Healthcare Revenue Cyle Automation - What & Why for Providers?

Revenue Cycle Automation in Healthcare: Where to Start and Why it Matters?

In today’s fast-evolving healthcare landscape, financial stability is just as critical as patient care — yet many providers are stuck navigating a revenue cycle filled with friction. From manual eligibility checks and coding errors to denied claims and delayed reimbursements, inefficiencies create a costly drain on time, revenue, and staff morale. In fact, nearly 90% of claim denials are preventable, yet providers continue to lose millions annually. It often feels like you’re leaving money on the table — and too often, that’s exactly what’s happening.

Enter Revenue Cycle Automation (RCA) — a strategic approach that redefines how healthcare organizations manage financial operations. By leveraging Robotic Process Automation (RPA) and intelligent workflow tools, RCA eliminates bottlenecks across the healthcare revenue cycle, driving greater speed, accuracy, and consistency in every transaction. The result? A more resilient, data-driven financial process built for today’s healthcare challenges.

Table of Contents

What Can Be Automated in the Healthcare Revenue Cycle, and Why?

Every step in the healthcare revenue cycle has one thing in common: complexity. From patient registration to denial management, repetitive tasks and manual workflows create bottlenecks that delay payments and drain resources. But not every part needs a total overhaul. In fact, some of the most critical processes are also the easiest to automate. Here’s where providers can get the biggest wins with the least disruption.

Patient Scheduling and Registration

Accurate patient information at the scheduling and registration stage is critical to a healthy revenue cycle. Yet in many practices, this process is still handled manually — leading to incomplete forms, incorrect insurance details, and workflow bottlenecks that often snowball into denials and revenue loss.

So how does automation help here? By streamlining data entry, insurance verification, and digital form completion, providers can capture clean, validated data upfront. Information flows directly into systems with minimal human input, reducing errors and saving staff time. The result is a faster, more reliable intake process that supports both financial performance and a smoother patient experience.

Eligibility and Benefits Verification

Verifying a patient’s insurance coverage before the visit is one of the most crucial and time-consuming tasks in the revenue cycle. This is also a leading cause of downstream issues like claim denials, payment delays, and surprise bills. When done manually, the process can involve long phone calls, navigate payer portals, and deal with outdated or incomplete information.

This is where automation becomes indispensable. Automated eligibility and benefits verification, often powered by RPA, can run real-time checks with payers at the point of scheduling or registration. They instantly confirm coverage details, including co-pays, deductibles, and authorization requirements, flagging any potential issues immediately. The result is faster pre-visit workflows, fewer denials, and greater financial transparency for patients.

Top 3 Revenue Cycle Processes to Automate Today!

Coding and Charge Capture

Coding and charge capture form the critical link between services rendered and payments received. Yet, the sheer volume and complexity of codes, combined with manual workflows, often results in missed charges, underbilling, and compliance risks. Even small errors can trigger delays in payment or lead to costly audits.

Automation helps bring consistency and control to this process. Intelligent systems extract clinical data from EHRs, suggest CPT and ICD-10 codes, and validate them in real time. They can also detect uncaptured services and flag potential errors before submission. By ensuring every billable item is coded correctly and completely, automation helps maximize reimbursement, reduce audit risk, and safeguard revenue.

Claims Submission

You’ve done all the hard work – patient registered, benefits verified, codes captured. Now comes claims submission, where even minor slip-ups can cause major delays. Each payer has different rules, and one wrong field, a missing modifier, or an overlooked denial reason from a previous claim can kick things back into rework, slowing everything down.

With automation, claims get cleaner and faster. Claims are auto-scrubbed for errors, tailored to payer requirements, and submitted electronically, on time, every time. The result? Fewer rejections, faster acknowledgments, and end-to-end tracking that keeps your cash flow steady and your team focused.

Payment Posting

Receiving payments is a win but posting them accurately is where the real work begins. Manually processing Explanation of Benefits (EOBs) and Electronic Remittance Advices (ERAs) is a time-consuming, error-prone chore that can lead to misapplied funds, missed follow-ups, and revenue that quietly slips through the cracks.

Automated payment posting, powered by RPA and AI, instantly processes EOBs and ERAs, automatically applying payments, adjustments, and denials to the correct accounts, and flags discrepancies in real time. That means faster reconciliation, cleaner records, and a healthier cash flow with far less manual effort.

Denial Management

Claim denials are inevitable in the healthcare industry. However, letting them pile up is costly! Manually identifying, researching, and appealing each denied claim is a monumental task. This leads to a backlog that consumes significant staff time and leaves revenue uncovered.

Intelligent denial management tools, a key component of healthcare revenue cycle automation, can categorize denials by root cause, auto-route them for correction, and even trigger workflows to resubmit clean claims faster. This means faster resolution, higher appeal success rates, a dramatic reduction in manual rework, and a significant boost in the operational efficiency.

Common Misconceptions About Automating Revenue Cycle

We’ve seen how Revenue Cycle Automation can significantly streamline your operations. But it’s understandable that you might still have questions on whether this will actually work for you or not. We hear you! Despite its growing adoption, a few common myths still hold providers back. Let’s clear those up!

We’re not a big healthcare provider; this isn’t meant for us!

We hear you, and that’s totally fair. But the truth is, automation isn’t just for health systems with massive IT budgets. While there’s an initial investment, the ROI is quite substantial. Many tools are modular and built for practices of all sizes. You can pretty much start small and scale up without turning everything upside down. The cost savings from fewer errors, faster payments, and drastically improved efficiency typically far outweigh the implementation expense.

Will Automation Replace My Staff?

This is perhaps the biggest fear among many providers. The truth is automation will never replace your staff but empower them. How? By offloading repetitive, mundane tasks like endless data entry and routine verifications. Think of automation more as a digital assistant that lets your staff to focus on complex problem-solving, building patient relationships, and higher-value activities.

It Sounds Complicated!

Won’t implementing automation be a nightmare for my practice?” We get it; bringing in new technology can instantly bring images of disrupted workflows and long staff training sessions. But modern RCA tools are designed with simplicity in mind. They integrate smoothly with your existing systems and start delivering value quickly, often without interrupting day-to-day operations.

That’s why working with the right partner makes all the difference. Reputable teams take a phased approach, integrating automation gradually into your existing workflows without flipping your operations upside down. This is exactly where VNB Health stands out. We specialize in Healthcare Revenue Cycle Automation that fits your pace and your priorities, helping providers start small, scale smart, and see real value early. Our team works collaboratively with you to identify high-impact opportunities, then implements automation step by step to ensure a smooth transition and continuous improvement.

Ready to Improve Your Revenue Cycle?

Healthcare revenue challenges aren’t going away — but how you handle them can change everything. The path to a healthier, more financially stable healthcare practice in today’s demanding environment isn’t about working harder, but smarter. While the challenges facing healthcare providers are significant, so are the opportunities for transformation. Eventually, automation is all about working smarter, reducing friction, and helping your people focus on what matters most – delivering exceptional care.

At VNB Health, we’re committed to making this transition seamless and impactful. We’re more than just a vendor; we are your strategic partner in this journey. Our phased approach and deep expertise in healthcare revenue cycles ensure that you gain efficiency from day one, with a clear roadmap for continuous growth.

Revenue Cycle Automation Services | Healthcare Revenue Cycle

Healthcare Data Solutions in Microsoft Fabric

Reimagining Healthcare Data Strategy: Microsoft Fabric and Beyond

Data is healthcare’s most valuable asset — but fragmented, incomplete, or hard-to-access data can cripple decision-making and slow down critical processes. Without timely insights, organizations struggle to improve patient care, manage costs, and maintain operational efficiency.

