McKesson is showing an early version of its InterQual Auto Review software here at HIMSS17. The product, which comes out of a partnership with the National Decision Support Company, automates medical necessity reviews by tapping into patient data residing in electronic medical records.
The software ties NDSC’s automation engine, which processes some 3 million data transactions every month, into InterQual’s technology for evidence-based content and automated review.
“InterQual AutoReview takes discrete data from the EMR and pulls it into our engine that feeds into InterQual Connect to automate evidence-based content and serve clinicians the results they need to see, all in one screen,” said Nilo Mehrabian, vice president of decision management products at McKesson Health Solutions.
InterQual Connect, which McKesson released last year, integrates the evidence-based capability into the clinician workflow to decrease administrative expense, Mehrabian said. McKesson’s strategic direction has been to make that process easier for providers and payers and enable them to collaborate better.
“AutoReview brings efficiency in completing these reviews,” she added. “It’s more objective than subjective and improves care for patients as well as increasing efficiency for nurses because they can spend more of their time looking at the exceptions or patients that are not low-hanging fruit.”
What’s more the software advances exception-based utilization such that clinicians only have to handle exceptions that cannot be processed automatically.
Mehrabian explained that McKesson started the process with 7 conditions that are high volume cover approximately 30 percent of ED admissions nationally and the company intends to expand to 41 conditions — comprising more than 90 percent of admissions. She also said that thus far approximately one-third of cases get auto-reviews.
The software also enables McKesson to be a facilitator of easing prior authorization because once the medical necessity review is conducted, that patient gets submitted to payers for authorization, so having that data come directly from the EHR is going to be helpful, she said.
“It’s still in development, we are right now in the beta early adopter phase and hope to go general availability later in the year,” Mehrabian said.
McKesson is in Booth 3479.
HIMSS17 runs from Feb. 19-23, 2017 at the Orange County Convention Center.
This article is part of our ongoing coverage of HIMSS17. Visit Destination HIMSS17 for previews, reporting live from the show floor and after the conference.