An information highway: “Electronic Authorization” revolutionizes the health care system

Summary

Using fingerprints to identify and approve health care (electronic authorization) in clinics and hospitals has been a leading technological innovation in the Chilean health industry over the last few years.

Each transaction validates the identity of the patient, values each service, provides the insurer’s authorization and, if applicable, the supplementary insurer’s authorization. The patient can immediately pay the amounts not covered by insurance with any of the 18 enabled credit cards using only their fingerprint.

The system collects funds from the insurance and credit card companies every week, and pays 1,800 health care providers. It issues the respective electronic invoices, and publishes on the internet a current account for each entity involved in the process.

Business Need

The requirement for an information highway

Electronic authorization at accredited health care providers replaces the traditional sale of Health Care Vouchers (BAS in Spanish), which was previously undertaken at branches and other delegated entities representing various health financing institutions. The new process enables health care to be authorized in the same place and at the same time that it is provided.

The solution developed by SONDA conceived a company, called I-Med, which aims to market and implement the electronic authorization system to all the different stakeholders in the healthcare market. Since its inception four years ago, I-Med has created a true information highway that makes complex inter-agency transactions more flexible, transparent and rapid at the moment patients request health care.

I-Med was proposed by FONASA, who tendered all their systems, such as issuing traditional Health Care Vouchers, authorizing medical absences, and revenue collection. However, a chapter was included that contained an innovation to replace traditional Vouchers with electronic authorization. Electronic authorization already existed in the market, but this was a closed system for a unique group of Health Care Insurers that formed the company Atesa (Banmedica, Consalud and Promepart).

The project was entirely developed by SONDA, and the technologies employed included the transactional monitor Tuxedo, which enables a large volume of transactions to be handled simultaneously. Also ORDEN Dag Web technology was employed, which embeds applications in a Web browser, thereby paving the way for future system expansion, and the distribution of newer versions without having to reinstall the application at each health care provider, since updates are installed through the network.

Solution

System commissioning

Health care providers can interact with I-Med using this solution in three ways. The first solution is direct sales, where the provider has a cash sale application with I-Med; the second solution is where I-Med only issues the electronic authorization and assumes that the provider collects the cash; and the third solution is the interface mode where the provider interfaces with I-Med and issues the electronic authorization. This resulted in a new challenge, as all the providers used different codes for their services compared to those used by the Health Care Insurers. So we had to standardize these codes, consolidating a common language for both the insurers and the providers. Therefore, we built a modern and robust information highway, which allows the system to operate correctly.

Then the product was expanded, integrating new providers after verifying them with insurers. Furthermore, user payment using other debit and credit cards was activated.

Results

Benefits for patients means benefits for health care institutions

The electronic authorization system has improved the perception of patients from all social strata of the services provided by health care providers and insurers. Furthermore, it enables anyone to receive health care even if they are not carrying the necessary documents, such as an identity card, a Health Care Insurer or Fonasa card, a debit or credit card, etc.

Not only in Chile or Latin America, but throughout the world, there is currently an awareness that the healthcare market is complex. Health care for each patient requires many institutions to interact, which include financiers and insurers but more so providers, which cover the primary physician, specialists, hospitals, clinics, ambulances, laboratories and pharmacies, etc. There are even more stakeholders if payment is made using a bank or commercial credit card. The need to view medicine as many integrated services, encourages institutions to value an integrated system that allows them to operate efficiently and deliver value-added services to their patients.

Benefits

  • We implemented electronic authorization.
  • We developed a payment system for health care insurers and providers.
  • We use biometric verification.
  • We have registered 8.3 million people.
  • We process 3.1 million transactions per month.
  • We have installed 13,718 service points.