Enter Healthcare Data Solutions in Microsoft Fabric — a powerful platform designed to unify healthcare data, simplify reporting, and drive informed decisions.

Why Healthcare Organizations Need a New Data Strategy?

Healthcare organizations often face persistent challenges when managing data. Information is frequently scattered across multiple systems, stored in complex formats, and difficult to analyze. This fragmentation limits the ability to uncover meaningful insights — insights that could improve patient care, streamline operations, and enhance financial stability.

Healthcare Data Solutions in Microsoft Fabric addresses these issues by centralizing data from clinical, operational, and administrative systems. It breaks down silos and transforms complex data into actionable insights, helping healthcare providers unlock the full value of their information.

Understanding Microsoft’s Healthcare Data Solutions in Fabric

Understanding Microsoft Healthcare Data Solutions in Fabric

At the core of Healthcare Data Solutions in Fabric is its Lakehouse architecture — a foundation that consolidates data from multiple sources into a unified platform. This architecture streamlines ingestion, transformation, and storage, making it easier for organizations to manage and analyze data.

By integrating with Azure Health Data Services (AHDS), which supports the FHIR standard, Fabric enables the seamless ingestion of patient and operational data into a secure and centralized repository. This approach simplifies data preparation, making insights readily available for improved decision-making.

Some of the key capabilities that enable healthcare organizations to manage their data efficiently are:

Powerful Data Pipelines: Secure data ingestion and transformation through Fabric’s integration with OneLake ensures data consistency and reliability.

Advanced Analytics & AI Integration: Fabric enables enhanced reporting, predictive analytics, and AI-driven insights, improving clinical decision-making and operational efficiency.

Enhanced Security & Compliance: Built-in governance, role-based access control, and encryption ensure healthcare data is managed securely.

Why Microsoft Fabric Stands Out for Healthcare Providers?

The ability to unify and analyze data in a structured way creates powerful opportunities for healthcare organizations. With Healthcare Data Solutions in Fabric, healthcare providers can:

  • Track patient outcomes with greater precision
  • Streamline administrative workflows to improve operational efficiency
  • Optimize resource allocation to enhance financial performance

Microsoft Fabric stands out because of its technical strength and healthcare-specific capabilities. It integrates seamlessly with EHRs and other critical data sources, ensuring secure data exchange. Its scalability and flexibility help healthcare organizations adapt to changing needs while maintaining performance and reliability.

Whether handling large clinical datasets, financial reports, or operational insights, Fabric provides a strong foundation for healthcare data management.

Taking Healthcare Insights Further

While Microsoft Fabric provides a strong foundation for healthcare data integration, organizations often need more specialized insights tailored to their unique workflows.

This is where VNB’s Healthcare Analytics Solution takes healthcare insights to the next level.

By building on Fabric’s capabilities, our solution provides healthcare organizations with an end-to-end analytics platform designed to deliver deeper insights, improved reporting, and proactive data monitoring.

With VNB Health’s analytics solution seamlessly integrated with Microsoft Fabric, healthcare organizations can move from simply managing data to actively harnessing it — empowering data-driven decisions that improve patient outcomes, reduce costs, and enhance financial performance.

Bringing Healthcare Data to Life with Fabric & VNB Health

VNB Health’s Healthcare Analytics Solution is designed to empower healthcare organizations with deeper insights, improved reporting, and smarter decision-making.

By leveraging a robust architecture, our solution efficiently integrates data from multiple sources such as EHR systems, financial platforms, and admissions records. This seamless integration combines secure data ingestion, structured storage, and advanced analytics capabilities to deliver comprehensive insights — without adding complexity to existing systems.

Built to align seamlessly with Microsoft Fabric, our solution utilizes data pipelines for streamlined data ingestion, scalable storage solutions, and real-time data monitoring to transform raw data into actionable insights. With intuitive dashboards and dynamic reporting tools, healthcare leaders can make faster, data-driven decisions that improve operational efficiency, enhance patient care, and support financial growth.

Our comprehensive platform offers the below specialized analytics solutions to meet key healthcare challenges.

Healthcare Revenue Cycle Analytics

Boost financial stability by improving cash flow visibility and minimizing revenue leakage. Our healthcare revenue cycle analytics solution helps you track revenue cycle KPIs, identify billing inefficiencies, and close payment gaps — ensuring your bottom line stays strong.

  • Identify claim denials, billing inefficiencies, and payment gaps
  • Gain visibility into the entire billing process to improve cash flow
  • Track revenue cycle KPIs for improved financial performance

Request Demo

Healthcare Financial Analytics

Unlock financial insights to better manage expenses, improve payer performance, and predict revenue trends. Our healthcare financial analytics solution empowers healthcare leaders to make informed financial decisions that drive growth.

  • Track revenue trends, operating costs, and cash flow
  • Identify payment delays, revenue leaks, and financial risks
  • Monitor payer performance and enhance reimbursement strategies

Request Demo

Healthcare Clinical Analytics

Improve clinical outcomes by identifying high-risk patients, tracking treatment effectiveness, and predicting readmission trends. With proactive insights, your care teams can focus on what matters most — improving patient care.

  • Identify high-risk patients and predict readmission trends
  • Monitor clinical performance, treatment outcomes, and quality of care
  • Support evidence-based care decisions through proactive insights

Request Demo

Healthcare Admissions Analytics

Ensure smoother patient flow with insights into bed occupancy, discharge trends, and staffing needs. Our Admissions Analytics solution helps hospitals make smarter decisions to enhance patient experience and reduce wait times.

  • Track bed occupancy rates, patient admissions, and discharge trends
  • Optimize appointment scheduling and staffing needs
  • Enhance care coordination by identifying workflow gaps

Request Demo

Your Path to Smarter Data Management Starts Here

In healthcare, data is more than just numbers — it’s the key to improving outcomes, streamlining operations, and driving financial growth. But without the right tools to harness it, valuable insights often remain hidden. By combining Microsoft Fabric’s robust data platform with VNB Health’s Healthcare Analytics Solution, you gain an end-to-end solution designed to unlock insights that improve patient outcomes, streamline operations, and boost financial performance. Don’t let valuable insights remain hidden — take control of your healthcare data strategy today.

Whether you’re managing financial data, tracking clinical outcomes, or improving admissions processes, our solution helps you stay ahead with insights that matter. The best part? It seamlessly aligns with Microsoft Fabric, meaning you can build on an industry-leading platform while gaining enhanced reporting capabilities tailored to healthcare’s unique challenges.

Combined Power of Microsoft Fabric and VNB Health Analytics Solutions

Ready to see how VNB Health can transform your healthcare analytics journey?

Get Started Today | Book a Demo

Role of Clinical Analytics in transforming Patient Outcomes

The Role of Clinical Data Analytics in Transforming Patient Outcomes

Imagine this: a healthcare organization struggling with rising patient readmission rates and ballooning costs. Or a doctor drowning in a sea of patient data – mountains of electronic health records, discharge summaries, and lab results. While this data holds immense potential, extracting meaningful insights often feels impossible. Meanwhile, patients yearn for personalized care, yet too often receive generic treatment plans. This is the reality for many in today’s healthcare landscape. Enter Clinical Analytics – a powerful tool that empowers providers to unlock the hidden value within their data.

Redefining Care with Clinical Data Analytics

Clinical Analytics isn’t just about collecting data; it’s about transforming that data into powerful insights. By leveraging advanced techniques like AI and machine learning, healthcare businesses can uncover hidden patterns, identify patients at high risk, and even predict potential health issues.

