Last friday, I was googling for casemix for a future post when I stumble upon the announcement by The International Centre for Casemix and Clinical Coding (ITCC), UKM Medical Centre, Universiti Kebangsaan Malaysia (UKM), Malaysia which was planning to organise the 6th International Casemix Conference 2012 (6ICMC2012) from the 6th -7th June 2012 in Kuala Lumpur , Malaysia.
Reading through this announcement, I noticed for the first time the words “Medical Record Optimization”. The organiser was calling for invitations from local and international participants to attend and present their findings and papers in several areas, including on Medical Record Optimization.
I abandoned my search for casemix (after surfing briefly some casemix websites) and decided to find out what Medical Record Optimization was all about and blog about it soon after as in this post before you. More googling and reviewing my search led me to locate MedNeutral which stood out prominently in the search list.
MedNeutral which has its roots in the insurance industry is a Brahma Holdings company which provides transformational solutions to the insurance industry in the United States of America, is headquartered in La Jolla, CA, USA.
MedNeutral’s proprietary Medical Records Optimization™ (MRO) solution is a next-generation service comprising of a set of digital medical record solutions that performs a triage on the medical records for claims processors, legal counsel, financial personnel, medical professionals, and government agencies.
As you will be aware in the Malaysian hospital setting, medical records contain extremely important information for claims processing, and also for data analytics. As Health Information Management (HIM) / Medical Records (MR) practitioners still dealing with paper-based medical records in most of Malaysia’s public and private hospitals (as in most parts of the developing world and under-developed world regions), something as basic as illegible handwriting is still the biggest problem in paper-based medical records. Other challenges in paper-based medical records include the absence of medical context, missing or incomplete documentation, difficulty in accessing the necessary medical information and use of jargon and/or symbols.
MRO converts these unstructured data – as found in paper or imaged medical documents, housed in document management or claims transaction systems into highly structured information through file assembly.
Key features of MRO are:
- medical records are sorted and arranged in chronological order (with sorts also available by other fields). Raw medical data in different formats, and hand-written are further transformed into a set of electronically scanned, chronologically based, consistently indexed, and formatted records packages.
- medical abstracts for key record types, which summarize the medical facts contained within the files
- search and indexing tools embedded in the MRO solution allow to quickly call up facts and medical context around specific treatments or body parts; tracking algorithms enable automated identification of changes in diagnosis, medication, provider or facility
- MRO also features collaboration tools to facilitate rapid sharing of abstracts, facts and analysis which leads to improved organizational productivity and faster and efficient decision making
MedNeutral’s MRO solution (clicking on the image below for a larger view opens the larger view in a new tab of your current window) adds value in the following ways:
Soruce : MedNeutral, medneutral.com/solution-value/
Many top institutions like LexisNexis Communities have applied MedNeutral’s MRO solution platform to streamline the medical review process and make more accurate and informed decisions for example during the Gulf Oil spill, as an example of a scalable solution capable of processing voluminous medical records, identify factors which impact value, establishes legitimacy of claims and expedites the resolution of claims from the rash of personal injury claims during this man-made disaster.
An on-going, systematic study by Accenture (a global management consulting, technology services and outsourcing company) of insurance claims performance dating back to the 1990s, showed that insurers have difficulty accessing the information in medical records due to unstructured data and believes that investment in information technology in this area, with a shift to a structured data approach, is necessary.
It was clear from the articles I sourced that the hurdles for optimizing medical records for a meaningful use are both technological and organisational. An area for investment is in developing and promoting industry standards for medical records. But what is really important is taking a comprehensive look at the way medical information is acquired and handled, a probable progression to electronic medical records.
As hindsight, I could not find any mention of MRO from the scientific programme for the 6th International Casemix Conference 2012.
I can only assume that the topic Medical Records Optimization was planned to be included for this casemix conference as the processes of digitization, indexing, abstraction, collaboration and analysis are similarly applied to optimize medical records contents for casemix.
After knowing what MRO was all about, I decided to refresh my rusty memory about Casemix as I vaguely remembered casemix is about the difficult challenge of reducing costs while maintaining or improving quality of care and access. I also remember that Casemix was about methodologies, which categorise patients into statistically and clinically homogeneous groups based on the collection of clinical and administrative data and the interpretation of hospital patient data related to the types of cases treated, in order to assist hospitals define their products, measure their productivity and assess quality.
Casemix data also allows support for a unique collaboration between clinicians, statisticians, accountants, managers, funders and policy makers as it provides a common language that is freely shared with a strong focus on Peer Group review.
From further reading about Casemix lead me to believe that Casemix used similar techniques by MRO in claims processing, to optimize medical records. Casemix classified patients into a manageable number of groups (patients in the same group should cost roughly the same to treat) but poor quality information meant poor quality casemix information, and thus the quality of Casemix information rests with clinician documentation, clinical coders and accuracy of information systems, that is much needed and desperate call for a structured data approach in medical records.
I shall conclude that the reference to medical records optimization for the 6th International Casemix Conference 2012 had nothing to do with MedNeutral’s trademarked Medical Records Optimization™ (MRO) product solution that was largely used by companies for claims processing, but wanted would-be speakers to speak and present on how medical records could be optimised for Casemix purposes.
References :
Casemix for Beginners, The National Casemix & Activity Based Funding Conference, 3 to 7 October, 2011 – Radisson Resort Gold Coast, Queensland, Australia, casemixconference2011.com.au/
Casemix, Canadian Institute for Health Information (CIHI), cihi.ca/
“Mastering Medical Information”, May 2009, Accenture, accenture.com/
MedNeutral, medneutral.com/solution-value/
“MedNeutral’s Medical Records Optimization for Gulf Oil Spill”, August 19, 2010, LexisNexis Communities, lexisnexis.com/
“Optimizing medical claims: A data-centric approach”, March 5, 2010, Accenture, accenture.com/us-en/blogs/accenture-blog-on-insurance/default.aspx
The Irish Casemix Programme, casemix.ie
