Implementing Rule-based Healthcare Edits

Automated medical claims processing and billing is a popular application domain of information technology. Managing medical related data is a tedious job for healthcare professionals, which distracts them from their main job of healthcare. The technology used in data management has a sound impact on the quality of healthcare data. Most of Information Technology (IT) organizations use conventional software development technology for the implementation of healthcare systems. The objective of this experimental study is to devise a mechanism for use of rule-based expert systems in medical related edits and compare it with the conventional software development technology. A sample of 100 medical edits is selected as a dataset to be tested for implementation using both technologies. Besides empirical analysis, paired t-test is also used to validate the statistical significance of the difference between the two techniques. The conventional software development technology took 254.5 working hours, while rule-based technology took 81 hours to process these edits. Rule-based technology outperformed the conventional systems by increasing the confidence value to 95% and reliability measure to 0.462 (which is < 0.5) which is three times more efficient than conventional software development technology.