This empowers healthcare providers to make more informed decisions, personalize treatment plans, and ultimately improve patient outcomes. Imagine having a super-powered magnifying glass that allows you to see the bigger picture and make the best decisions for your patients’ well-being – that’s the power of Clinical Analytics.

From Insight to Action: The Role of Clinical Analytics in Decision-Making

So, you now have all this incredible data available with you with some amazing insights. Now what? That’s where the real magic happens. Imagine being able to:

Predict which patients are at high risk of readmission: By analyzing crucial factors like chronic conditions and medication adherence, clinical data analytics can identify patients with a high likelihood of hospital readmission. This will enable proactive interventions from healthcare organizations such as care coordination, patient education programs to reduce readmission rates and improve patient outcomes.

Personalize Treatment Plans: No two patients are the same! With clinical analytics, healthcare organizations can tailor treatment strategies based on everyone’s needs and preferences. Analyzing specific information such as genetic, behavioral and clinical data can lead to better clinical outcomes, improved patient satisfaction, and reduced side effects.

Enhance Medical Safety: Medical errors carry significant legal, financial, and reputational risks for healthcare organizations. Clinical data analytics plays a crucial role in mitigating these risks by proactively identifying and preventing potential harm to patients. For instance, it can flag drug interactions, detect allergic reactions, personalize treatment plans, and identify other safety concerns. This allows healthcare providers to make more informed decisions, adjust treatment plans accordingly, and ultimately improve patient safety and overall care quality.

Connecting the Dots: The Challenges and Triumphs of Clinical Analytics

We’ve explored the exciting potential of clinical data analytics, but it’s important to remember that implementing any major change within a complex system like healthcare comes with its own set of hurdles. Let’s explore these and discover how healthcare organizations can overcome them to unlock the full potential of this transformative technology.

1. Breaking Down Data Silos: A Unified Vision for Patient Care

Imagine trying to build a puzzle without all the pieces. That’s often the reality for healthcare organizations grappling with fragmented data. Patient information resides in disparate systems – electronic health records (EHRs), lab results, imaging reports, and more. This data isolation hinders a comprehensive view of patient health and limits the insights that clinical analytics can provide.

To overcome this, organizations must invest in robust data integration tools and strategies such as:

  • Centralized Data Warehouses: Creating a secure and centralized repository for all patient data.
  • API Integration: Utilizing APIs to seamlessly connect different systems.
  • Data Governance: Establishing clear data governance policies to ensure data quality, accuracy, and consistency.
  • Fostering Collaboration between IT, clinical, and administrative teams to break down departmental silos and share data effectively.

2. Building Trust: Prioritizing Patient Privacy and Security

Patient data is highly sensitive. Trust is paramount, and any breach of patient privacy can have severe consequences. Implementing robust security measures is crucial to protect patient information and maintain public confidence.

To tackle this, organizations can implement the following strategies:

  • HIPAA Compliance by ensuring strict adherence to HIPAA regulations. This means regular audits to identify and address potential vulnerabilities, and a commitment to prioritizing patient privacy in all aspects of operations.
  • Advanced Encryption: Encryption isn’t a set-it-and-forget-it thing. The cyber world is constantly evolving, so organizations need to stay on top of the latest security measures. This means regularly updating encryption systems, making sure they have strong key management in place, and always looking for ways to improve defenses against cyber threats.
  • Data Access Controls: Giving people the exact access they need is key. By carefully controlling who has access to what information, businesses can minimize the risk of any accidental or intentional data breaches while still making sure the teams have the information they need to do their jobs.

3. Achieving Seamless Interoperability: Speaking the Same Language

Imagine healthcare providers speaking different languages. That’s often the reality with different systems and data formats. Lack of interoperability hinders data exchange and collaboration, hindering effective patient care.

To address this challenge:

  • Invest in interoperable solutions that act like bridges connecting different systems, allowing to easily share and access information.
  • Embrace standards like FHIR provide a common language for healthcare data, allowing different systems to “understand” each other. By adopting these standards, businesses can break down the communication barriers and ensure that patient information flows smoothly between different providers and systems.

By investing in data integration, prioritizing patient privacy, and embracing interoperability, healthcare organizations can unlock the full potential of clinical data analytics and deliver better, more informed patient care.

Unlocking the Future: Clinical Analytics Trends to Watch Out For

The future of clinical analytics is bursting with possibilities, with several emerging trends poised to revolutionize how organizations deliver healthcare.

1. AI-driven Insights: Based on studies, AI in healthcare (worldwide) was estimated at USD 19.27 billion in 2023 and is expected to reach a projected revenue of US$ 208,225.9 million by 2030. The healthcare industry’s CAGR is expected to be 37.5% from 2024 to 2030. Imagine AI sifting through mountains of data to uncover hidden patterns and predict potential health risks. Artificial intelligence and machine learning are revolutionizing clinical analytics by enabling faster, accurate diagnoses and deeper insights.

2. Real-Time Data Integration: Wearable devices and the rise of IoT are opening up a world of remote patient monitoring. Imagine a future where your health data is constantly monitored, allowing for early detection of potential problems and more proactive interventions. Wearables are set to reduce hospital costs as much as 16% by 2027 and poised to deliver global cost savings of about $200 billion in the health care sector.

3. Value-Based Care (VBC) Models: The focus is shifting from simply providing services to delivering value for patients. Clinical data analytics plays a crucial role in this shift, helping businesses understand what truly matters to patients and identify the most effective ways to improve their health. According to reports, the U.S. value-based healthcare service market size is expected to grow at a CAGR of 7.4% from 2025 to 2030. Based on data from Centers for Medicare & Medicaid Services (CMS), the VBC model has seen a 25% increase in healthcare provider participation from 2023 to 2024.

How can VNB Health help with your Clinical Analytics Needs?

We believe that data should empower organizations, not overwhelm them! Our Clinical Analytics solution empower you to unlock the full potential of your data. This data-driven approach helps to enhance patient care, optimize resource allocation and reduce costs.

We believe that data-driven healthcare is the future, and we’re committed to helping you build a brighter future for your patients. Get in touch with our experts today!

Healthcare Revenue Cycle Management (RCM) Analytics

Everything About How Revenue Cycle Management (RCM) Analytics Can Transform Healthcare Finance

In an industry where every dollar counts, are you confident that your healthcare organization is maximizing its revenue potential? With complex billing codes, evolving regulations, and a myriad of payer contracts, the healthcare revenue cycle management can be a labyrinth. Imagine a hospital or clinic as a game of chess with high stakes. Every move, every decision, can significantly impact the bottom line. A missed claim, delayed payment, or a coding error can lead to substantial financial losses. But what if there was a way to navigate this with ease?

Why is Healthcare Revenue Cycle Complicated?

The healthcare revenue cycle is like a complex puzzle with many moving pieces. It starts when a patient makes an appointment and ends only when the provider gets paid for the services rendered. Along the way, there’s a maze of steps like patient registration, insurance verification, medical coding, claim submission, and payment collection. Each step has its own set of rules and regulations, and any hiccup can delay the process, leading to lower revenue and frustrated patients. Throw in the ever-changing healthcare landscape with new regulations and technologies, and you’ve got a real challenge on your hands.

