News 12/13/24

Top News

ASTP publishes a slimmed-down version of the TEFCA HTI-2 final rule. Some parts that were unrelated to TEFCA, such as those related to public health data exchange and payer API standards, were moved to another final rule that is being reviewed by the Office of Management and Budget.

HIStalk Announcements and Requests

Teacher Mr. F in New York City sent over photos of his middle school students using the STEM kits that were provided by a reader’s donation.

Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present or promote your own.

Acquisitions, Funding, Business, and Stock

Analytics platform vendor Particle Health, which recently filed a lawsuit against Epic for antitrust behavior, raises $10 million from existing investors. Insiders say the money won’t be used to fund the lawsuit’s expenses.

CoachCare,which offers tools for remote patient monitoring and virtual care, raises $11 million in funding.

Patient engagement software vendor SpinSci raises $53 million in growth equity funding.

Health system risk analytics vendor 1m raises $10 million in Series A funding, most of it from large health systems. The two co-founders are former Goldman Sachs VPs.

Business Insider profiles Claimable, which offers patients an AI-powered platform to help them appeal their health insurer’s medication coverage denials. The company says that its $40 service has an 85% success rate in getting denials overturned.

Microsoft hires several former employees of Google’s DeepMind to run its new London-based AI consumer health team.

Sales

• University of Cincinnati Health chooses Laudio’s workflow hub for hospital frontline leaders.
• Gibson Area Hospital and Health Services, the country’s fifth-largest Critical Access Hospital, will implement Meditech Expanse under the Meditech-as-a-Service cloud delivery model.

Announcements and Implementations

The first participants in Meditech’s Traverse Exchange — the company’s nationwide private, FHIR-first network that went live in the US in August following its launch in Canada — begin exchanging health data. The service includes connections to CommonWell and Carequality and offers an embedded record locator service.

The Sequoia Project publishes the Data Usability Implementation Guide Version 2 that was created by its Interoperability Matters Data Usability Workgroup.

Ellkay seeks nominations for its Women in Health IT digital health series.

Atropos Health, which provides evidence-based clinical insights by analyzing real-world data, offers access to its Atropos Evidence Network to developers and health systems for AI training.

Privacy and Security

Puerto Rico-based clearinghouse Immediata Health Group pays $250,000 to settle charges that it stored the information of 1.5 million patients unsecured on the internet, allowing it to be found via Google searches. The company previously paid $2.5 million in civil settlements that were related to the misconfigured server.

A report finds that hospitals are administering pain and epidural medications to pregnant women during their C-sections, then reporting the women to child welfare authorities when their newborns test positive for the same drugs. Hospitals often file the reports without checking the mother’s medical records, frequently placing the responsibility on social workers who have little drug testing experience or authority. At least 27 states require reporting a baby’s positive test, but none of them require hospitals to confirm the results before doing so.

A UK court dismisses an appeal that would have reactivated a privacy case that involves the transfer of patient data from The Royal Free London NHS Trust to Google-owned DeepMind to use in a kidney injury detection app.

Sponsor Updates

• A new EClinicalWorks survey finds that AI is a catalyst to transform the healthcare industry, with 90% of respondents reporting favorable views of AI.
• Ellkay publishes a new success story featuring Delta Pathology + Omega Diagnostics, “Optimizing Efficiency for Independent Labs.”
• Findhelp offers a new case study, “NYC Health + Hospitals Supports 100,000+ Patients in Six Months Using Automated Epic-Findhelp Social Determinants of Health Assessment Integration.”
• Five9 announces that it has won the 2024 Aragon Research Innovation Award for AI Contact Centers and been named a Leader in two Aragon Research Globe reports, “AI Agent Platforms in the ICC, 2025,” and “Intelligent Contact Center, 2025.”
• Goliath Technologies releases a new case study, “Leading not-for-profit health system isolates and resolves speed & reliability of Citrix related Epic and ChromeOS device issues .”
• Modern Healthcare recognizes Clearwater and Laudio as two of the Best in Business of 2024.
• Impact Advisors releases a new Impactful AI podcast titled “Inside the ‘Minds’ of LLMs: Behavioral Capabilities & Quirks.”
• Linus Health names former Providence president Mike Butler as an independent board director.
• KLAS Arch Collaborative features Meditech customer Ozarks Healthcare’s enhanced physician user experience in two case studies.

