can be performed quickly and accurately. Medicine and other forms of treatment are available. In the coming years, patients will receive the best care that man has been dreaming and working towards to for thousands of years.

The health care trends discussed above are just but a fraction of what we should expect in the near future. With technology advancing at a rapid rate, we look forward to quick and efficient medical tools and treatments. As technology advances, it will reduce the burden on healthcare practitioners and they will be able to deliver the best quality of service.

Talk to our experts to know more about Healthcare updates.

How Can Automated Referral Workflows Increase Patient Satisfaction?

Today’s healthcare model demands that services be centered around patients. This model faces additional challenges when care needs to be coordinated among multiple providers. Between 1999 and 2009, the number of primary care visits resulting in referral has increased by 159%.

Problems with the existing referral workflow

Research strongly indicates that referring physicians need to improve the quality of information they provide to consulting physicians. When surveyed, 63% of PCPs and 35% of specialists report dissatisfaction with the current referral process because,

Paper referrals often do not provide adequate information
Consult reports are not delivered in a timely manner
Many referrals do not even include transmission of information, either to or from specialists

Consequently, PCPs are always not aware if a patient has seen a specialist. To add to this, up to 80% of ACO clinicians report the lack of interoperability among data systems is the greatest challenge. It happens particularly when they are attempting to locate information from out-of-network providers. Physicians consistently indicate that improvements are needed in the referral system to optimize patient care.

Why are automated workflows important?

Did you know? Among all patient referrals from PCP to the specialist, it is estimated that only half as many patients show up for their specialty care appointment. Furthermore, “self-referral” patients who see specialists without a recommendation from a PCP are associated with higher patient dissatisfaction and poorer continuity of care with the primary care doctor. A study states that 70% of specialists rate the referral information they receive from Primary Care Providers as fair or poor.

In a patient-centric healthcare environment, patient satisfaction is the major concern of many practices. An automated referral workflow provides a way for physicians to ensure that patients are getting the care they need when they need it. As PCPs refer more patients to specialists each year, coordinated care and automated referral workflow become an urgent issue for both independent and hospital-based practices.

How can an Electronic Referral System help?

Information Technology enables patient referral workflow automation. HealthViewX Patient Referral Management System simplifies the process and closes the referral loop on time.

The Primary Care Provider (PCP) identifies the need for a referral and initiates the same through the EHR system.
The referral coordination team then validates the referral and does the insurance pre-authorization with the help of HealthViewX solution.
The Intelligent Provider Smart Search feature of HealthViewX Patient Referral Management System helps in finding the right specialist or imaging center easily.
The referral coordination team then sends the referral with the necessary documents to the relevant specialist or imaging center through the HealthViewX platform.
The receiving provider gets notified about the referral and can schedule appointments with the patient.
The patient and the receiving provider get reminders of the appointments thus reducing no-show rates.
The referring provider is also notified about the status of the referral and how it is progressing. HealthViewX timeline view makes tracking and managing the referral lifecycle easier.
HealthViewX tracks and sends reminders to the receiving provider to update the diagnosis, treatment recommendations, care plans in the referral.
HealthViewX makes it easy for the referring provider by automatically updating this information back to the EHR system.
Thus the HealthViewX solution closes the referral loop on time and helps in easy monitoring of the same.

Impacts of implementing an electronic referral management system

After the implementation of an electronic referral system, providers have observed,

Enhanced direct communication between PCPs and specialists regarding their mutual patients
Better appointment tracking
Improved access to specialty care
Increased consult report compliance and follow-up

In addition, referral systems appeal to front-office staff because of its intuitive user interface and human-centered design. When providers can easily access needed information, they’re empowered to deliver better care.