Challenges faced by Healthcare Organizations in Managing their Revenue Cycle

Healthcare organizations face numerous challenges in managing the revenue cycle. These challenges can lead to significant financial losses, operational inefficiencies, and patient dissatisfaction. Some of the key challenges are:

Revenue Cycle Analytics - Challenges

Compliance Nightmare

Navigating the complex web of healthcare regulations, such as HIPAA and other data protection laws, can be a daunting task. Staying up to date with the latest changes and ensuring compliance can be time-consuming and costly. Non-compliance can lead to hefty fines, penalties, and reputational damage.

The Coding Conundrum

Accurate coding is crucial for proper reimbursement. However, with the constant evolution of coding guidelines and the potential for human error, coding errors remain a significant challenge. Inaccurate coding can lead to claim denials, delayed payments, and reduced revenue.

Getting Paid on Time

Collecting payments in a timely manner is a persistent challenge. Factors such as slow payer reimbursements, complex billing processes, and patient responsibility can significantly impact cash flow. To optimize the payment cycle and accelerate revenue, healthcare organizations must focus on efficient claim submission, timely follow-up, and effective patient billing strategies.

Delayed Data-driven Decisions

Many healthcare organizations still rely on manual processes and outdated systems to manage their revenue cycle. This lack of data-driven insights hinders their ability to identify trends, optimize processes, and make informed decisions. By leveraging advanced analytics, organizations can gain valuable insights into their revenue cycle performance and take proactive steps to improve it.

Overall, the healthcare revenue cycle management is a complex web of processes, regulations, and payer interactions. Traditionally, organizations have relied on manual processes and reactive approaches to managing this cycle. Yet, a more proactive and intelligent approach is needed.

Power of Data & Analytics!

McKinsey studies reveal that 15% of US healthcare spending, or $400 billion annually, is wasted on inefficient revenue cycle processes like claims processing, payments, and billing. This inefficiency is largely due to outdated methods and manual processes.

Data is crucial for modern healthcare. By analyzing historical data, organizations can identify trends and patterns in claim denials, helping them improve revenue cycle efficiency and reduce losses. 

Industry experts also believe that data analytics contribute to about 5-10% of revenue increase. By analyzing large datasets, healthcare organizations can uncover hidden patterns and correlations. For example, they can identify specific claim types frequently denied due to coding errors. This insight allows them to implement targeted training and strategies to reduce future claim denials.

The Role of Predictive Analytics in Healthcare Revenue Cycle

With the advancements in AI-technology, healthcare organizations are increasingly turning to predictive analytics to gain a competitive edge. Predictive analytics involves using historical data to forecast future outcomes. In the healthcare context, this can be applied to various aspects of the revenue cycle, such as predicting claim denials, identifying high-risk patients, and forecasting future revenue. This data-driven approach helps optimize staffing, resource allocation, and overall revenue cycle efficiency.

By harnessing the power of data and predictive analytics, healthcare organizations can revolutionize their revenue cycle. As we look to the future, a data-driven approach will be essential to navigate the complexities of the healthcare landscape. This is where Revenue Cycle Analytics comes into play.

What is Revenue Cycle Analytics?

Revenue Cycle Analytics helps healthcare businesses gain valuable insights into the organization’s financial health, identify potential revenue leaks, and optimize processes for maximum efficiency. Revenue Cycle Management Analytics (RCM Analytics) is like a crystal ball that can predict future challenges and opportunities. Revenue Cycle Analytics (RCA) combines predictive and real-time analytics to forecast future trends and monitor current operations.

The Role of RCM Analytics in the Future of Healthcare Industry

Role of Revenue Cycle Analytics in Healthcare

In Healthcare, Revenue Cycle Management (RCM) Analytics is more than just a buzzword! It’s a transformative tool that’s reshaping how organizations operate and thrive.

By leveraging data-driven insights, healthcare providers can streamline their financial processes, improve patient care, and adapt to the ever-evolving healthcare landscape. But how exactly does it help your organization, and why is it so crucial for the future of healthcare?

Enhancing Financial Performance

In a healthcare environment, profit margins are often razor-thin. Revenue cycle analytics help organizations identify and address bottlenecks in the billing and payment processes. With detailed insights into denial patterns, payer trends, and payment delays, RCA ensures faster reimbursements, reduces claim denials, and optimizes revenue collection. This means improved cash flow and the ability to allocate resources more effectively.

Improving Patient Experience

Typical challenges faced by patients like billing issues and unclear payment processes put them under a lot of stress. This can damage your organization’s reputation. RCA identifies these potential areas of conflict and helps streamline the cost estimation, reduce billing errors, provide patients with transparent payment options—all contributing to a smoother healthcare journey.

Driving Operational Efficiency

Manual processes, redundant tasks, and data silos are the common causes for inefficiency in the revenue cycle. RCA automates and integrates these processes, providing a real-time view of financial performance and pinpointing areas needing improvement. Automation reduces administrative burden, freeing staff to focus on providing better patient care.

Enabling Strategic Decision Making

Having the right data is critical for healthcare organizations. Revenue cycle analytics provides actionable insights into metrics like average reimbursement rates, payer performance, and more. With these insights, organizations can make informed decisions about contract negotiations, resource allocation, and future investments.

The Road Ahead: Leveraging a Revenue Cycle Analytics Dashboard for Success

Did you know that over 90% of claim denials are preventable, yet two-thirds of denials are never resubmitted? This alarming statistic highlights the need for healthcare organizations to move beyond traditional revenue cycle practices and embrace smarter, data-driven solutions. For example, something as simple as inaccurate patient registration can snowball into billing errors, payment delays, and revenue losses.

This is where a Revenue Cycle Analytics Dashboard becomes a game-changer. By offering real-time insights and a holistic view of your revenue cycle, an analytics dashboard enables healthcare organizations to identify gaps, streamline processes, and make data-backed decisions to drive financial performance.

A well-crafted Revenue Cycle Analytics Dashboard is the key to unlocking your healthcare organization’s full potential. VNB Health’s Revenue Cycle Analytics Solution is designed to bring unparalleled visibility and actionable insights across every stage of the revenue cycle. 

Healthcare Revenue Cycle Stages

Front Desk Operations: From scheduling appointments to registering patients, we ensure a seamless and efficient patient experience.

Insurance Verification: Avoid costly claim denials with timely and precise insurance verification, ensuring eligibility and coverage are validated upfront.

Charge Capture & Billing: During the treatment phase, our solution enables healthcare organizations to meticulously capture all relevant charges, optimizing charge entry and billing for maximum revenue realization.

Payment Posting & Reconciliation: Our solution tracks incoming payments and reconciles accounts, giving you clarity on payment statuses and financial performance.

Accounts Receivable (AR) Analysis & Denial Management: By analyzing unpaid claims and identifying patterns in denials, organizations can uncover the root cause of denials, fix the problem, and get paid faster.

Wrapping Up

In this fast-paced healthcare world, efficient revenue cycle management isn’t just a nice-to-have; it’s a must-have. By leveraging the power of Revenue Cycle Analytics, healthcare organizations can revolutionize their financial health. Imagine a future where operations are streamlined, patient experiences are top-notch, and financial sustainability is guaranteed. With the right analytics solution, this future is within reach. It’s time to embrace the tools that not only conquer today’s challenges but also position your organization for a brighter, more resilient tomorrow.

Ready to transform your healthcare revenue cycle? Contact us today to explore how our RCM Analytics solution can help your organization drive efficiency, maximize revenue, and stay future-ready. Let’s build a healthier financial future together!

Microsoft Fabric for Healthcare | VNB Health

Microsoft Fabric for Healthcare

Data plays a pivotal role in modern healthcare, serving as the cornerstone for informed decision-making, improved patient outcomes, and operational efficiencies. Healthcare organizations rely on data for a multitude of purposes, including clinical decision support, patient monitoring, disease management, resource allocation, and performance evaluation. By harnessing data-driven insights, healthcare providers can personalize treatment plans, identify trends and patterns in population health, predict and prevent diseases, and optimize workflows for better resource utilization.

