• CHIME
• Medical billing
• Remote patient monitoring
• Revenue cycle
• Value-based care

Can process automation dial down healthcare inefficiencies?

There’s no lack of evidence that healthcare inefficiency is real – studies suggest that as much as one third of all healthcare spending provides no benefit to patients.

Different studies slice and dice this data into more digestible but disturbing chunks. A study reported by R1 RCM, Inc. says 88 percent of all patient appointments and bookings are made manually, leading to waits of as much as two months between a referral and an appointment.

In addition, information transmitted via these manual bookings includes misspelled names, duplicate records, incorrectly identified medications, incomplete follow-up instructions, delays in care, unnecessary readmissions and inadequate informed consent. STAT cited research that indicates these types of human errors contributed to more than 1,700 preventable deaths and billions of dollars in malpractice costs.

Today, patients frequently receive treatment at multiple facilities operated by different healthcare organizations. Their files are scattered, often mismatched and, according to a Black Book survey, services they receive are repeated because of duplicate records, leading to annual unnecessary costs of $1,950 for each patient per hospital stay and $1.5 million per hospital.

Long-standing inefficiencies

Declining revenues and capacity constraints, exacerbated by the pandemic, have made it essential for healthcare delivery organizations to prioritize investments that increase efficiency and lower costs. To that end, automation is being applied to processes, operations and workflows.

“All of this makes sense to me, but it has barely come up within our organization, and I wonder why.”

This past summer, Galen Healthcare Solutions hosted a focus group for the College of Healthcare Information Management Executives (CHIME) to discuss the potential process automation may have in achieving greater efficiencies in healthcare. Galen invited hospital, health system and physician group leaders to the CHIME focus group to share perspectives on how they are currently using automation, best practices to successfully implement it and future needs. In this session, focus group participants discussed:

• IT automation use cases, including data acquisition, document and scan indexing and classification, and EMR/EHR upgrade regression testing.
• IT automation framework for appropriate deployment.
• Digital workforce governance and performance management.

One of the executives described the frustration like this: “How do we solve a problem that occurs when you’re in a room with several people, each of whom is facing towers of papers, and a patient’s files show up from somewhere else, or an insurance company faxes something over to someone or other, and there are one thousand fax machines leading to nobody knows where. The days when various units’ records are on paper and they were all scanned at the end of the day, are gone.”

Estimates suggest that for every 10 physicians providing care, seven additional people are engaged in billing-related activities. A study in Health Affairs shows that doctors spend three hours per week dealing with billing matters; each doctor receives an additional 19 hours per week in support by administrative workers, each devoting 36 hours per week to such tasks. Obviously, these costs are not associated with actual medical care.

Finally, from a 2019 study published by the Journal of the American Medical Association, based on research compiled from 54 peer-reviewed publications and government-based reports, here are estimated ranges of total annual costs of waste:

• Failure of care delivery: $102.4 billion to $165.7 billion.
• Failure of care coordination: $27.2 billion to $78.2 billion.
• Overtreatment or low-value care: $75.7 billion to $101.2 billion.
• Pricing failure: $230.7 billion to $240.5 billion.
• Fraud and abuse: $58.5 billion to $83.9 billion.
• Administrative complexity: $265.5 billion.

Automation’s impact on inefficiencies

According to McKinsey Research, artificial intelligence has the potential to automate tasks that currently consume as much as 60 percent of the administrative work done by healthcare providers.

Robotic process automation (RPA) is software running on a physical or virtual machine. It is a form of business process automation that programs a robot to perform error-free at high volume and speed. It incorporates automation, computer vision and machine learning to complete some of the most mundane, repetitive, rule-based, and trigger-driven tasks and processes in the workplace.

An easy way to think about it is to compare it with work performed by a virtual robot copycat – tasks performed by humans on computers are recorded and then replicated without human intervention.

Instead of running reports, writing extracts, managing interfaces and data feeds, duplicating work in different systems, doing analysis and monthly reports in Excel, reworking and redoing, entering and uploading data manually, or repeatedly doing rote tasks, smart, well-paid people can take action, drive change, increase value, reduce cost and increase revenue.

The scope of RPA technology is wider than data-processing. It will help in administering business practices; it will carry out IT support activities; back-office work and remote infrastructure; it will deliver cognitive technologies like optical character recognition, image recognition, handwriting recognition, and natural language processing.