Benefits of automating the referral workflow

Increased Medicare reimbursements – Medicare considers closing medical referral loop as a benchmark for giving reimbursements. Closed medical referral loops increase the opportunities for Medicare reimbursements for referral marketing.
Streamline referral management – With HealthViewX Patient Referral System in place, the referral workflow is automated and streamlined.
Improved patient care – Reduced waiting time gives patient satisfaction thereby improving the care quality.
Increased productivity – Reduced operational time improves the efficiency of the patient referral system.

Reference

3 Ways Through Which A Practice Can Enhance Patient Experience And Improve Patient Engagement

Patient experience is not just about the quality of care measurements and outcomes. Today, there are about 10 aspects that define the patient experience, and each one has its own impact to attract and retain patients within the network.

Patient experience and engagement can be defined by the following aspects,

Meeting with a doctor
Wait time
Billing
Scheduling appointments
Appointment follow-up
Staff interactions
Pharmacy
Online reviews
Social media
Website

Let us explore a few tips that will enhance the patient experience, improve patient engagement, drive better outcomes and keep staff engaged. We know patients actively involved in their health tend to have better outcomes, report higher overall satisfaction, and experience lower health-related costs.

Enhancing and transforming the patient experience and providing first-rate, patient-centered care revolves around the consistent development of processes to meet patients’ expectations and needs. Understanding patients’ preferences and priorities will allow practices to identify and optimize opportunities to increase comfort and reduce suffering which will ultimately strengthen the patient-provider relationship.

Let us first define exactly what patient engagement is and break down top-level strategies that practices can use to stay connected with their patients outside traditional clinic walls.

What is the difference between patient engagement and patient experience?

The patient experience is influenced by the perception of the care they received. Ultimately, patient experience represents the overall satisfaction of their personal experience with the practice, which, more often than not, is beyond control.

Patient engagement, however, relates to the way a patient mobilizes their healthcare experience. What actions do they take that allow them to take an active role in their healthcare? What tools, technologies, and programs are available to encourage patients, caregivers, and families to play a more engaged role in administering their long-term health and wellness?

To improve patient engagement, a practice must recognize that engaging with patients is a triangular synergy between the physician, the patient, and the practice. It is about encouraging interaction between patients and providing meaningful opportunities for your patients to engage in the ways they know and are comfortable with.

1) Keeping patients engaged after they leave

Patient engagement is no rocket science. Patients want any practice to be accessible. They desire simple ways to schedule appointments, and perhaps most important of all, they want transparent and straightforward billing.

Technology has its purpose, but nothing can substitute for genuine interpersonal communication. Compassion and empathy are not something patients can get from AI or an app; they are, however, things the practice and their staff can use to promote greater engagement.

If a practice has the latest technological gadgets, it doesn’t mean that they can check patient engagement off your to-do list. Improving patient engagement is about that personal touch, human connection, feeling like taking an active role in managing healthcare delivery.

Therefore, how can a practice engage their patients? The answer lies in the space between a doctor’s visit and the following chapter in a patient’s care.

Patients have climbed on the digital bandwagon and ready for technological engagement. Patients already interact daily with different technologies, so practice should consider employing those to boost engagement. Here are some ideas that will work:

Smartwatch health data monitoring
Real-time educational opportunities through the website or Alexa-like devices
Push notifications to remind patients to exercise, pick up their prescriptions, or invite them to special events or seminars

To impact patient experience, satisfaction, and engagement, it will be critical to concentrate on the tiny adjustments within the practice’s workflow that will have a significant impact on the patient.

2) Leverage Artificial Intelligence

Three-quarters of aging households are expected to adopt voice-assisted technology by 2020 making artificial intelligence (AI) the tech frontrunner to enhance patient engagement.

Not inconceivable is the presence of an Alexa like Bluetooth speaker running through exam rooms, performing like closed-loop HIPAA-compliant systems. Patients would be able to ask questions related to their file and diagnosis, change the TV channel or dim the lighting in the room.