However, healthcare organizations face significant challenges in managing the increasing volume, velocity, and variety of data generated within their systems. The rapid increase of electronic health records (EHRs), medical imaging, wearable devices, and other healthcare technologies has led to an exponential growth in data. This data is often siloed across disparate systems, making it difficult to aggregate, integrate, and analyze effectively. Furthermore, ensuring data accuracy, security, and compliance with regulatory requirements adds another layer of complexity. Addressing these challenges requires strategic investments in data infrastructure, interoperable systems, advanced analytics tools and data governance frameworks. A recent study by HIMSS Analytics revealed that 72% of healthcare providers struggle with fragmented data leading to increased costs.

So, what can healthcare organizations do to harness the power of data to drive transformative changes and ultimately improve patient outcomes? The solution is to adopt a holistic approach to data management by leveraging innovative technologies. This is where Microsoft Fabric for Healthcare comes in to the rescue of healthcare organizations.

Microsoft Fabric – The Bridge Between Disparate Data

Back in October 2023, Microsoft announced the preview of Microsoft Healthcare data solutions in Microsoft Fabric. Microsoft Fabric for Healthcare is a secure, cloud-based data analytics platform designed specifically for the healthcare industry. Microsoft Fabric bridges the gap between your siloed systems, bringing together all your healthcare data – structured, unstructured, imaging, and even medical device data – into a single, unified environment. Imagine a world where all your healthcare data – electronic health records (EHRs), medical images, lab results, and more – reside in a single, unified platform. This is the power of Microsoft Fabric for Healthcare. It acts as a central hub, breaking down data silos and bringing all your valuable information together.

Streamlined Workflows

Imagine a doctor trying to diagnose a patient. They need to review the patient’s medical history from their EHR, analyze recent X-rays, and check the latest blood test results. But here’s the catch – all this information is scattered across different computer systems, each with its own login and interface. Microsoft Fabric brings together patient data from various sources like EHRs, imaging, and lab results into one central location. This eliminates the need for clinicians to log into multiple systems, saving them time and reducing frustration. With all relevant information readily available, clinicians can make quicker diagnoses, develop more effective treatment plans, and improve overall patient care.

Benefits:

  • Fabric eliminates the need to chase down information scattered across disparate systems
  • Unified data minimizes the risk of errors stemming from incomplete or conflicting information
  • Fabric fosters seamless communication between care teams
  • Faster access to information translates into shorter wait times and more efficient appointments

Proactive Care Delivery

For decades, healthcare has primarily focused on reactive care – treating patients after they fall ill. While this approach has saved countless lives, it often comes at a cost. Early intervention and prevention can lead to better patient outcomes, reduced healthcare burdens, and a more sustainable healthcare system.

This is where Microsoft Fabric for Healthcare steps in. As a unified data platform designed for the healthcare industry, Fabric goes beyond simply organizing patient information. It leverages the power of Artificial Intelligence (AI) to unlock the potential for proactive care delivery. Advanced algorithms can identify patients at risk for developing chronic conditions, allowing for early intervention and preventive measures. This proactive approach can significantly improve patient outcomes and reduce healthcare costs.

Benefits:

  • Fabric empowers healthcare providers to leverage AI and analytics to identify potential health issues before they become major problems
  • Fabric allows for a more individualised approach to treatment
  • Public health efforts can be significantly enhanced with Fabric’s data analysis capabilities

Industry Standard Adherence for Seamless Data Exchange

Microsoft Fabric for healthcare ensures data isn’t locked into specific systems by adhering to industry standards like FHIR (Fast Healthcare Interoperability Resources) and OMOP (Observational Medical Outcomes Partnership). This standardization allows for seamless data exchange and analysis between different healthcare institutions and platforms. With compatible data formats, healthcare organizations can collaborate and share information more efficiently, potentially leading to improved patient outcomes. This standardization streamlines data sharing and compliance with healthcare regulations like HIPAA and GDPR.

Benefits:

  • Standardized formats eliminate the need for complex data translation processes between different healthcare information systems
  • Readily ingest data from various sources by following these standards. Therefore clinicians can access patient data from disparate systems seamlessly, reducing administrative burdens and allowing them to focus on delivering care.
  • Breaks down information siloes and healthcare organizations can easily share patient data across different platforms and institutions
  • Standardized formats ensure data consistency and accuracy across healthcare systems. This reduces errors and inconsistencies that can arise during data exchange, leading to more reliable data analysis within Fabric.

Scalable Security Built for the Healthcare Cloud

Built on Microsoft’s secure and reliable Azure cloud platform, Fabric offers unmatched scalability. Healthcare organizations of all sizes, from small clinics to large hospital networks, can leverage its functionalities. Resources can be easily scaled up or down as their data storage and processing needs evolve. Security is paramount, and Fabric prioritizes patient data privacy by adhering to strict security protocols and offering features like granular access controls and data encryption. This ensures that sensitive patient information remains protected. In addition, Azure’s pay-as-you-go model ensures cost-efficiency. Healthcare organizations only pay for the resources they utilize, eliminating the need for upfront investments in expensive hardware or software. Fabric’s security features are designed to scale with the healthcare organization’s data growth. This ensures consistent data protection as data volume increases.

Benefits:

  • Fabric integrates with Microsoft Purview to provide scalable governance. Purview helps organizations to maintain consistent data classification throughout the platform. This ensures compliance with healthcare data privacy regulations like HIPAA.
  • Fabric utilizes encryption to protect both static data and data in transit
  • Fabric offers scalable auditing capabilities by enabling granular control over user access rights. This allows healthcare organizations to define role-based permissions based on job responsibilities and data sensitivity. Healthcare organizations can also track user activity efficiently, even with massive datasets.

Imaging support for healthcare data solutions

One of the most exciting recent advancements in Microsoft Fabric for Healthcare is its ability to seamlessly integrate medical imaging data. This goes beyond the traditional focus on clinical data like lab results and doctor’s notes. Fabric now has the capability to ingest, store, and analyze metadata associated with X-rays, CT scans and MRIs. At the recently concluded HIMSS ’24, Microsoft announced the availability of this feature in Private Preview. This capability unlocks a new era of collaborative healthcare, empowering various medical professionals to work together more effectively.

Imagine a scenario where a surgeon about to perform a complex knee surgery can view the patient’s medical history alongside their latest MRI scan, all within the Fabric platform. This allows the surgeon to not only see the current injury but also assess the patient’s overall bone health and potential risk factors for complications. This collaborative approach can lead to more informed surgical decisions and potentially better patient outcomes.

This capability can also prove to be very useful in rural or underserved areas where access to specialist physicians’ care can be limited. Fabric allows medical professionals to share patient imaging data securely with remote specialists. A cardiologist in a major city hospital can collaborate and review a patient’s ECG report along with the local clinic’ physician within Fabric. This remote consultation can expedite diagnosis and treatment recommendations, improving patient care even in geographically dispersed locations.

In addition to collaboration, the integration of medical imaging data in Fabric paves the way for the development of powerful AI-powered diagnostic tools. Data scientists can train the ML algorithms to detect early signs of any disease (such as cancer) which makes it crucial for improving the treatment outcomes and patient survival rates. AI can also automate specific tasks that will free up the physician’ time and focus on complex cases.

