Digital Healthcare Faces Hurdles, But The Push Continues

Digital technology is changing healthcare, from recordkeeping to disbursements, but the move away from analog is a journey that involves significant hurdles.

Consider the ongoing “Patients Over Paperwork” effort from the Centers for Medicare & Medicaid Services (CMS). Designed to cut “red tape” from healthcare, the initiative seeks to reduce the amount of documentation produced by doctors. Some 150 medical organizations have come out in support of the program, but that doesn’t mean they are 100 percent behind it. Doctors worry that the CMS will simplify billing codes so much that physician pay and reimbursement will decline.

As people live longer, which can drive up healthcare costs, digitalization can help bring down expenses and lead to better care via more access to data and coordination among various medical professionals, along with other features, according to analysts.

Reduced Costs

“Health insurers also can use digital tools to cut costs — by as much as 15 percent to 20 percent,” read a recent report from Bain and Co. “They can realize much of these savings by more efficiently processing claims and by detecting and preventing fraud, not by cutting back on services to the customer.” Such saving could theoretically be passed along to consumers, who would gain more efficient care, said the report.

Digital technology is quickly moving further into mainstream healthcare, as PYMNTS’ recent Deep Dive into medical-related disbursements showed. In the $3.5 trillion-per-year healthcare space – once ruled by checks – insurance players, both large and small, are increasingly embracing new methods of digital disbursements.

One of the companies covered in that new PYMNTS reports, called Better, focuses on smartphone-assisted payouts. The startup advocates on the patient’s behalf to reduce expensive, out-of-network medical bills. Better combines automation with human expertise to cut down on healthcare costs. That includes finding billing errors — which can result in overcharges of up to 26 percent — and addressing any other sources of medical billing confusion.

After downloading the Better app, users verify their identities by entering their personal information and adding a photo. Using that data, the company’s technology gets in touch with insurance companies and works to reduce consumers’ medical bills. The technology aims to make the insurance claims process easier and more efficient — for instance, by filing out-of-network claims for medical expenses and handling similar tasks.

Digital Backlash

Digitalization does not automatically lead to efficiencies, however. That’s a point driven home by Danielle Ofri, a medical doctor and New York University School of Medicine professor, in a New York Times column that focuses on what she calls the “growing burden of electronic busywork generated by the E.M.R., the electronic medical record.”

Among the reports she cited to support her point was one from the Annals of Family Medicine that found “doctors spent more than half of their time — six hours of their average 11-hour day — on the E.M.R., of which nearly an hour and a half took place after the clinic closed.” All that time takes away from patient interaction.

“Part of the issue is that there are simply more patients, most of whom are living longer with many more chronic illnesses, so each patient has many more health concerns that need to be taken care of in a given visit,” Ofri wrote. “But the main reason that I can’t keep up is the E.M.R. Like some virulent bacteria doubling on the agar plate, the E.M.R. grows more gargantuan with each passing month, requiring ever more (and ever more arduous) documentation to feed the beast.”

New Standards

Still, the drive toward more digital healthcare continues as the industry steadily moves away from analog processes.

In May, for instance, the Electronic Healthcare Network Accreditation Commission (EHNAC) said that its new Trusted Exchange Accreditation Program (TEAP) “will leverage existing industry-wide identity verification, authentication and privacy/security frameworks and best practices in use across the ecosystem,” according to a press release. TEAP will “align with many national efforts … to improve data exchange and enable interoperability across different health information networks.”

Put a different way, EHNAC intends to bring together people from across the healthcare industry to figure out how to best speed up its information machinery. Increasing the efficiency of access to that data — and securing it from misuse — can lead to better care and lower costs for healthcare providers and consumers, according to analysts and other experts.

Major players in the digital space also have their own healthcare plans. That includes Amazon, which has built a team to focus on making Amazon’s Alexa voice assistant more useful in the healthcare field. Sources say that a key task of the team will be working through regulations and data privacy requirements laid out by HIPAA (the Health Insurance Portability and Accountability Act). The group is focusing on areas like diabetes management, care for mothers and infants and aging.

Healthcare is a massively complicated industry whose laws, payment flows and workforce and labor needs present specific, often unique challenges for digitalization. But the investment and regulatory attention are increasingly tilting away from analog.