It was just a passing comment during a pretty creative presentation; but it really stood out for me. The Southern Association of Workers' Compensation Administrators (SAWCA) is currently producing it's 69th Annual Conference here in Pinehurst, NC. The session, a “skit” about the torturous claims process of a specific injured worker, starred numerous regulators and administrators known as the “SAWCA Players”. It was both serious and hysterical, aided by two staged “grumpy old men”, modeled after the “old geezer's in the balcony” characters of Muppet fame. Those old geezers were convincingly portrayed by retired Kentucky Commissioner Dwight Lovan and Maryland Comp Chairman Karl Aumann.
But the previously referenced comment came from Kentuckian Rosalie Faris, during a critique of the scenes we had just witnessed. The story, rumored to be based on real life, involved an initial utilization review denying requested surgery, even though an MRI clearly showed a fracture in need of repair. She explained that this could happen because the MRI was not included in the information made available to the UR doctor. She told us that, “Once the MRI was sent, the decision was reversed and surgery was approved”. This frustrating delay, however, was just one of many in the life of this claim, and by that time the exasperated injured worker, played by Georgia Comp Chairman Frank “I'll never break character no matter what the grumpy old men say” McKay, had retained an attorney.
And the comment about the once delayed MRI was firmly embedded in my mind. A critical piece of the puzzle had been omitted from distribution to yet another cog in the enormously complex claims machine, causing more needless delay as a result.
I mean, it's not like we are talking about human lives here. Oh, wait a minute, we are. That is just so darn easy to forget.
How, with all our advanced technology and knowledge, have we not managed to create a secure medical records pipeline that can effortlessly distribute complete and accurate medical files between all the necessary players? We have digital imaging. We have EDI for medical billing. We have the growing telemedicine industry. We have cloud computing, ample bandwidth and a completely networked nation. We have all the parts. They just cannot fit well with each other. We do not yet have the medical equivalent of the portable document format; the ubiquitous PDF that revolutionized document management.
I must ask, why?
Certainly, cost is a consideration. Privacy is also an encumbering variable. Yet, the technology march is on. What the band lacks is choreography, and a drum major to make sure everyone marches to the same beat.
Our local county hospital, Sarasota Memorial, was an innovator in the digitization efforts of medical records. As early as the 1990's, the hospital was making huge investments in proprietary systems that would make all medical files and images available electronically. My father in law, a former hospital chairman and board member for 24 years, was very proud of the system they created. Recently, when I encountered issues with my knees, my records, x-rays and MRI's were immediately available to my GP and specialists; any authorized medical provider in the SMH ecosphere could get complete and comprehensive electronic records related to my condition.
Of course, the transferability of those records to providers beyond the network is, to me, unknown. I am sure many medical systems today have similar capabilities. What is needed is an interpretive system, a bridge, that will allow those records to be shared to diverse providers all serving the same patient. We need the medical equivalent of a PDF style transformative technology. I am not talking about changing the data in a myriad of incompatible systems. After all, a PDF document doesn't change any underlying data; it simply makes it PORTABLE, and available across diverse platforms. We should be able to do the same thing with medical documents and images.
Who, I ask, will lead the way in that? Who is going to build a medical records pipeline that allows otherwise incompatible platforms to communicate? Who will help remove the needless delay caused by incomplete records?
It's a feasible idea. Now we need someone to take the lead on it.
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Robert Wilson is President & CEO of WorkersCompensation.com, and "From Bob's Cluttered Desk" comes his (often incoherent) thoughts, ramblings, observations and rants - often on workers' comp or employment issues, but occasionally not.
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