Wrapping Up

In conclusion, Microsoft Fabric for Healthcare aims to transform the way healthcare is delivered, streamlining workflows, enhancing patient care, and ensuring data security and compliance. With its interoperability, AI-powered insights, and scalable security features, the platform equips healthcare organizations with the tools they need to thrive in an increasingly digital landscape.

At VNB Health, we are ready to support your organization on your healthcare journey. Whether it’s getting started with Microsoft Fabric for Healthcare or implementing Fabric within your organization, VNB Health, a trusted Microsoft partner, offers expertise, guidance, and tailored solutions to empower your organization to harness the full potential. Contact us today to take the first step towards a future of connected and intelligent healthcare delivery.

Analyze Oncology data using Microsoft Power BI | VNB Health

Analyze Oncology data using Microsoft Power BI

In this blog, we talk about how analyzing oncology data with Power BI and gaining insights can aid healthcare organizations in the battle against cancer. This blog aims to provide valuable insights for business analysts looking to stay up to date on the latest trends, developments, and opportunities in the healthcare industry related to cancer diagnosis, treatment, and research.

Cancer is a significant and growing challenge for healthcare systems worldwide. According to the World Health Organization, cancer is the second leading cause of death globally, with an estimated 10 million deaths in 2020 alone. This represents a significant burden on healthcare systems and presents an opportunity for businesses to develop innovative solutions to address this challenge.

Business Intelligence (BI) involves the use of data analytics tools and techniques to gather, analyze, and present data to support business decision-making. Below are some ways healthcare organizations can analyze Oncology Data with Power BI and the different details that can be visualized through the reports.

Data Analysis using recent trends of Power BI

Power BI is a business intelligence and data visualization tool that enables users to connect to various data sources, create interactive reports and dashboards, and share them with others. It is a powerful tool for analyzing big datasets and gaining insights that can aid in decision- making. Power BI has grown in popularity in the healthcare sector in recent years, where it is used to analyze patient data, clinical trials, and other healthcare-related data.

Identify cancer metrics: BI tools can be used to analyze cancer data from various sources such as electronic health records (EHR), insurance claims, and public health data to identify the prevalence and incidence rates of different types of cancer. This information can help businesses identify market opportunities related to cancer diagnosis and treatment.

Here’a an overview of how data is collected, cleaned, transformed and can be represented in visuals.

Data Collection

The first step in using Power BI to analyze cancer is to gather data. Power BI includes the ability to connect to various data sources. We will use the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program dataset, which contains information on cancer cases . The dataset includes information on patient demographics, cancer type, stage at diagnosis, treatment, and survival.

Data Cleansing

The next step is to clean the data after it has been loaded into Power BI. Data cleaning entails removing missing values, duplicates, and any other errors found in the data.

Data Modeling

After importing the data into Power BI, we will create a data model. In the data model, we will create relationships between tables and define measures and calculated columns. Measures are calculations that aggregate data, such as the number of cancer cases or the average age at diagnosis.

Calculated columns are columns that are created using a formula, such as calculating the BMI of a patient based on their height and weight.

Data Visualizations

We can now create various visualizations using the data model. One of the recent updates in Power BI is the introduction of smart narratives. Smart narratives allow us to add narratives to our visualizations automatically. We can use this feature to add descriptions to our charts and tables, explaining what the data means and why it is important.

For example, we can create a stacked column chart that shows the number of cancer cases by cancer type and stage at diagnosis. We can add a smart narrative that explains that the chart shows the distribution of cancer cases by cancer type and stage, and that the chart can be used to identify the most common cancer types and stages at diagnosis.

Analyzing Cancer Measures

Analyzing cancer is essential for several reasons:

  • Understand cancer prevalence and incidence: Analyzing cancer helps us understand the prevalence and incidence rates of different types of cancer. This information is crucial for developing effective cancer prevention and control strategies, identifying high-risk populations, and allocating healthcare resources to address the burden of cancer
  • Identify risk factors and causes: Analyzing cancer data can help us identify risk factors and causes of different types of cancer. This information can help us develop effective cancer prevention strategies and reduce the incidence of cancer.
  • Develop effective cancer treatments: Analyzing cancer data can help us understand the biology and behavior of different types of cancer. This information is critical for developing effective cancer treatments that target specific types of cancer cells and minimize harm to healthy cells.
  • Monitor cancer trends and outcomes: Analyzing cancer data over time can help us monitor cancer trends and outcomes. This information can help us identify changes in cancer incidence and mortality rates, evaluate the effectiveness of cancer prevention and treatment programs, and inform healthcare policy decisions.
  • Improve cancer patient care: Analyzing cancer data can help us improve cancer patient care by identifying gaps in care, developing evidence-based treatment guidelines, and improving cancer patient outcomes.

Here are a few trends to analyze Oncology Data with Power BI more efficiently.

Analyze Survival Rate using Sparkline

Survival rate: This refers to the proportion of people diagnosed with cancer who are still alive after a specified period. Survival rates can help assess the effectiveness of cancer treatments and can be used to identify areas for improvement in cancer care. Sparklines are used  to show trends in a series of values, such as increases or decreases or to highlight max and min values.

To analyze the trends of cancer survival rate – 

  • Create a table or matrix.
  • Select the dropdown arrow next to one of the numeric fields, and select Add a sparkline

 

  • In the dialog box, configure the details of your sparkline. The numeric field you started with is pre-populated for the Y-axis. You can change field and Summarization type, if needed. You also need to select a field, typically a date field, to use as the X-axis of the sparkline.

 

  • Select Create. The sparkline is automatically added to your table or matrix as a new column.

 

  • Select the dropdown arrow next to sparkline and select Edit sparkline.         

 

  • In the Sparklines card in the Format pane, modify the sparkline line and marker formatting. Change the line color and width, add markers for different value types (highest, first, last, and so on), and change the marker size, color, and shape.

Visualize Cancer Mortality Rates using Line Charts

Mortality rate: This refers to the number of deaths caused by cancer in a population over a specified period. Mortality rates can help assess the impact of cancer on a population and can be used to identify disparities in cancer outcomes among different demographic groups.

The best indicator of progress against cancer is a change in age-adjusted mortality (death) rates, although other measures, such as quality of life, are also important.

To observe the changes, line charts are used and with the new feature format a visual on object, we can cross highlight and cross filter by right clicking on the visual.

To analyze the mortality rate measures, in a few cases we have overlapping data elements. Power BI takes the best guess at our selection. If we want to modify it, right-click and use the dropdown menu to change your selection to the element you’d like to format.

Visibility of Prevalence of Cancer by Age

Prevalence is defined as the number or percent of people alive on a certain date in a population who previously had a diagnosis of the disease.

Information on prevalence can be used for health planning, resource allocation, and an estimate of cancer survivorship. Power BI is providing a new feature to show the data underlying the visual to view the data in the form of a table along with the visual.

For this:

  • Use Visual table to display the data underlying a visual. Visual table is available from the Data/Drill tab in the ribbon when a visual is selected.

 

  • When you select Visual table or Data point table, Power BI displays both the visual and the textual representation of the data. In the horizontal view, the visual is displayed on the top half of the canvas, and the data is shown on the bottom half.

 

  • To get back to the report, select < Back to Report in the upper-left corner of the canvas.

 

Analyze Cancer Cases using Small Multiples

With this growing global burden, prevention of cancer is one of the most significant public health challenges of the 21st century. For this it is essential to explore which countries have the highest cancer cases of different types. For this:

  • Create small multiples on column chart and drag the country field into the small multiples in the fields section of Build visual pane.

 

  • Analyze number of cases of different types of cancer across countries. So, change the layout dimensions accordingly.

