MENDEL - digitisation of communication between healthcare professionals and health insurance companies
Innovative treatment is often only available upon approval of the application by the medical examiner, which is submitted by the patient's attending physician. At CEEOR, we digitise and automate this administrative process, reducing the bureaucratic burden on nursing staff.
Affordable, innovative medicines funded by public health are and should be available to all patients who need them. The indication of financially demanding treatment is conditioned by the submission and approval of an application for consent to reimburse or to initiate and control treatment.
The application and approval process itself is an administrative−bureaucratic process that keeps the healthcare provider (PZS) away from its professional performance, but for many specialisations, it has become a necessary daily routine. Despite the advancing digitisation of healthcare and PZS communication with insurance companies, this part of the process remains unnoticed, both by health insurance companies and by NCZI as the eHealth coordinator for the Slovak Republic.
We think that administrative processes should be set up so that the doctor can devote the maximum amount of time to the patient during working hours. Thus, everyone—doctors, insurance companies and, especially, patients—benefit from the MENDEL application.
At CEEOR, we therefore decided to address this niche market situation by creating our own solution aimed at digitising the creation, submission and approval of requests for consent to reimburse or any other requests and protocols for treatment. Through a simple user interface, the MENDEL application enables PZS to create different types of requests for different types of treatment to minimise the manual, bureaucratic–administrative burden of a doctor or nurse.
The creation of the MENDEL application was a logical upgrade aimed at modernising application approval processes, which had been going on for a long time between the healthcare professional and the health insurance company. Supporting the drug approval process by digitising the application approval process to enable the timely adjustment of the patient for treatment was the "trigger point" that led our efforts to develop an application that would speed up the approval process while being easy to use.
MENDEL is a web application that works in a standard web browser and can be used by a doctor or nurse. Through a set of tools, it allows the user to automatically create requests or protocols, manage patient cards, monitor request expirations and, for example, record and control the number of approved and prescribed packages.
The regular use of the MENDEL application by healthcare providers not only streamlines the communication of PZS with the health insurance company, but also adds value to generating a database of local treatment of patients for a given indication, which can serve as the basis for anonymised, quantified prescription and treatment effectiveness reports, country or region perspective, user effectiveness reports, patient numbers and many other outcomes.
Through a set of tools, MENDEL allows the user to automatically create applications or protocols, manage patient cards, monitor application expirations and, for example, record and control the number of approved and prescribed packages.
At CEEOR, our priority is the security and anonymisation of processed data. CEEOR stores data in a centre certified according to the ISO 27001 standard on physical and data security.
Our goal at CEEOR is to make the MENDEL application a standard for healthcare providers and to digitise and streamline communication between the doctor and insurance companies so the doctor pays attention to what is most important in his or her practice—the patient.
Simultaneously, it’s in everyone’s interest—both the user and the supporter of the application—that the MENDEL application can be used by healthcare professionals from all over the market because it is then that the data collected by the application will provide sufficient informative value to anyone interested in receiving it.
MENDEL APPLICATION FEATURES
The application enables the simple and efficient creation of applications for health insurance companies (Union, D’vera, VŠZP) with predefined epicrises, medicines, dosing and the maximum simple generation of repeated applications from already pre-filled patterns valid for each insurance company. It enables the electronic sending of the created application to the health insurance company. The application guards deadlines and alerts users to upcoming deadlines, whether the expected approval by the insurance company or the expiration of an already-approved application.
The application allows communication with the patient and notifies the patient via SMS or email about the dates of the examination, the status of the request, the prepared prescription and other events during treatment.
The application monitors the number of prescribed packages vs. insurance-approved packages and helps prevent prescription mistakes, leading to the prescription of more packages than approved by the review physician.
The application allows one to anonymously query healthcare professionals for simple but also more complex questions through an integrated market research interface.
The application meets all GDPR regulations.
Patients' personal data is encrypted by the physician; CEEOR does not have access to this data.
BENEFITS OF MENDEL APPLICATION
Benefits for patients
Faster access to treatment, early treatment and effective communication with the doctor
Benefits for doctors
Reduction of paper load, reduction of telephone calls, more time for the patient, overview of all applications in one place.
Benefits for application supporters
An overview of the number of approved packages, the number of patients for each insurance company, the number of users per region, information on medicines in the given indication, faster approval of the application, faster patient setup for treatment.
Local data on the number of patients treated by the insurance company, the number of approved packages and the average per patient who can compare with the recommended treatment according to guidelines.
Benefits for the health insurance company
More effective communication with the user (doctor, nurse). Progress leads to efficient work within the insurance company.
Marketing tool for the doctor. Differentiation from the competition.
