Independent Review Organizations and IT Systems

Gone are the days when you can just have Microsoft Word and a couple of other applications at your company and be capable of dealing with the administrative and quality workflow that is required in order to be an IRO. Today, best in class IROs are investing in integrated web applications that provide an automated workflow between clients, their own operations, and peer specialists. In fact, AllMed Healthcare Management is in the process of rolling out it's own application called PeerPoint, which will greatly streamline and improve our ability to automate the workflow.

Companies that want to be in the business of providing independent medical reviews have to have a high degree of integration of their IT systems in order to be competitive. That includes having standardized operating systems at the network level and at the application level building customizing software applications that integrate and provide for administrative efficiency when it comes to taking in, assigning, processing, and returning independent medical reviews to its clients.

An IRO needs to have a quality IT process, standardization of operating systems, privacy and security procedures as it relates to IT information systems. These are all the kinds of things that the IRO has to maintain from an IT standpoint in today's environment.
healthcare
medical management

Independent Review as a Highly Optimized Work Flow

We hear about companies that are considering getting into the business of doing independent medical reviews and indeed, on the surface it looks like it's quite easy for any doctor to organize a small panel and start doing specialist reviews for a few clients. The fact is, that in today's environment, an IRO is called to build rigorous processes and standards and the investment required in order to do this correctly to meet the demands of large health plans and other healthcare organizations is very rigorous. I would like to outline in the next several blogs why it is that independent review is not a trivial, easy to organize function inside any organization, and why it requires a significant amount of investment and diligence.

The first thing to know about any IRO is that in order to be competitive they need to have a highly optimized work flow that breaks down the independent review process into a number of standard steps capable of providing a consistent level of turn around time and quality. Today's independent review organization typically has a staff of operations people, clinicians, as well as several software applications, each which have been brought together to organize a workflow that is capable of meeting the turnaround time of our customers.

When 20, 30, or 50 of our clients are calling in review requests that need to be received, dispatched, typed, proofed, edited, and finalized within a 24 hour period, you can imagine how demanding that is on your systems and procedures and how critical it is that your organization has optimized all aspects of the process. We have invested considerable sums of money into integrating our applications, databases, reporting, tracking, data entry procedures, word processing systems, and other aspects of our business including accounting, sales, and customer service in order to be able to provide the level of responsiveness the average health insurance payer or manage care organization needs. The independent review process itself requires an incredible amount of efficient organizational streamlining in order to be effectively and competitive.