AI for medical practices

The practice software handles the schedule, medical history and billing. What remains are letters from insurers, referrers and social insurance bodies that the practice has to read, compare with the patient file and answer.

First, the cost approval request to the health insurer. Basic insurance only pays for a medicine outside the approved prescribing information on special approval by the insurer after consulting the medical examiner, as set out in Article 71d(1) KVV. The standard is Article 32(1) KVG: the service must be effective, appropriate and cost-efficient. From the patient file, findings and the doctor’s note on the indication, a request is drafted along these three criteria, with diagnosis, previous therapies and justification. If a detail is missing from the file, the gap is flagged. The doctor adds the medical justification, checks and signs.

Second, the query or rejection from the medical examiner. Under Article 57(4) KVG, medical examiners check the conditions for the obligation to pay benefits, and under paragraph 6 the practice must provide them with the information needed for this. Vectoryon compiles each item requested in the letter from the patient file, with a reference to the passage. This becomes a reply draft that contains only what was requested. Whether medical information goes only to the medical examiner under Article 42(5) KVG is decided by the doctor. She checks, adds and sends.

Third, the rejection of an invoice. Since 1 January 2026, practices and hospitals have billed outpatient services under TARDOC and the outpatient flat rates; TARMED no longer applies. Under Article 42(3) KVG, the invoice must be detailed and understandable and contain all the information needed to check the remuneration and cost-efficiency. If the insurer rejects an item, the assistant places its justification next to the service record and the consultation note and shows where invoice and documentation diverge. It drafts a justification to the insurer or a proposal for correction. The MPA checks with the doctor whether the tariff item is correct; corrections are made in the practice software.

Fourth, the referral. It arrives by email, with previous findings as a PDF. Vectoryon checks it against the admission criteria the practice or clinic has stored as a document and lists what is missing, such as current lab values, imaging or the medication list. It also writes a query to the referrer. The doctor decides whether and how urgently the patient is admitted. The MPA sends the query after her approval.

Fifth, the medical report to the disability insurance (IV) office or the accident insurer. By registering with the IV, the insured person authorises the named doctors to provide information, and under Article 6a(1) IVG they are obliged to do so. For accident insurance, Article 28(3) ATSG applies: doctors are obliged to provide information if the insured person authorises them to do so in the individual case. The assistant pre-fills the questionnaire from the patient file, each answer with a reference to the source, and flags the questions only the doctor can answer, such as those on fitness for work. The doctor answers them, checks the rest and signs.

In none of the five cases does Vectoryon make a diagnosis or a decision on indication. Preparing is the assistant’s job, deciding is the doctor’s.

Manufacturers of medical devices carry a large documentation burden: technical documentation, risk file, test reports, supplier correspondence and quality management with its procedures. The Medical Devices Ordinance (MepV) governs these documents.

Vectoryon helps with the groundwork there too. The assistant searches the connected file store on SharePoint and answers a question such as “Which procedure governs supplier evaluation?” with a reference to the document. It summarises test reports, drafts letters to suppliers from templates and keeps a list of open points in the Tables module, such as dates for audits and recertifications. An example: before an audit, the QM manager asks which test reports have been added since the last recertification. The list comes back with date and storage location.

Vectoryon is not a document control system and does not replace QM software. Approvals, signatures and the assessment of whether a change is relevant for regulation stay with the responsible people. The work is similar to that in mechanical engineering.