I think the fact it’s a checkbox is irrelevant here. From what I understand, these yes/no questions have very real consequences for the patients they’re about. If entering the wrong thing can have negative consequences, an AI shouldn’t be filling that out. Not to mention, if the data in the medical file is wrong, a nurse who’s actually spoken with the patient will actually have opportunities to correct things that an AI will never see.
Of course. From the practices I’ve seen and learned from national conferences its never 100% AI. There’s still a nurse that is reviewing and a physician as well when needed.
Also not sure about Milliman, but for the InterQual Autoreview the accuracy is there. Its been out and in use since 2018. If it wasnt all the UM nurses would be griping. They are not people that are afraid of advocating for themselves. No way they’re not reviewing/auditing unless they want their license to be at risk. It’s more like an advanced algorithm that pulls from the epic EHR system. Labs values, icd 10 codes, iv antibiotics, vitals are some examples of things i would imagine it can pull with high reliability. Normally 1 day retrospective but to your point, if something is missing, can notify the attending Dr. Utilization review team is looking back at charts retrospectively and sending interventions and findings to insurance to get patients covered. And if something is missing, they will let the drs know and the Dr can ensure they add the nebulizer or whatever patient was missing going forward.
The charting documentation is a different thing.
Re: Her job. Sucks. There will be less nurses needed to do the same amount of work with technology. All of us knew this. I think the best thing to do as a UM nurse is continue what they’re doing, be a high performer and keep up. If you don’t keep up, 100% you’re going to go first. The quotas sucked while I was working in this position. I kept up. But mostly didn’t stay as it wasn’t for me. Felt very monotonous and missing direct patient interaction. Def important but unfortunate position needed as result of our dysfunctional healthcare system. Its bittersweet.
I think the fact it’s a checkbox is irrelevant here. From what I understand, these yes/no questions have very real consequences for the patients they’re about. If entering the wrong thing can have negative consequences, an AI shouldn’t be filling that out. Not to mention, if the data in the medical file is wrong, a nurse who’s actually spoken with the patient will actually have opportunities to correct things that an AI will never see.
Of course. From the practices I’ve seen and learned from national conferences its never 100% AI. There’s still a nurse that is reviewing and a physician as well when needed.
Also not sure about Milliman, but for the InterQual Autoreview the accuracy is there. Its been out and in use since 2018. If it wasnt all the UM nurses would be griping. They are not people that are afraid of advocating for themselves. No way they’re not reviewing/auditing unless they want their license to be at risk. It’s more like an advanced algorithm that pulls from the epic EHR system. Labs values, icd 10 codes, iv antibiotics, vitals are some examples of things i would imagine it can pull with high reliability. Normally 1 day retrospective but to your point, if something is missing, can notify the attending Dr. Utilization review team is looking back at charts retrospectively and sending interventions and findings to insurance to get patients covered. And if something is missing, they will let the drs know and the Dr can ensure they add the nebulizer or whatever patient was missing going forward.
The charting documentation is a different thing.
Re: Her job. Sucks. There will be less nurses needed to do the same amount of work with technology. All of us knew this. I think the best thing to do as a UM nurse is continue what they’re doing, be a high performer and keep up. If you don’t keep up, 100% you’re going to go first. The quotas sucked while I was working in this position. I kept up. But mostly didn’t stay as it wasn’t for me. Felt very monotonous and missing direct patient interaction. Def important but unfortunate position needed as result of our dysfunctional healthcare system. Its bittersweet.