The Challenges of Complex Clinical Systems

I wanted to become a doctor so that I could diagnose patients’ conditions, cure their diseases and ultimately help people be healthier. After getting my medical degree at Northwestern University’s Feinberg School of Medicine I was a practicing physician for many years, and as a provider I saw the complexities of the health system firsthand, complexities that create an immense burden on clinicians.

When physicians are spending one-sixth of their working hours – which is on average about 8.7 hours – on administrative work, you know there is a problem with how our health care system works.

These highly educated individuals should be putting this time toward much more impactful work, but these administrative burdens and complexities are wasting time and costing the health care system more than $1.1 trillion.

A large part of this issue comes down to the lack of interoperability in the health care system.

To paint the picture, a patient comes in to see you for the first time. They’ve never received care within your particular health care system, so you don’t have a clear view into their medical history. While a patient can try to explain their history to you, we need the data from the other health care system for a more complete clinical view.

However, today’s Electronic Medical Record (EMR) systems lack standardization and end up inundating providers with a high volume of low-quality data. We can end up with dozens, hundreds or even thousands of pages of information. Sorting through this information takes time – that is if you were even able to get the information quickly. If this isn’t the case, you may begin ordering your own tests, which may duplicate tests – adding health care costs and time to reach a diagnosis.

The complexity caused by inefficient information sharing ultimately causes a delay in getting your patient the care they need.

The second piece is the time and energy that goes into the prior authorization process. Sometimes, this process is seamless, but oftentimes it becomes complicated involving back and forth phone calls and paperwork. Whatever tests or treatments you ordered are delayed – again hindering the patient’s health.

These may sound like insurmountable challenges, but there is a way to fix the complexity through interoperability. We need better collaboration between health care systems and payers. We need standardization in the way we report data, so that all data is valuable. We need an intuitive technology system that eliminates administrative burdens.

While we are making progress with tools that provide more information into a physician’s workflow, we are working to simplify the prior authorization process at the point of care, and we are continuing to work with providers to understand the pain points we need to address – the solution isn’t easy.

It will take time, collaboration, standardization, and technology, among other considerations. But when providers, payers and patients can come together, that solution has the potential to be mutually beneficial to all parties and truly change the way the system works.

Learn more about how UnitedHealth Group is working towards a future where health care is simple, efficient and easy to navigate, and read how Optum is modernizing health care through Joan's Journey.