In part one of this article, I covered several aspects that, together conspire to create a process nightmare when it comes to document-based information contained within attachments. And while many efforts and desires are focused on how to rid processes of documents altogether, the most comprehensive and flexible means to transform slow, complex, and manual processes into controllable and efficient ones is to embrace documents as a standardized means to exchange rich levels of information.
A mindset of “embrace, don’t avoid” enables organizations to free themselves to choose a more flexible and less disruptive path to existing workflows. And even though industry initiatives generally are also taking a more-or-less embracing approach towards attachments, taking a more agnostic path places more control of technology and business impact with the organization, instead of ceding it to potentially competing industry initiatives. Here is what it might look like from three different angles: the current process, the disruptive “digital-only” approach, and a document-embracing approach.
Prior Authorization and Attachments – A Chronic Condition
Few processes draw the ire of providers than prior authorization. Regardless of where you stand on the necessity of prior authorization, the benefit beyond just cost control is showing promise, but at great pains to physicians and patients. Most of the focus on improvement is about reducing or eliminating all of the unknowns and the resulting back-and-forth that occurs, mostly in a fury of requests, ad-hoc responses for additional documentation, and uncoordinated follow-ups via secure messaging, fax, and phone. Ultimately the goal is to support much more automation through interoperability so that physicians are automatically informed when additional data is needed and any need for follow-up or status checks is automated and coordinated.
But with increased automation comes increased expectations regarding the time required to respond to requests. Expectations that will place a new burden on payers. And when prior authorizations require supporting documentation, automation and the efficiencies they bring fall apart pretty quickly. Why? Because even while physicians may easier find needed documentation and proactively send it, each file must be identified and reviewed. And the myriad of different file types and formats makes this process of identification and review even more challenging. While standards bodies such as HL7 and X12 are defining ways to make attachment identification easier, any improvement requires broad support and will likely not remove documents at all due to their relative simplicity and wide use. Is there a better way?
The Digital Dream
Imagine a world where any documentation need is met by an automated response from a physician’s EMR which automatically locates the information within an EMR system and sends it via a structured HL7 or X12 transaction. Payers, instead of taking time to review the data, benefit from the structured data and quickly respond, needing manually review only in exceptional cases. But here’s the thing: there are literally hundreds of competing interests that are in-between today and that dreamland and even considering wide support of a standard, the time and expense to implement and achieve widespread removal of traditional attachments might stretch into a decade or more. And even then, no standard really solves the usability issue of medical prose. Even if standards adopt structure around common elements such as service date and entry of diagnosis or procedure codes, physicians and staff are not likely to adopt anything that requires a significant amount of structure when it comes to the ability to create a useful narrative of patient history. Any technical requirement that relies upon changing entrenched behavior is often the biggest reason for project failure.
Best of Both Worlds
Ultimately standards adoption won’t solve the problem alone and attempting to change behavior is a fool’s errand. So can there be a “best of both worlds solution” that exists today but won’t prevent complying with tomorrow’s regulations or standards? In short, yes. The key distinction is to embrace documents as a critical and useful part of the business process and not a necessary evil. When we accept that documents are not the problem, we then turn to technologies that can make processes like prior authorization that use documents much more controllable and efficient. Instead of a process reengineering effort, imagine your current process but with one key new capability – the ability to analyze documents which automates the discovery of what they are and what key information they hold. This means that when physicians send supporting attachments (regardless of whether it is automated or manual), payers can quickly and automatically:
- Detect attachment presence.
- Analyze the file (or files) and identify the types of documents, e.g. labs, progress notes, exam results, etc.
- Locate the specific information on the relevant documents and index it.
- Cull any unneeded or irrelevant documentation.
- Organize the documents in a sequence that is most efficient for review.
What’s even better is that none of the automation described requires waiting for and implementing a standard. The software can work with any type of document and data – you don’t need to restrict it to only PDFs with specific formats. Yet when standards do become available, the same technology can be used to support them; there is no need to replace anything. And the use of the same system allows payers to support both standard and non-standard requests meaning a more comprehensive level of automation.
No Time to Wait
Given that a solution to attachment disorder is available now that provides insurance for future changes while imposing minimal disruption to existing processes and behavior, you’d think that organizations are rushing to implement it. But that’s not the case. The main reason is that the technology to achieve reliable automation on complex attachments is relatively new and unknown. Early adoption is occurring and those organizations actively pursuing the implementation of attachment automation will have an advantage over those that are still on the fence.
Come hear more about attachment disorder at Claims Innovation USA, where industry veteran Mike Hurley of BRYJ Consulting will discuss the art of dealing with attachment disorder.