Blog Posts

• AI and the Age of Intelligence Has Arrived (EClinicalWorks)
• Healthcare Cybersecurity Threats: November 2024 (Fortified Health Security)
• Transforming Patient Access: Epic Optimization Drives Scheduling Efficiency and Revenue Growth (Health Data Movers)
• Release of Information and Audits: Birds of a Feather (And They Should Stick Together!) (HealthMark Group)
• How to Use Epic Gold Stars to Maximize Your EHR Investment (Healthcare IT Leaders)
• Is Your ACO Prepared to Report Promoting Interoperability Measures for All ACO Participants? (Impact Advisors)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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EPtalk by Dr. Jayne 12/12/24

The US Department of Health and Human Services recently launched the National Healthcare Safety Dashboard that tracks patient and workforce harm. The goal is to monitor patient safety indicators so that improvement can result. It draws data from the HHS Agency for Healthcare Research and Quality (AHRQ) including its Hospital Patient Safety Indicators, Hospital Medicare Adverse Events, and Surveys on Patient Safety Culture (SOPS) Hospital Survey. It also pulls from the CMS Hospital Reporting Program Safety Measures. Hospitals and health systems have been trying to reduce preventable harms for decades and hopefully the additional transparency from such a dashboard will better support those efforts. Future plans include dashboards for other care settings including nursing facilities and ambulatory care sites.

I took a peek at the Hospital Patient Safety Culture Survey (SOPS) data, and although the results weren’t surprising, they were still disheartening. Some of the least-positive scores were around Staffing and Work Pace, Response to Error, and Hospital Management Support for Patient Safety. A number of research articles have listed topics like these as contributing to care team burnout and I hope that institutions are making plans to address them. The most recently displayed data in the dashboard was from 2022. I’d love to see more public information on what staff members think about the culture of the institutions where they work and whether hospital leadership becomes more responsive when light is shining on those kinds of concerns. If you’re working in this space, feel free to reach out.

In conjunction with HIMSS, Medscape has released its 2024 AI Adoption in Healthcare Report. I was saddened to see it delivered in a format I detest, that being a 22-item, web-based slide show. Results are from “a jointly managed survey to practicing physicians and other clinicians, practicing nurses, IT professionals, clinical leadership, and executive leadership at medical organizations” in the US. That’s pretty vague and I was looking forward to seeing increased stratification of the findings based on the type of medical organization – care delivery, payer, software developer, etc. – since all of those are technically medical organizations. Highlights from the survey that should surprise no one: AI is most frequently used with administrative tasks, it’s producing solid results for transcription for everything from meeting notes to patient documentation, and a large number of respondents are concerned about data privacy and/or ethical issues.

Other facts I wasn’t expecting: only 24% of employers are providing AI training, physicians are less likely to use AI away from the office than non-physician respondents, and 28% of physicians believe it will eventually replace the need for human doctors. Looking at respondent demographics, almost a third were nurses and nearly two-thirds worked in hospitals, so I’m not sure this is representative of medical organizations as a whole. Only 1% of respondents were healthcare IT, however. The data wasn’t further stratified by those groups, so it’s really a limited view into the issue. It was one of those attention-grabbing articles, and given the report’s sponsors, I didn’t expect much more from it than a superficial review of the topic.

From The Mitten: “Re: new scam. People are offering fake jobs.” The scam was mentioned in a security bulletin from Michigan’s Munson Healthcare. Scammers are “imitating Munson human resources’ leaders offering people false jobs and sending them fraudulent checks to purchase their own equipment.” From the information available, I can’t seem to figure out what else was involved in the scam, whether it involved theft of financial information related to the phony checks or something else. If you know more about it, feel free to share with the rest of the class.

The year is coming to a close and most of my time now is spent gearing up for 2025. A new year always brings new opportunities. I had the chance to catch up with a friend who works as a healthcare IT consultant and she mentioned that work at her current consulting gig has just about ground to a halt. It seems that all the people who didn’t take their allotted vacation time throughout the year are racing to try to take it before the “use it or lose it” deadline of December 31 and it’s a ghost town as far as finding people with whom to collaborate. It’s a bit surprising to me since this is a care delivery organization that needs to make sure that essential functions are covered, but I guess that as long as they have one person around to field support calls, they’re OK with it.

