The #1 Workflow Software Problem Insurance Companies Face

| | UR Software

Utilization review organizations, insurance companies and healthcare providers must communicate patient data quickly and efficiently to be effective. Unfortunately, industry integration capabilities still struggle to keep up with technology.

Many of these entities use proprietary software solutions, which makes industry-wide, standardized communication difficult. Medical providers often rely on old software systems as a way to control costs. These outdated systems often cannot easily transmit or receive data from the newer, more advanced systems that many insurance companies and UR organizations use.

Inconsistent integration of software solutions slows down workflow across the industry, often forcing patients to wait longer than necessary for treatment or financial resolution to their claims.

The Solution: Interface Standards

To optimize workflow, the industry needs to adopt universal interface standards. Interface standardization does not control the software options; it stipulates a standard way to communicate information across platforms, improving information flow significantly.

As an analogy, consider two people, one who primarily speaks English, and the other who primarily speaks German. Neither speaks the primary language of the other, but both speak French. Thus, they can communicate with each other when they need to, and they can still use their primary languages in their day-to-day lives. Software integration would provide a common language for review organizations, insurance companies and healthcare providers, eliminating the need for a translator.

From Custom Integration to Standard Integration

For the most part, integration occurs within and through software, placing responsibility for integration on software providers. Most insurance companies use proprietary or customized software and create their own information technology (IT) infrastructures. Software providers work with individual insurance companies to build custom integration systems – effectively acting as the translator between parties trying to communicate with each other.

The implementation of industry-wide standards, such as those proposed by the International Association of Industrial Accident Boards and Commissions (IAIABC), would make integration much less complicated and render customization simpler. As interface standards were adopted, all parties would ensure that their software meets those standards. Implementation would likely start with software providers and insurance companies, but the ideal would be for healthcare provider software to integrate as well.

Standards Are Not Stagnant

Some businesses — especially those that work with proprietary software — dislike the idea of standardization. The people at these organizations want customization. They want software tailored to their specific and special needs. They want their ‘standard’ to be everyone’s standard. To realize the benefits, businesses need to understand that standardization works to meet everyone’s needs.

Currently, every instance of integration is customized. Standards would reduce the need for customization, but not eliminate it entirely. When a company has specific needs that are not met within the standards, the standards can be revisited and updated accordingly. Over time, this would lead to a self-sustaining system that would evolve to accommodate the ever-changing medical environment.

Industry-wide adoption of interface standards would speed up workflow, make communication easier, and help all involved parties achieve better results.

Todd Davis

Todd Davis, Vice President of IT – ReviewStat Services for UniMed Direct, is responsible for the continued development the industry-leading ReviewStat system. Leading a team of like-minded professionals, Todd works to review and improve ReviewStat’s full-featured and robust system to make it even more efficient and easy to use.