Using Data Integration, AI and Automation for Improved Member/Client Services
SphereGen Case Study
Our long-term client, ActualMeds, provides a Medication Management platform which incorporates data integration, AI and automation to deliver thorough care plans based on the best possible medication history (BPMH).
Since inception, SphereGen has been ActualMeds’ trusted partner in building this complex software platform that improves patient outcomes through evidence-based action plans which are produced on-demand with less manual effort.
OVERVIEW
ActualMeds is a Web based solution which provides “medication reconciliation on demand” at point of care. ActualMeds produces the best possible medication history (BPMH) by seamlessly combining medication information from multiple health systems along with a Provider in-person interview with the patient. This information is used to create an AI generated care plan which is aligned and ready for reconciliation based on information from Providers, Payers and validated Patient data.
Challenges
High-risk patients (those with multiple chronic diseases and taking more than six medications) account for most hospitalizations. Care transitions can cause medications to fall through the cracks, putting patients at even greater risk. Creating comprehensive care plans for hospitalization releases required tracking patient medication data across multiple providers using manual lookups and validations. This resulted in lengthy efforts to build accurate and timely action plans.
Solution
SphereGen worked with ActualMeds to create the software platform InConcert Medication Management (ICMM), which automates the creation of validated care plans for medical reconciliation. ICMM reduces the time required to produce an action plan by 80%, improving patient care and vastly reducing costs for their clients.
The solution focuses on four key areas:
- Integrating data from Health Information Exchanges, prescription claims databases, electronic health records using CCDA/CCD/CCR/FHIR, and a direct provider-conducted structured interview with the patient.
- Creating a central cloud data store / data warehouse which provides a single, centralized resource for data storage, analytical systems and online access by individual clients.
- Using AI to determine a comprehensive med reconciliation plan based on clinically validated rules-based medication interactions along with usage data from the patient’s medical profile.
- An easy-to-use front-end application which allows Payers, Providers and Pharmacists access to the information they need to provide the most complete care for the Patient.
RESULTS
THE DETAILS
In order to create their medical management platform, ActualMeds worked with SphereGen to design and build InConcert Medication Management or ICMM which provides comprehensive medication action plans for patients. This platform includes automating the creation of action plans by integrating data from multiple sources and formats, using AI to build evidence-based plans, and providing customizable workflows for providers and patients.
APPROACH
Flow of Data into the System
The inflow or input of data is designed for maximum efficiency and speed. Data integration originates from multiple sources including Health Information Exchanges, prescription claims databases, and electronic health records using CCDA/CCD/CCR/FHIR. Many different file formats are standardized and reformatted, maintaining secure data encryption and compliancy.
The system automatically monitors data feeds. If feeds/ transfers are not completed, the system sends a notification to the Provider to prompt further investigation. This results in a high level of data reliability that ensures current, validated data is available. In addition, information is gathered directly from the patient through a provider-based interview.
Pre-Processing of Data During Intake
The ICMM platform uses AI to intelligently pre-process data during intake. All data is run through a rules-based analysis which derives medication action plans based on the combination of the patient profile, the medication and the care environment. Prior to the ICMM platform, Clinical Pharmacists had to manually research data from multiple systems and build the medication action plan. This process could take many hours, impeding the immediacy of patient care.
The InConcert platform vastly improves the ability to determine a comprehensive care plan taking all data sources into account. The time savings for this automated process saves a Clinical Pharmacist hours of time, improving the overall process efficiency by 80%.
Ease of Use
Payers and Providers can go online to customize their settings for file transfer and web services. Allowing customers to customize their own settings, facilitates the onboarding process with no manual intervention required.
With the ICMM platform, users can view or update their records. This range of options makes it easy to automate the upload, viewing and transfer of data. The system is very flexible, and clients can choose between pulling and sending the data themselves or using an automated data feed.
CONCLUSION
The aim of the InConcert Medication Management platform is to Improve care for patients in transition by providing validated, comprehensive Medication action plans quickly. Getting Clinical Pharmacists the information they need in a timely manner impacts the quality of patient care they can provide.
ICMM solves this challenge by automating data retrieval from multiple systems and reformatting it for AI processing. Action plans are created when they are needed and can be verified by Providers before a patient is discharged.
Reducing the manual effort and time required to produce an action plan, not only results in better care and less readmission for Hospitalization, Providers also realize a huge cost savings. The turn around time for producing a verified Action plan has been reduced by 80% saving multiple hours of effort.
By building a custom application which incorporates automation, AI processing, security, compliancy and scalability – ActualMeds is able to deliver a comprehensive software platform which solves a major healthcare problem and saves their clients thousands of dollars.
SphereGen is a technology company that specializes in developing innovative solutions to improve business outcomes. Our customer-centric approach focuses on finding the right solution to meet the need at hand, using technologies like AI, Robotic Process Automation (RPA), and Extended Reality (XR) to improve workflow and productivity. We also offer custom software services in Application Modernization/Support.
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