Virtual reality (VR) can also drive patient engagement. Some hospitals in California are employing VR to show patients how specific brain surgeries will be performed, thus elevating patient satisfaction scores as well as reimbursements. There’s a real possibility of home care and wound care with patient and provider interacting one-on-one from different locations is just around the corner.

3) Remember who you are talking to

The language also has a great impact on patient engagement. Instead of focusing on “adherence and compliance,” the practice should try to discern the underlying social or environmental factors hindering a patient from complying with medical recommendations.

Why is a particular patient unable to comply? A practice must take the time to connect with and understand their patients. They need to have conversations, put themselves in their patients’ shoes, and then find methods to boost patient engagement and enhance overall patient satisfaction.

Roughly 40 million U.S. adults read at a junior high school level. However, most healthcare directions are written in much more complex language (usually in tiny fonts) which cause confusion and increase non-compliance, particularly among aging populations. To fully engage patients, practices must make sure they can comprehend the instructions we’re giving them.

What does it all mean?

At the end of the day, an engaged patient has superior outcomes, reduced costs of care, and greater satisfaction overall. The more a practice develops a culture beyond the clinical atmosphere to one that connects both patient and provider through a digital culture of wellness, communication and personalization, the more the patients and the practice will benefit.

Patients demand experiences be more custom to them, and one of the best ways to deliver is to keep them engaged outside of the office, leverage technology and utilize the proper language to drive your points and treatment plans home.

How To Identify An Under-performing Referral System And Make Improvements For The Same?

For many health systems, referral leakage may equate to millions of dollars in foregone revenue. Every patient who seeks care elsewhere is a lost revenue opportunity now and potentially into the future. Thus it is important for health systems to increasingly focus on minimizing referral leakage while managing referrals. The following are the symptoms of an underperforming referral system which have a negative impact on referral leakage,

Disability to identify in-network or aligned providers.
Inept or unclear information on what patient types or conditions a provider treats.
Limited or no ability to measure the referral management team performance or financial outcomes.
Ineffective prioritization and workload management.
Increased authorization-related denials and write-offs.
Too much reliance on paper-based or manual communication and tracking systems.
Increased patient referral leakage due to complicated, cumbersome, or unclear referral processes.

Analyzing your organizations’ opportunity for improvement

The ability to make significant improvements in referral processing efficiency and patient retention depends on the following factors,

Degree of process standardization
Organization’s accountability
Underlying infrastructure
Organization of staff
Technological capabilities

Accountability and standardization of the process

There is a huge communication gap between the referring provider and receiving provider offices which makes the process inconsistent. Organizations often fail to standardize the process by defining who is responsible for

Obtaining prior authorizations
Locating a specialist with good access who will treat the patient’s condition
Gathering relevant medical records
Contacting the patient to schedule the appointment

Organizations with strong referral management programs have developed a consistent and standardized workflow that clearly delineates responsibilities by role. Achieving this level of efficiency requires that operational and clinical leadership collaborate to design and develop policies, procedures, standards, and workflows to support strong referral management practices.

Technology Systems and Capabilities

Despite having a thoughtful and disciplined approach to monitoring and managing referrals, technology systems are often unable to facilitate best practice workflows or deliver the performance data necessary to effectively manage the end-to-end process. Therefore, the following processes have been happening manually,

Tracking authorization status
Monitoring scheduled appointments
Calculating referral conversion rates, staff productivity, and downstream revenue

Furthermore, the inability to share information electronically among providers necessitates increased use of paper-based and faxing processes. Without the proper supporting technologies, there is increased processing effort and workload, risk of lost or inaccurate data, and, most importantly, the potential to delay patient care.

The following are the technological capabilities needed to support the best practice referral, management team,

Identifies providers in the referral system
Matches patients with the ideal scheduling providers
Prompts follow-up when appointments are not scheduled or care is not received
Facilitates the transfer of post-visit documentation between providers
Supports detailed reporting to manage performance

Close your referral loops with the HealthViewX Patient Referral System