I’ve worked in organizations with all kinds of vacation policies, some of which make it difficult for employees to take time off on their preferred schedules. One employer had a strict accrual policy that started over each year, essentially preventing anyone from taking a full week of vacation in the early parts of the year. Others have had accrual policies, but allowed you to use vacation in advance of the actual accrual, adding flexibility. I’ve also worked in organizations with unlimited time off, which can be good or bad depending on the company culture and how such a program is administered.

I’m not a fan of use it or lose it plans that are tied to the calendar year since life sometimes doesn’t always deal us opportunities on that kind of schedule. I get that you don’t want people banking ridiculous amounts of vacation, which means that they’re not taking the time they should in order to relax and recharge. On the other hand, it would be great to take a multi-week trip to celebrate a marriage, milestone birthday, or other life event without having to time it to a certain part of the year.

Of all the arrangements I’ve worked under, my favorites are either a well-administered plan for unlimited time off that ensures that employees actually take it, or one that lets employees roll vacation over from year to year as long as they don’t exceed a certain number of banked hours. Either way, those require adequate involvement from managers to ensure that people are taking time away at regular intervals, and it seems that some organizations don’t want the hassle of either.

What kind of vacation or time off plan does your organization have? Does it meet your needs or do you wish you had something different? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 12/12/24

CoachCare Announces $11 Million Investment from Catalyst Investors, Expanding Growth Potential

Remote patient monitoring and virtual care management vendor CoachCare raises $11 million in new funding.

Dallas-Based Healthcare IT Leader Secures $53M Investment to Transform Patient Care and Expand Global Reach

SpinSci, a healthcare technology company specializing in patient engagement and access solutions, announces a $53 million investment from Aldrich Capital Partners.

Particle Health lands $10 million in funding after lobbing antitrust lawsuit against medical records giant Epic

Business Insider reports that healthcare API company Particle Health has raised $10 million.

Healthcare AI News 12/11/24

News

OpenAI launches AI-driven video generator Sora, then disables it when it is overloaded from heavy traffic. It can generate video from text instructions and existing media, but only up to a final length of 20 seconds. The company also releases its Canvas feature to all ChatGPT users, which allows users to work on writing and coding projects with increase editing capability.

Google announces Willow, a new quantum chip that performs a benchmark computation in under five minutes versus the 10 septillion years that is required by the fastest supercomputers.

Business

Corewell Health chooses Abridge for ambient clinical documentation, with a rollout to 4,000 physicians planned.

Research

A Washington State University sociologist finds that rural clinics aren’t ready to use AI to optimize proactive text messages to patients. An AI-polished lung screening message drew fewer responses than the traditional one and more than 50% of all sent messages bounced back as undeliverable, raising the question of how the clinic could contact its patients in an emergency. The local hospital also noted that the area has a high population of Hispanics, which raised its own messaging challenges.

Other

Corpus Christi Medical Center Chief of Surgery Michael Ewing, MD credits his use of MedQuill’s newly launched SurgeOn Scribe – which he helped create — to saving an hour of clinic time each day. 

Joe Raetano, the VA’s AI architect, says that the organization is using AI to extract social determinants of health from clinical notes and to manage patient data via an agentic chatbot.

In England, a woman credits AI with saving her life after her lung cancer was diagnosed by Royal Surry NHS Foundation Trust using AI imaging triage tool Annalise.ai.

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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Morning Headlines 12/11/24

Oracle Announces Fiscal 2025 Second Quarter Financial Results

Oracle reports Q2 results: revenue up 9%, EPS $1.10 versus $0.89, missing Wall Street expectations for both and sending shares moderately down.

Healthier Capital Invests in Hyro’s Responsible AI Agents for Healthcare

Healthcare conversational AI company Hyro extends its Series B round of funding, bringing its total raised to $50 million.

Walgreens shares soar 20% on reported talks to sell itself to Sycamore Partners

Walgreens is reportedly considering selling itself to private equity firm Sycamore Partners in a take-private transaction.

Evidently Closes $15M Series A

Healthcare workflow AI startup Evidently raises $15 million in a Series A funding round.

