Semantic

How We Are Unlocking Data-Driven Care Applications By Helping Medical Coders and Auditors

Unstructured data has significant value but is underutilized. The future of patient care demands improved access to this data and the analytical value that can be generated from it. To get there, we are using artificial intelligence to unlock unstructured medical data by helping providers optimize their medical coding, auditing, and data quality workflows.

At Semantic Health, we are revolutionizing legacy medical coding and auditing processes. This is our story


Our Origins: The Problem with Healthcare


When Nicola Sahar went to medical school, he believed that patient care was all about medicine. However, he quickly learned that inefficiencies in healthcare operations were impacting patients well before and after they arrived at the hospital. Every year, health systems spend billions in financial resources to manually structure clinical data into formats that can be used for reimbursement, decision-making, and analytics—like converting physician notes (unstructured data) to medical codes (structured data). However, they are doing so in error-prone and inefficient ways.


In conversations with coders, Nicola learned that current processes require specialists to comb through hundreds and sometimes thousands of pages of complex clinical documentation to identify relevant information, map key clinical events, and appropriately code diagnoses and treatments. The complex and inefficient workflow design puts medical coders and auditors under significant time constraints and pressure.


Our Spark: The Challenge With Medical Coding Today


Nicola was in his last year of medical school when he found himself in the Health Information Management department of a local hospital. As a medical student, he was surprised to see that this department staffed large teams of experts, known as medical coders, whose focus was to analyze all clinical documentation and convert it to codes. What was even more surprising was that they were using several disconnected and legacy tools to manually complete this process.


This first peek behind the curtain of healthcare compelled Nicola to drive across the province and connect with folks all over the country to understand why healthcare information management systems were failing us. With his experience in the world of clinical machine learning and informatics, Nicola knew that there was a significant opportunity to help.


Despite his far reach across the country, Nicola began to discover a common story emerging. From poor physician documentation that could not be caught until months later to manually searching through thousand-page codebooks, medical coders face intense time pressures, growing backlogs, and are provided with legacy technology that reduces their efficiency. In fact, nearly everyone Nicola spoke with had their own story, all of which shared one common thread: inefficient technology was causing medical coders to have time-consuming and error-prone workflows with some very negative downstream effects.  


Medical coding and auditing inefficiencies are a multi-billion dollar problem. And, as coders will tell you, miscoding or undercoding can have severe consequences for healthcare providers, including:

  • negatively affecting reimbursements;
  • risking denials and audits;
  • decreasing patient care quality; and 
  • risking improper patient treatment. 



Our Vision for the Future


As healthcare makes strides to optimize resources and improve the quality of care, providers increasingly need access to healthcare data in structured and actionable ways. By making healthcare data more actionable, providers can power operations, reporting, and analytics to improve patient care. Data-driven care is essential to delivering high-quality value-based healthcare, but it requires accurate, real-time access to structured data. Nicola believed this was possible, and determined that “this is the problem that [he] wanted to dedicate [his] career to solving.” And so, with the bold vision of a doctor and technical expertise of an AI researcher, he left medical practice to solve this problem and Semantic Health was born.


At Semantic Health, we are on a mission to improve care delivery and operational efficiencies by transforming the use of unstructured data in healthcare within the revenue cycle, starting with medical coding and auditing.



We Are Semantic Health


Over the past year, we have built a team of experienced medical coders and auditors, technologists, and designers to achieve our mission and have tested our product with hospital partners. The result is an all-in-one, concurrent AI platform for coding and auditing that offers automatic code suggestions with a clinical evidence trail. If you have already coded clinical notes, our software will audit and identify any potential coding-based deficiencies that require further review.


Backed by great investors, including Preface Ventures, Liquid 2, RiSC Capital, Wayfinder VC, as well as several early adopters, like Humber River Hospital, the Semantic Health Information Platform has been a major success at leading North American hospitals. The platform has:


  • significantly improved coding efficiency and accuracy;
  • increased data quality;
  • uncovered millions in missed reimbursements;
  • reduced claims denial risk; and
  • created an actionable data layer to enable further analysis and research of unstructured data. 


We are excited to bring our software offerings to systems around North America and help them transform their medical coding and auditing process while generating an actionable data layer for operational and clinical use cases. To learn how the Semantic Health Information Platform can make a difference for your organization, email contact@semantichealth.ai.



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