 

  • Number of cases by types of cancer and country is analysed as shown below –

AI Insights within Power BI

Machine learning and artificial intelligence (AI) are also playing an increasingly important role in cancer analysis. These technologies can analyze large amounts of data and identify patterns that might not be immediately apparent to human researchers. This can help accelerate the development of new cancer treatments and improve the accuracy of cancer diagnoses.

AI Insights in Power BI can also be used to analyze metrics of cancer.

Apply Insights in Power BI to explain Incidence Rate of Breast Cancer

Often in visuals, you see a large increase and then a sharp drop in values and wonder about the cause of such fluctuations. To use insights to explain increases or decreases seen on charts, just right-click on any data point in a bar or line chart and select Analyze > Explain the increase or decrease.

Power BI then runs its machine learning algorithms over the data and populates a window with a visual and a description that describes which categories most influenced the increase or decrease. By default, insights are provided as a waterfall visual, as shown in the following image.

Wrapping Up

Microsoft Power BI is an important tool for anyone working in the healthcare industry due to its ability to connect to various data sources, create interactive reports and dashboards, and safeguard confidential data. By analyzing oncology data with Power BI, we can gain insights that will help us better comprehend the disease, develop new treatments, and, eventually, save lives.

VNB Health Solutions is a Healthcare Analytics services provider with expertise in data governance, data integration, data warehousing, data science and data visualizations. Please connect with us to learn more about our Healthcare Analytics services.

Women’s Healthcare providers leveraging Data science | VNB Health

Women’s Healthcare providers leveraging Data science

Good Healthcare is important for everyone, but there is a need to bring women’s health issues separately under the magnifying lens. Most past clinical studies recruited candidates which had a higher representation of men than women and hence it’s taken a long time for researchers to know that certain diseases manifest differently in women than in men. Also, specific areas of healthcare related to pregnancy, fertility, and pelvic health, menopause, to name a few, are especially relevant to women’s health needs. Over the past decades we’ve seen a increase in the number of women’s health care providers. In this post we will focus on the benefits of data science for women’s healthcare providers.

Availability of big data has now made it possible for data scientists and healthcare experts to understand the factors that lead to certain undesirable events related to women’s health which can be prevented by bringing in timely intervention and having the right preventive actions in place. We’ve listed the journey for women’s health care providers as they step on the wagon to become more data savvy and start reaping the benefits of data science for women’s healthcare.

Creating an integrated data repository known as a “Data Lake”

Care providers might not have a single source of truth which collates and ingests data from varied data sources such as Electronic Health Records or EHR, diagnosis from past medical check-ups, health indicators such as body mass index, blood sugar etc, pregnancy and surgical records from the past, diseases and health emergencies. Along with this any other demographic details such as age, genetic conditions, and family history are also crucial pieces of information. Starting point for drawing the benefits from data is to establish and maintain a steady stream of relevant data from all available internal and external sources and then storing them in a data repository. Data Lake is one such useful storage where data of all formats, shapes and sizes can be stored and made available for analysis as needed. 

Making the data ready for business intelligence and analytics

Often data in its raw form is far from being useful. There can be many issues with the raw data such as missing values, corrupted codes, erroneous values, created due to technical issues while reading information and duplicate values. All these reasons make it important for data to be cleaned and processed before analysts start to make sense of it. Along with the reasons mentioned above, data also needs to be pre-processed before it becomes suitable to be analyzed by machine learning models specially the ones that make assumptions about the values related to data distribution, ranges of data values, format of data such as numeric or non-numeric etc.

Having insightful dashboards for ongoing monitoring and decision making

Business Intelligence is the very first mandatory step towards becoming data savvy. An organization needs to have a collection of insightful reports, scorecards and dashboards that have been carefully designed with a purpose in mind. Some of the relevant dashboards for health care providers include those related to insights about hospital admissions, costs incurred by patients based on treatment type, operational metrics related to waiting and processing time for forms and documents.

Building predictive models to improve outcomes

There are many use cases where data can be converted into actionable intelligence such that professionals working in the women’s healthcare facilities can work alongside the machine-based recommendations to expedite their own decision making in way that improves final outcomes.

For example, there are many undesired situations related to child birth which can be prevented or treated in a timely manner with the help of data science. Preterm labor is one such example. The World Health Organization (WHO) categorizes preterm births based on the gestational age as follows: “Extremely preterm (<28 weeks), Very preterm (28–32 weeks), Moderate or late preterm (32–37 weeks)”

An earlier preterm birth is strongly associated with increasing mortality, incidence of disability, high intensity of neonatal care, and higher consequent costs incurred by the patients. Data can be used to develop an individualized prediction model of preterm birth risk, to estimate the delivery period using a wide range of clinical variables obtained at the initial hospital admission. These include useful patient information related to demographics, obstetric and medical histories and basic laboratory test results, including blood tests and vaginal discharge findings for clinical and basic characteristics. Health care provider can use this score to evaluate the risks and provide appropriate information for avoiding or managing preterm birth.

Predictive models can also be used to analyse factors related to incidences of infections occurring post Caesarean sectional births at the hospital. Despite World Health Organization (WHO) recommendations that the optimal rate of Cesarean sectional births should lie between 5 and 15%, these surgical operations are significantly increasing and the reasons for the continued increase in the rates are not completely understood. Postpartum fever, surgical site infection, puerperal sepsis and maternal mortality are among common complications of Cesarean birth. Global reported rates of Sectional Site Infections are reported to be 3–15% which poses great burden on health-care systems, as they increase the length of hospitalization and subsequent re-admissions inflating the overall costs of post-discharge care. Data science models can help to bring these numbers down in a significant manner.

Data Science for Women’s Healthcare can be very useful for providers to specifically target the ailments that are pertinent to women’s health. Overall, when used effectively they can help to improve health outcomes and reduce costs for the patients and hospitals.

Wrapping Up

VNB Health is a Microsoft certified Power BI solutions partner and a Gold Partner for Data Analytics, providing BI and Analytics solutions to customers for over 15 years. We can partner with you on your data science and analytics journey using Microsoft Purview, Synapse Analytics and Power BI. Contact us for a free consultation.

Untapped potential of AI in Healthcare | VNB Health

Untapped potential of AI in Healthcare

AI has been instrumental in transforming multiple industries. The potential of AI hasn’t been fully achieved in healthcare and there is a lot that can be done when medical practitioners truly work along computers.

While people are great at empathizing with colleagues at work and contextualizing the problems being faced, AI in Healthcare can help to perform complex computations that can provide a lot of insights to improve the quality of outcomes for the healthcare industry. Unlike other fields such as retail and logistics, data collection and usage in healthcare is highly regulated as it pertains to personal data of the patients which is often sensitive in nature. Many use cases of AI in healthcare, which are technically feasible often don’t materialize into real solutions due to regulatory constraints and lack of trust and know-how by the specialists in the AI technology. In this blog we have listed down some of the benefits of AI in healthcare and how AI can bring transformational change over the coming years.

AI in Healthcare: Helping drive efficiencies in text processing

Most healthcare providers perform a series of manual tasks related to reading and storing documents. These functions could be automated by digitalizing, extracting, and analyzing the forms filled by the patients automatically using Natural Language Processing techniques. NLP is a field of AI that makes the machines adept at understanding and contextualizing language. Textual data can be converted into structured tables and fed into the health records of patients which can be very useful in providing timely and accurate care to patients. This can lead to massive savings in time and costs which can be channeled into prioritizing the healthcare needs of the patients without causing fatigue to clinicians.  

