The Future is Now
Over the next several years, experts agree that some of these issues will begin to work themselves out, but it will take a lot of effort by many smart and dedicated people to make it happen. Nelken says his project is beginning to show progress and the Israeli healthcare system is showing signs of moving forward. "It's a slow process, but if you look at healthcare today, we are making significant progress compared to what we had even three and four years ago. I am less familiar with the U.S., but if you ask doctors in Israel, they have more information at their fingertips, and processes that used to take months are automated," Nelken says.
Miller agrees that it will take time and effort and small but significant steps, but he is confident that the industry will get there. He says, "There is major stuff moving forward, a commitment of resources and a lot of attention being paid to this, and you are going to find pockets of success."
IBM Integrated Medical Records Project
Perot Systems Corporation
Sidebar: New England Healthcare EDI Network (NEHEN)
One of the success stories of Massachusetts Health Data Consortium is NEHEN, which facilitates transactions between member providers and member insurance companies, providing a fully electronic solution.
According to Joe Miller, the project director, this was the first major effort of his group and it has resulted in dramatic savings for members. "Major health care providers and vendors are partners, meaning they have equal shares, in a private network that transports HIPAA-transformed transactions from the providers to payers and has taken the middleman out and saved millions of dollars for healthcare providers and insurance companies," Miller says.
Sira Cormier, project manager at NEHEN, explains that this system helps facilitate communication between the providers and the payers, so when a patient calls for an appointment and gives an insurance number, the provider can sign onto to the NEHEN system and confirm all of the patient's information including co-pay and any co-insurance information instantly. The system also provides the ability to do fully electronic referrals, so that when a primary care provider schedules a visit with a specialist, all of the paperwork gets transmitted electronically.
She says after the patient sees a provider, the billing is done electronically and provider staff can log onto the NEHEN system to see the status of the bill, rather than making calls to the insurance company. Ultimately, Cormier says, this system works for both providers and payers because it allows all members to take advantage of the technology. "If we were not developing this software, members would need the technical sophistication to build something to automate the sending and receiving of transactions themselves. By becoming a member, they don't need to develop their own and we give them tools to streamline the process," she says.