AI Promises New Levels of Organizational Sustainability

Health care organizations consist of teams (large and small), which consist of individuals, and all three conceptual entities must perform optimally to maximize value to patients and ensure organizational sustainability. Authoritative information about patients and the business is the lever for streamlining valuable activity within, across, and up and down these groupings. Sharing information elevates performance throughout the matrix.

The ultimate information-sharing technology is artificial intelligence (AI). So far living up to the hype, it promises great power to foster new levels of effectiveness, quality, and sustainability for integrated health care organizations.

The trick, of course, is applying it well. The best place to start is with electronic health record systems (EHRs), where AI can automate workflows, enable better virtual care, and improve revenue cycle management.

Automating workflows

With 340 million patients in the U.S., there are a lot of repeatable workflows in health care for AI to automate. AI is now automating processes that for decades have been manual, expensive, and cumbersome.

AI, for example, is quickly becoming essential in the most fundamental activity in health care, the office visit. Natural language processing captures clinician-patient conversations, generating accurate transcripts, summarizing them, pulling keywords, and leveraging the data to populate patient profiles in the EHR. 

Automatically populated patient profiles can include patient ailment, history of present illness (HPI), diagnoses, treatment options, and social determinants of health. AI is also identifying recurrent patient themes, gauging patient sentiment, drafting treatment plans, and offering (but never pushing) potential diagnoses.

Innovators are extending this powerful automation to all members of a patient’s care team regardless of the artificial boundary separating behavioral and physical healthcare. In the AI age, a clinician can start a session by viewing complete (but digestible) profiles of a patient, including their histories on both sides of the house. Never again should communication gaps lead to misdiagnoses, adverse drug interactions, and substance abuse complications. AI is becoming especially valuable in delivering care to patients who have health comorbidities exacerbated by a combination of mental health and substance abuse.   

Improving virtual care

Many repetitive or lower-value processes can be mostly or completely automated, including appointment scheduling, ordering labs, prescription refills, progress reporting, care team alerting, patient notifications and more. Moreover, AI can train on all of the data from these processes, making it smarter and more helpful as time passes.

AI brings all of these capabilities to the virtual visit process, benefiting providers and their patients alike. Patients can quickly and easily schedule their telehealth appointments, facilitated by portals that AI personalizes for the patient. As with in-office visits, AI autonomously transcribes consultations, setting robust information sharing in motion. 

What’s more, AI enables richer virtual visits, including ones that convene multiple specialists from anywhere in the world, all the while tapping the patient’s integrated records for comprehensive care management. As AI manages the data, clinicians in a telehealth conference enjoy a greater ability to maintain a personal connection, making more eye contact and listening with undivided attention.

Better revenue cycle management

If any function can benefit from intelligent automation, it’s revenue cycle management (RCM). Inefficient RCM erodes financial sustainability, putting busy staff to work on denied claims, reworking, and resubmission. In fact, hospitals spend nearly $20 billion per year to fight denied claims. Eighteen percent of all claims are denied, each costing $31.50 in rework and resubmission for each. At last reckoning, organizations spent $68,000 per physician per year to interact with payors.

To mitigate such costs, AI tackles challenges like under-coding, under-documentation of claims, contract management, and overbilling, in every case coaching business staff to clean up flawed claims. It can prioritize and automate claims appeals, capturing lost revenue and making RCM staff more productive. AI can also help create detailed financial reports, ensuring accurate billing compliance for quality-based care reimbursements.

No more burnout

Capabilities like these are critical for improving care and maximizing revenue, but they’re also important for mitigating the well-documented burnout caused in part by cookie-cutter electronic health care systems.

The Surgeon General recently cited “burdensome administrative tasks” and “lack of human-centered technology” among burnout factors. “For every hour of direct patient care, physicians currently spend 2 hours on the Electronic Health Record (EHR) system,” the report says. 

AI, however, is supporting new levels of usability through unprecedented configurability and customization. The EHR system that’s been burning you out now feels like a system of your own. To foster this feeling, innovators are striving to put every user’s required data or functionality no more than one click away. In some cases, AI even carries on a literal conversation with the user, showing up on user interfaces in the form of a chatbot fluent in the information that individual is authorized to see. 

Ironically, the best thing about the new technology is that users spend less time with it. More automated information sharing means less screen time and more patient time. It also means more family time for clinicians who have long toiled after hours to catch up on data entry. Benefits like these roll up to the team and organization levels, making the matrix efficient and the enterprise sustainable for decades to come. If your EHR system isn’t doing this, you should find a way to make that happen.