We all know that the global healthcare industry is simply enormous. It's a multi-billion dollar industry in the United States alone. The size of the industry and the amount of money involved varies significantly from country to country. The United States definitely leads the way in comparison to the countries around the world; however, we cannot completely ignore healthcare in other countries. The industry landscape is constantly changing around the world due to changing economic conditions. It is quite noticeable especially in the emerging markets. Despite the regional differences, one fact remains constant - every human being, regardless of income and social status, is somewhat connected to the healthcare industry.
Many different sectors of this industry may not be as ideal as we would like it to be. In fact, it might be completely unfair in some areas. Similarly, when we observe healthcare around the world, the disparity is simply staggering. I will not try to discuss these disparities and unfairness; instead, I will discuss briefly about present and future of healthcare technology.
Initially, let me attempt to analyze how the healthcare systems of the world are connected to the people of the world. Many types of sicknesses and injuries are simply a fact of life. Whenever we get sick or injured, we require treatments from one or more healthcare providers. It is also very common to seek specialized treatments that may result into prolonged hospitalization. Sometimes a recurring treatment can last for a long period of time. During the span of treatments, Doctors may perform many different types of procedures in order to find cure for their patients. At the same time, patients and doctors may need medications, specialized equipments and other supplies for various medical procedures. So, during all these types of treatments and procedures, an individual may need to obtain services (directly and indirectly) from different types of people due to the nature and severity of health conditions.
Patient care is definitely the most important aspect of healthcare; however, we cannot ignore the financial side of healthcare services. Who pays the doctors, pharmacists, technicians, hospitals/clinics or any other involved parties in patient-care? Is it solely the patients’ responsibility or someone else’s? We know that sometimes it’s the responsibility of a patient, and other times the responsibility may fall on an insurance carrier or even the government. Needless to say, large sums of money can potentially flow through all involved parties. These money transactions can potentially give rise to errors, missed or delayed payments and even frauds - the result is unhappy patients and/or doctors. Therefore, it sometimes becomes necessary to regulate and control a fair-pay structure as well as build efficient money transaction systems. Similarly, we cannot ignore the importance of standardized money and data transaction procedures to reduce errors and increase efficiency.
Many private and independent agencies as well as local and central governments may assume the role of regulators, and standard bearers. We may or may not like regulations, and once again I don’t want to get into the moral discussions in this article. Nevertheless, some of these regulations may end up impacting the healthcare sector in some form or fashion. Standardized procedures on the other hand, can improve many areas within the industry. Some government and independent agencies are constantly engaged in creating healthcare standards in many areas such as insurance, claims/bills processing and data interchange. However, it is unfortunate that many of these standards have not been completely adopted across regions and organizations. At the same time, we are not even close to creating a global standard since the healthcare is simply a different beast when we consider how things vary from country to country. Suffice to say, healthcare industry is a very complex entity when we take all these areas into account.
How can a very complex entity (such as the healthcare industry) function in an efficient manner? Well, the truth is, it doesn’t. This industry has been operating inefficiently for many years now. Many countries have established some standard procedures to streamline some processes within healthcare; but they haven’t proved to be sufficient. I have mentioned earlier that many organizations that are tied to healthcare industry, have not adopted some of these standards wholeheartedly. Some are still doing things in an archaic manner. Many corporations find it extremely difficult to automate systems, reduce paper dependencies or simply attempt to improve business processes. As if breaking away from old business processes is a call for disaster. In other words, many corporations are finding it difficult to understand and utilize technologies to optimize business processes. It would be wrong on my part to simply point fingers at corporation for not embracing technology. Investments in technology may lag behind for many reasons such as budgetary constraints, lack of qualified resources, and revenue driven project prioritization. Whatever the reason may be, the fact is many organizations have not been able to emphasize on electronic record keeping, business and workflow process improvement and system/process automation. It is not uncommon to see many people in these organizations maintaining and utilizing huge stacks of papers and binders to organize data and manage workflows. Some organizations may not properly evaluate the existing manual processes before attempting to utilize technology. Eventually, they end up creating a very inefficient computer based data organization and management methodology, resulting into creating a discouraged group of people who may not see the need for further technology investments. These inefficiencies have somewhat contributed to delayed claim and bill processing throughout the industry thus raising the overall cost within the healthcare sector. In the United States, we are seeing more and more states imposing hefty fines on insurance carriers for delayed bill processing. Some states are also starting to enforce electronic claim/bill submission procedures. Consequently, as more and more states implement similar policies, many organizations will be forced to invest in process and technology improvement.
I believe many people are starting to recognize the need for effective utilization of technology in the healthcare industry. Some organizations are already spending a large amount of money trying to re-evaluate and optimize business processes. Many are evaluating the need for electronic medical record, efficient claims/bill processing systems and standardized data interchange procedures. I must say that everyone in Rising Medical Solutions (my current employer) recognizes the benefit of technology. We are constantly trying to improve our overall business processes. Since medical bill review/re-pricing is our main line of business, it is extremely important for us to efficiently provide our services without errors so that our clients (insurance carriers) can benefit from savings. Any delay in our process can result into hefty fines for our clients. We definitely don’t want that to happen. Therefore, we see technology and automation as a way to optimize the overall business processes. So, we constantly evaluate new technologies, build new tools, streamline workflow-based systems, and perform numerous data analysis in order to continuously improve the way we do things. This definitely enables us to provide better services to our clients.
Some technology giants are also trying to penetrate this industry with new services and products. Since I am more involved with Microsoft technologies, I feel Microsoft’s investment in the healthcare technology is worth mentioning. BizTalk has long supported HIPAA and HL7 accelerators. They have recently launched Microsoft Health Vault beta to manage health information on line. They have significantly improved their document/content management and CRM systems that would definitely aid the healthcare industry. Microsoft has also implemented many projects around the world in the healthcare arena, and as I understand, they will continue to increase their investments in the healthcare sectors. One can take a look at Microsoft’s healthcare site to see how serious Microsoft is about healthcare. I am sure other technology giants are not going to stay far behind if they are not already involved. I must also mention that the new Obama administration is supposed to heavily invest in the healthcare technology. Hopefully it will bring about the necessary change with increased technology investments in the healthcare sector in the coming years. The companies who will refrain from investing in technology will fall behind from their competitors.
Finally, healthcare technology may not be in an ideal state right now, but there is a huge room for improvement. Many private and public organizations, as well as the governments around the world are starting to pay the necessary attention to this sector. New technologies and standards are emerging. Some states in the United States are starting to establish mandatory procedures for electronic claim/bill submissions. Most importantly, despite the economic downturn, this might be the ideal time for organizations to embrace technology before the competition surges ahead. As IT professionals, we may also be able to have significant impact in this industry. We can get involved in many areas – Business Process or Workflow Optimization, Electronic Medical Records, Document/Content Management, Data Interchange, Business Intelligence to name a few.