24/7 monitoring via smart wearable devices

The smart gadgets that are being worn by individuals these days are a great example of how the health parameters of patients can be monitored 24/7 to prompt timely action, such as a recommendation to head to a nearby clinic. This use case of AI falls into the class of Internet of Medical things where sensors collect health data and transmit it to the internet to provide round the clock monitoring of one’s health. ECG or the Electrocardiograph app on Apple watch that can record the timing and the strength of the electrical signals that make the heartbeat is one such functionality.

Providing preventive care to the patients

The main goal of providers is to provide timely care to patients and very often preventive care is the best answer to many health urgencies. The electronic health data including lifestyle information and past medical records can all be fed into powerful predictive models that can trigger alarm in case the likelihood of a certain health emergency is high and hence extra care and precaution can be taken by providers to stop the situation from worsening. This can enable huge benefits in terms of saving lives and prevent the escalation of medical costs which is a big concern for most patients. For example, providers of women’s healthcare needs, those specializing in maternity care, can greatly benefit from implementing predictive models that flag high likelihood cases of emergency C-Section and other complications related to surgical site infections.

Making healthcare equitable and accessible

One of the biggest concerns for governments and regulators is to ensure equal benefits of healthcare facilities to all groups of the population. This concern is especially valid for classes related to minority races, weaker socio-economic groups, and women. Many drugs and treatments are more catered towards certain well-established segments of the populace and tend to ignore the needs of those that have been underprivileged in the past. Predictive models can be checked for such biases and adjusted to make amends for these drawbacks by doing the required data driven testing to ensure fairer final outcomes.

Wrapping Up

This post talks about some of the benefits of data science and AI in healthcare industry. While many providers are now beginning to adopt these into their functions, the pace of adoption has been lagging due to the complex regulations and sensitivity of patient data. For healthcare to fully achieve its goals the regulators, providers and patients need to be more open to changing the status quo and accepting the AI driven transformation in the industry, without this collaboration any meaningful change can only be superficial!

Enabling Patient Access and Provider Directory APIs using Azure API for FHIR to meet CMS guidelines | VNB Health

Enabling Patient Access and Provider Directory APIs using Azure API for FHIR to meet CMS guidelines

The final rule of the ONC’s Cures Act Final Rule is aimed for patients and healthcare providers to provide secure, seamless access and exchange of patient’s electronic health information. The rule also implies exceptions to blocking of information when it comes to patients accessing their electronic health record information (EHI). Centers for Medicare & Medicaid Services (CMS) has been working hard on improving the roadmap to improve interoperability and health information access for all stakeholders – patients, providers, and payers. 

One of the key rules released specific to interoperability is the Interoperability and Patient Access final rule (CMS-9115-F). This rule mandates the access and availability of the health information for patients whenever they need it. It also implies that patients must be able to use the information in the best way they can. The inability for seamless data exchange has deteriorated patient care, leading to poor health outcomes and increased medical costs.

The final rule that has been released includes key policies that impact different stakeholders. These policies focus on driving interoperability and delivering access to patient health data for health plans by liberating patient data using CMS authority to regulate Medicare Advantage (MA), Medicaid, CHIP, and Qualified Health Plan (QHP) issuers on the Federally-facilitated Exchanges (FFEs). The final rule ensures patients with better access to their health information, improves the interoperability and reduces burden on payers and providers.

Earlier this year, given the ongoing Covid-19 pandemic situation and recognising the challenges faced by payers, CMS exercised enforcement discretion of the Patient Access and Provider Directory API policies for Medicare Advantage (MA), Medicaid, and the Children’s Health Insurance Program (CHIP) for a period of six months. The revised date of enforcement of these policies was set to July 1, 2021.

So, What’s Next post July 1, 2021?

It’s July 2021, and the Patient Access and Provider Directory API requirements from CMS are now effective. The rule requires the regulated payers to enable these new APIs with immediate effect. According to the Health Insurance Portability and Accountability Act of 1996 (HIPAA), patients have the right to access their health information. It also requires the information to be exchanged in a way that ensures their privacy and security. The new CMS mandate to deliver Patient Access and Provider Directory API is a major breakthrough in the healthcare industry. This promotes the much needed interoperability of the patient’s medical data between payers and providers.

Patient Access API

According to the Interoperability and Patient Access final rule, all CMS-regulated payers are required to implement and maintain a secure and standards based API (HL7 FHIR API). Through this Health Level 7® (HL7) Fast Healthcare Interoperability Resources (FHIR®) API, patients shall be able to access their claims and encounter information easily. Patients can also choose to receive a subset of their medical information through authorized third-party applications of their choice. This information along with clinical data offer a broader perspective and understanding of the patient’s interaction with the healthcare system. This improves the overall decision making and leads to better health outcomes.

As your trusted partner, VNB Health can help to implement these new CMS requirements and better organize data within your organization. To successfully meet the CMS Patient Access rule for Health plans, we can assist to set-up your fully managed, enterprise-grade FHIR Server on Azure. The offering will be a HIPAA-compliant, platform as a service (PaaS) that can help to convert the clinical data such as claims, encounters and subsets of clinical data into FHIR supported format (FHIR Release 4.0.1 (R4)) using FHIR converters, set up third-party access management (e.g., OAuth 2.0) to ensure safe transmission of the data with the patients.

Azure API for FHIR has new REST API features and capabilities, and offers complete flexibility to businesses on what they can search in the system. The search can be performed using the common search parameters as well as resource-specific parameters and composite search parameters. VNB Health can help in implementing end-to-end solutions using Azure API for FHIR including integrations with specific apps, portals and analytics platforms.

Provider Directory API

The rule finalizes that CMS-regulated payers are regulated to make provider directory information publicly available via a standards-based API. This gives third-party application developers the advantage to access patient information. With this information, they can create services that help patients to find providers for care and treatment. On the other hand, it will also help clinicians find other providers for care coordination purposes. Overall, this aims to improve the quality, accuracy, and timeliness of information.

VNB Health’s experienced team can assist to build information of the providers using the FHIR based API in accordance with the HL7 FHIR 4.0.1 standards. This helps to retrieve provider names, address, phone number, speciality information, pharmacy information from publicly available sources. The API will keep a timely check on these data sources and will keep the data up-to-date. On top the API, our experts will assist in setting up a robust provider directory application. This will enable users to filter providers based on location and/or speciality, search for providers based on their location and office hours, filter specialists and their affiliations with local health practices, and identify a local health practice and their specialities seamlessly onto your application

Payer-to-Payer Data Exchange

The rule requires CMS-regulated payers to exchange patient clinical data (specifically the U.S. Core Data for Interoperability, USCDI, a spec on top of FHIR) on request from the patient. Patients can have this information handy when switching between payers to build a cumulative health record with the current payer. This requirement will take effect from January 2022.

VNB Health can assist your business to enable data exchange between payers. Our experts can easily implement this capability on top of the existing patient access API infrastructure and FHIR APIs. When the patient makes a data request, the payer can make this data available via the FHIR-based API in the form of electronic data and/or the format in which it was originally received.

Get started with FHIR on Microsoft Azure for Health today!

VNB Health has more than 15 years of proven experience working with healthcare organizations using Microsoft’s integration platform. Our experience with HL7 FHIR and Microsoft Azure technology enables us to build the technology to meet the CMS guidelines. As a trusted Microsoft Partner, we’ll work alongside your healthcare transformation journey to deliver improved data accessibility and patient care. Looking for a trusted partner to get started with your interoperability journey? Contact us today to embark on the healthcare transformation journey.