Healthcare has come a long way from the days of Dr. Schuckner. (If you're not sure who Dr. Schuckner is, my native-New-Jersey grandmother can explain.) For a very reasonable fee, he gave a checkup while showing off the postcards from his "boys" in faraway places like Midway and Marseille. Quite a contrast from the big buildings today that dole out drugs, fax forms, or mail members.

Although some of the "personal touch" is lost in the quagmire of acronyms and authorizations, the quality of care that we appreciate has improved tremendously. Phrases like open-heart surgery, lasik and arthroscopic procedures have become commonplace. While procedures and diagnostics typically take center-stage, other technologies work behind the scenes.

Healthcare management software has provided valuable tools to both providers and payers. On the provider side, hospitals and clinics have used such software to make calculated business decisions in managing resources. With healthcare management software, facilities can provide patients the optimum care they require.

Consider the utilization management department at a hospital; staff ensure time and money are used in the right way, at the right time, in the right amounts. Were it not for software applications that gather clinical data, utilization managers could not develop sophisticated reports to "slice-and-dice" the volumes of information. Reports that reveal unnecessary lengths of stays, delayed patient reviews, and underutilized hospital rooms are like gold nuggets. Timely responses to this information can result in significant savings and improved services.

On the payer side, healthcare management software has allowed the "Big Blues" and other insurers to meet their members' needs more effectively. With such software, they can authorize procedures more efficiently, refer to specialists more appropriately, and provide medical services more specifically.

For example, software business rules can execute specific tasks based on pre-determined decisions and specific member criteria. Take for example a man who is admitted to a hospital with congestive heart failure. Based on the member's health record, admitting diagnosis, and other relevant factors, the software automatically authorizes procedures, generates a referral to a cardiologist, and sends an email to a case manager.

The case manager—the human clinician in this part of the story—calls the member at his home several days later. With the member's consent, the member is sent a packet of preventive healthcare materials and a follow-up clinical visit is scheduled. Albeit valuable for the member, this effort is not entirely altruistic. The payer organization has also reviewed reports that identify groups of individuals who are likely to incur future medical expenses. By reviewing such reports and responding with targeted early intervention, payers can potentially save millions of dollars by having healthy members.

Both payers and providers have benefited from healthcare management software; these rewards have been ultimately passed on to end consumers. So although I listen wistfully to the office visits with Dr. Schuckner, I don't altogether long for the "good old days."

Tom Urbanowicz is the owner of DataDesignIT, helping businesses operate efficiently and communicate effectively. Tom can be reached at tom@datadesignit.com or at 530.513.1691.