For healthcare providers, the process of getting paid is still one of the more time consuming practices in healthcare, especially for those using legacy health IT systems and adjudication engines. For those who may not know, adjudication is the process insurance companies must go through to decide whether or not they’re responsible for paying for healthcare services. The process has never been completely efficient, even for organizations utilizing the most sophisticated systems.
Healthcare payers that are using dated adjudication systems face problems, and with the imminent changes in healthcare insurance rules and contracts, there are some hurdles to overcome. Many of the legacy adjudication engines are written in COBOL and use either information management systems (IMS) or flat files; though some have been upgraded to relational database management systems like DB2. Here are some of the major problems I’ve seen with healthcare providers using legacy adjucation systems:
- In many cases, they run on mainframes, and the expertise is becoming more difficult to find.
- Documentation of programs are deficient and not up to date. Much of the expertise and knowledge is stored as folklore in the people who have been maintaining the applications for the last 30 years.
- Changes, enhancements, and bug fixes are dependent upon the knowledge and skills of the people who have been supporting the applications, resulting in an elevated level of key person exposure.
- The programs are not well structured, and after many years of patches and work-arounds, they’re challenging to debug or find the place in the code base where changes must be made. This can be especially difficult if the rules are located in multiple sites or as part of numerous steps in a batch run…. Yes, these programs still use batch runs.
Given these issues, what can we do? Like most solutions, they require the will to act and the facility to change old habits. Let’s explore some practices we have found to be useful:
- Document the code, either through manual or automated means. Ensure what is running, and your documentation of the code is in synch. There are several innovative and powerful automated documentation tools available, so use them – they can make a difference!
- Document the job control language (JCL) and schedulers. This is a scarce skill and the more you can codify the better.
- Start training new COBOL programmers; there are many training partnerships and internships that can provide you with the talent that you need.
- Remediate the code, and as you make changes and enhancements use the opportunity to eliminate dead code and restructure what you have. This, like many other IT methodologies, should be a continuous process of improvement.
- Establish standards, procedures, and guidelines for remediation and enhancements.
- Establish a system of recognition and reward for legacy programmers. While the job may not seem as glamorous as other areas of IT like web development, employees with legacy expertise help keep the lights on!
In subsequent blogs, I will cover the topic of automated documentation tools.