Encouraging data from a Deloitte survey on robotic processing automation:

• Return on investment occurred in less than 12 months.
• Compliance improved 92 percent.
• Quality and accuracy achieved 90 percent.
• Productivity went up 86 percent.
• Costs were reduced 59 percent.
• Productivity and staff morale increased.
• Scalability improved.
• Sensitive data was better protected.
• Tasks were completed faster.
• Medical errors were minimized.
• Workload fluctuations were more easily managed.

There has been intense interest in RPA in the healthcare industry. An August 2020 survey from Navigant shows 15 percent of healthcare revenue cycle leaders planned to invest in robotic process automation, up from zero a year earlier. LinkedIn reports that there were more than 3,500 searches for jobs pertaining to RPA, Deloitte research shows that more than half of the healthcare providers it surveyed have adopted RPA initiatives, and Forrester predicts that the RPA services market will swell to $12 billion by 2023.

The long road ahead

But during the focus group, it’s clear that there’s a long way to go. While being aware of the extent of the problem – and conscious of the claim that AI can significantly ameliorate it, few of our participants reported their institutions embracing the technology, except on a very limited scale.

Everyone participating in the focus group acknowledged the benefits that process automation would achieve in revenue cycle management, supply chain efficiencies and even some clinical operations. But as one panelist remarked, “All of this makes sense to me, but it has barely come up within our organization, and I wonder why.”

“We’re not hearing much about the need to automate,” another participant noted. “Where I’m getting complaints – and we may be just further behind because we’re a smaller organization – is with regard to our manual paper-intensive account payable process. As a result, we are looking at potentially some automation there (invoices and routing).”

If pressure to automate does not come from an organization’s financial leadership and unless the IT departments are empowered to initiate changes, automation may require buy-in from the clinical side. But, here too, urgency is lacking. A survey of 1,500 doctors conducted by Medscape in 2019 found that a majority were anxious about or uncomfortable with the use of automation in healthcare.

Potential for progress

However, it is in this area that some significant progress could occur. Several CIOs on the panel cited applications being made in an array of clinical departments that are being well-received.

For example, one panelist reported that, at her organization, “In radiology, we’re considering ways to accelerate our detection of damage by looking at how encoding can put the scan at the front of the line for the provider, so we’re prioritizing their reads.”

Another participant in the group said her organization is “studying throughput for the emergency department, using AI to help prioritize those at highest risk, with the most urgent issues, not just what’s being said by the patient’s family, but what’s in the record, especially for those at high risk for readmission, or those in a managed care contract that demands a particular level of service.”

Another panelist added that “AI can help identify masses in mammography, spots during lung cancer screening and other high-volume areas of concern within the images, instead of always looking for the needle in the haystack a couple hundred times a day.”

Ultimately, it’s clear that a consensus exists, certainly among those in the community of information technology, that the time has come to employ and reap the benefits of robotic process automation in healthcare. Whether for budgetary reasons, too much unwieldy and distributed data or preference for the familiar, resistance remains and advances are slow.

Nevertheless, the industry is getting closer to the summarization from the CIO of a provider network. “When you automate a function, it becomes invisible to the organization,” he said “That’s where a lot of concern comes from, so, we need to be careful when we automate something that we have a reasonable review process and that a part of that process demands periodic checking to make certain that the business hasn’t changed or regulations changed – because that would affect the automation.”

Justin Campbell is vice president of strategy at Galen Healthcare Solutions.

Participants in the Galen-led focus group included:

• Anupam Sule, Chief Medical Informatics Officer, St. Joseph Mercy Oakland
• Audrius Polikaitis, CIO and Assistant Vice President, University of Illinois Hospital and Health Sciences System
• Beth Hunkeler, IT Director, Dayton Physicians Network
• Carl Ahmed, Consultant, CA Associates, LLC
• Christine Brutschea, ACIO Information Technology, St. Luke’s Hospital and Health Network
• Curt Kwak, VP and Chief Information Officer, Proliance Surgeons
• Cynthia Davis, Consultant, Davis Digital
• Kerry Kerlin, CIO, Roswell Park Cancer Institute
• Randy McCleese, Consultant, Sparksbridge Consulting
• Roger Lutz, CIO, Butler Health System
• Sam King, CIO and Chief Innovation Officer, Care to Caregiver