IAAI and Healthcare

Intelligence Automation/Artificial Intelligence (IAAI) within the Healthcare Arena

by: Rachel Rayfield
Visual Connections IAAI Expert & Project Manager

IAAI is on the rise across the healthcare industry. It's sweeping through all actors in the healthcare field from providers and enrollees, to clinicians, and the insurance companies who process claims. The nature of healthcare is complicated with increasing cost and decreasing accessibility to care, often causing it to be an ineffective industry. IAAI solutions cut costs and produce returns, so it is a natural progression. IAAI seeks to look for automated efficiencies within existing processes. It begins with understanding and documenting the current processes and associated requirements you are looking to automate. IAAI isn’t trying to overhaul or change the process completely, rather make improvements to the current process that functions within the existing requirements.

Automated efficiencies are the future of continuous improvement. The possibilities with IAAI include higher efficiency, higher accuracy, the ability to reallocate resources, and the potential for a very high return on investment. While clinical solutions seem to be less explored, IAAI has incredible potential to cut administrative costs within healthcare, but it also presents challenges. The Health Insurance Portability and Accountability Act (HIPAA) has strict standards for securing protected health information (PHI) and personally identifiable information (PII), so all IAAI healthcare solutions must at least proceed with caution.

Stethoscopes with Heart Representing Healthcare Industry

Additionally, the industry isn't standardized from an operating perspective. All providers have different processes and systems for medical record-keeping and billing. Not all medical records are standard or even electronic. There are no central data sets available for all patients in the United States, and publicly available data is often representative of only certain populations. Working through, and even around challenges makes up a significant part of the current climate of IAAI within the healthcare market.

Implementing the use of IAAI within medical record review. From the Visual Connections (VC) lens, we have several IAAI endeavors underway. However, in reference to the healthcare arena, let’s focus on medical record review for the moment. VC is currently implementing the use of IAAI within medical record review. For a particular project, our process began with documenting the customer's medical record review process, and the functional requirements of the system used to complete these reviews. Once completed, we made several classifications for each requirement, identifying whether it could be fully or partially automated, rankings for expected accuracy, and rankings for expected difficulty. These classifications were used to develop our proof of concept requirements and iteration schedule.

The proof of concept was built, tested, and approved by the customer and went live in April 2019. We completed the first sample of records reviewed in September 2019. For this proof of concept, we used optical character recognition (OCR), natural language processing (NLP), and robotic process automation (RPA) to optimize medical records and make determinations on required information and compliance. For the proof of concept, we only sought to automate steps that did not require medical decision making. For this process, participants were given the option to choose automated or manual review; 87 % of participants chose an automated review.

How we help new customers with this experience. VC can offer expertise on getting started, executing, and optimizing your IAAI project. Regardless of specific project goals, the foundation of understanding the process you want to automate, the current process requirements, and the business needs of the project are critical to success. VC has a developed project lifecycle methodology for IAAI projects that we have used successfully. VC can help with discovery and initial assessments, designing, building and testing IAAI solutions, and optimizing the solution for the customer.

Additionally, VC brings a wealth of knowledge and expertise from current/past projects and staff on hand. Along with a portfolio of IAAI projects and tasks, VC has staff with expertise in each area to advise and assist in the lifecycle. Whether you need assistance in analyzing and understanding the existing processes and requirements, assessing IAAI potential, technical direction, and advisement during building and testing, or in successful implementation, VC has staff and experience to support your endeavor.

Rachel Rayfield is an experienced Program Manager with more than 12 years’ experience with State and Federal healthcare programs. She is a certified PMP with a Master of Public Administration. Her background in healthcare encompasses Medicare and Medicaid, and she possesses expertise in Medicare policy. Additionally, Ms. Rayfield is an expert in innovative intelligence automation/artificial intelligence (IAAI) solutions within the healthcare industry.

“I feel these programs have tremendous impacts on the populations, and I wanted to do a small part to ensure the funding continues and beneficiaries continue receiving benefits.”

— Rachel Rayfield