Healthcare's persistent pain point, prior authorization, has long been synonymous with inefficiencies, delayed patient care, and clinician burnout. Today, groundbreaking technologies such as Fast Healthcare Interoperability Resources (FHIR) and Artificial Intelligence (AI) promise to dramatically streamline these cumbersome processes. In a revealing conversation with Dr. Colin Banas, Chief Medical Officer at DrFirst, we explored how integrating these technologies is revolutionizing healthcare workflows, significantly reducing clinician workload, and enhancing patient outcomes.
Prior authorizations, required by insurance companies for certain medications and treatments, have historically burdened healthcare providers and delayed necessary patient care. Dr. Banas explained the critical nature of this issue clearly: "There are armies of people sitting at desks doing this in a very manual fashion right now…which is ridiculous. Those nurses, MAs, and PAs could be taking care of patients or doing quality initiatives." This manual process consumes considerable time and resources, negatively impacting patient care and clinician productivity.
FHIR (Fast Healthcare Interoperability Resources) is a standardized API that simplifies the exchange of healthcare information across various platforms and systems. Unlike previous protocols, FHIR streamlines and standardizes both data structure and transmission.
Dr. Banas highlights why this matters: "FHIR has the unique distinction of not only being a structural standard but also a protocol for transmission." Its adoption allows:
Consistency across different systems
Faster data transmission
Greater interoperability between healthcare providers and insurance companies
Artificial intelligence enhances the capability of healthcare systems to manage data efficiently and accurately. Dr. Banas prefers to call it augmented intelligence, emphasizing AI's supportive role: "AI is helping. AI is not replacing."
AI's role in prior authorization includes:
Automating document searches and evidence gathering
Summarizing complex patient histories quickly
Drafting authorization and appeal letters with minimal human intervention
For more on AI's broader impact, read Navigating the Intersection of Medicine and AI.
Dr. Banas provides a vivid example: clinicians currently spend 10-20 hours weekly on prior authorizations. With AI integration, that workload significantly decreases, freeing clinical staff for patient-focused tasks.
DrFirst is uniquely positioned, actively developing solutions that incorporate both FHIR and AI technologies. Dr. Banas described their strategy clearly: "We want to automate this to the extent that we can, and to the extent that it is safe to do so."
Their innovative approach includes:
Real-time price transparency directly within prescribing workflows
Seamless initiation and tracking of prior authorizations within EMRs
Integration of both pharmacy and medical benefits to handle comprehensive medication management
How does integration practically look within major EMR systems like Epic? Dr. Banas clarifies:
Solutions appear native within existing EMR workflows.
Clinicians see immediate price and authorization status.
Prior authorizations can be initiated without navigating away from primary patient records.
Such integration dramatically reduces disruption and streamlines clinical workflows, creating tangible efficiency and patient-care benefits.
To learn more about how healthcare IT is transforming care delivery, explore How Innovative Tech Tools Are Transforming Clinician Efficiency.
With regulatory changes mandating faster turnaround times for prior authorizations expected by 2027, healthcare organizations must adapt swiftly. FHIR standardization and AI technologies are essential to compliance and efficiency.
Dr. Banas emphasizes urgency: "Legislation without technology relies on brute force. When structured in FHIR, you can automate significantly, only bringing humans in as checks."
The long-term vision is clear: clinicians writing prescriptions with minimal additional steps, leveraging automated systems that understand patients' medication histories and required documentation.
AI could autonomously handle:
Verification of prior medication trials
Compilation of required clinical documentation
Automated status tracking and real-time updates for all stakeholders
Dr. Banas confidently projects that significant automation advancements are imminent, bringing dramatic changes by 2027.
DrFirst has proactively made strategic acquisitions, notably MindShift, enhancing capabilities to manage medications under both pharmacy and medical benefits. This forward-thinking move ensures comprehensive, seamless solutions for managing increasingly complex prior authorizations, especially as more medications transition to coverage under medical benefits.
Learn how others are preparing for the future by reading Mastering Innovation in Healthcare: Practical Strategies for 2025.
Integrating FHIR and AI into prior authorization processes offers healthcare professionals substantial benefits:
Reduced administrative workload
Faster patient care initiation
Enhanced clinical productivity and job satisfaction
Significant cost savings and efficiency gains
Clinicians will no longer waste valuable clinical hours handling paperwork but instead can focus on patient-centric, quality care.
Adopting standardized frameworks like FHIR and integrating AI capabilities now positions healthcare organizations strategically for upcoming regulatory changes. It also addresses current inefficiencies directly impacting patient outcomes and clinician satisfaction. Organizations should proactively evaluate their readiness, seek strategic partnerships, and invest in solutions that leverage these innovative technologies. As Dr. Banas succinctly stated, "The technology is the force multiplier." Healthcare leaders who embrace this early will lead the industry in efficiency, quality, and innovation.