News 12/11/24

Top News

CVC Capital Partners will likely acquire German health IT company CompuGroup Medical in a take-private deal valued at $1.2 billion. The acquisition is expected to close in the first half of 2025.

CGM acquired EMDs in 2020 in a $240 million deal that included the assets of Aprima Medical Software, which EMDs had acquired the year before. CGM, which has a US office in Austin, also acquired certain European assets of Cerner’s portfolio around the same time for $236 million.

Reader Comments

From Independent Primary Care: “Re: CareMax. Has laid off 530 employees since filing for bankruptcy in November. I think it’s safe to say that the Medicare Gold Rush has ended with the implosion of VillageMD, Walmart Health, Cano Health, Clinical Care Medical Centers, and now CareMex. Who’s next? Amazon’s One Medical, CVS’s Oak Street, or Optum?” CareMax, which is a Medicare Advantage delivery system, hopes to sell its management services organization and care centers to Revere Medical, the private equity-backed recent acquirer of Steward Health Care’s physician group. CMAX shares, which began trading in 2021 via a SPAC merger, are approaching worthlessness. The sustainability of MA value-based care is uncertain due to high labor costs, unexpectedly high demand for services, competition among publicly traded companies, and more complicated payment rules that are tied to quality ratings. The MA business isn’t making anyone happy, as those plans cost taxpayers a lot more money than traditional Medicare, companies use questionable diagnostic and documentation practices to exploit the system, and sicker patients who encounter MA denials or restrictions can move their high costs to traditional Medicare when it benefits them.

Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present or promote your own.

Acquisitions, Funding, Business, and Stock

Oracle reports Q2 results: revenue up 9%, EPS $1.10 versus $0.89, missing Wall Street expectations for both and sending shares moderately down. The company’s healthcare business wasn’t mentioned except as a use case for its AI agents.

Walgreens is reportedly considering selling itself to private equity firm Sycamore Partners in a take-private transaction. The drugstore operator is struggling with lower prescription payments and front-of-store competition with Walmart and online retailers such as Amazon. It took a $6 billion charge this year for the declining value of its investment in primary care operator VillageMD, its only significant non-drugstore business. Sycamore invests in dying mall retail businesses such as Hot Topic, Belk, and Lane Bryant and, like most PE firms, has a history of loading its acquisitions with debt and pulling out billions of dollars from the already-struggling businesses.

The US Patent and Trademark Office grants TeamBuilder a patent for its predictive staff scheduling technology that incorporates patient volume, workflow, and employee availability and characteristics.

Healthcare workflow AI startup Evidently raises $15 million in a Series A funding round.

A new KLAS report on clinical communications technologies finds that PerfectServe Telmediq is the most broadly adopted and has the most users live on physician scheduling, while users of TigerConnect and Symplr report simple deployments and easy adoption. End user training and integration are the biggest implementation obstacles.

Sales

• Syracuse Area Health (NE) will launch telenephrology services using technology from Teledigm Health.
• Sanford Health (SD) selects Availity’s Essentials Pro RCM software.

People

Wolters Kluwer names Mark Sherwood, MBA (Microsoft) EVP/CIO.

Lori Jones (Agiliti) joins Aptarro as chief growth officer.

C3HIE promotes Jim Hoag, MA, MBA to interim CEO. He takes over from Phil Beckett, who will join Texas Health Services Authority as CEO.

RhythmX AI names Andrei Zudin, PhD (Carequality) head of interoperability and security.

Tyler Turner (Optum) joins Edifecs as RVP of payer sales.

Announcements and Implementations

Broward Health (FL) goes live on Epic.

Privacy and Security

HealthAlliance (NY) will pay a $550,000 fine for its failure to prevent a cyberattack in July 2023 that exposed the information of 243,000 patients. The organization had been made aware of a system vulnerability by one of its vendors, but failed to implement a patch because of technical issues.

Other

Informatics researchers propose adapting the Clinical Laboratory Improvement Amendments (CLIA) model — which allows labs to develop and modify FDA-approved tests without further review — to regulate healthcare AI. The framework could include local oversight, risk stratification, assurance of appropriate staff training, validation of developer claims using local data, a recalibration schedule, ongoing quality control, and a certification program for AI-competent organizations.

Sponsor Updates

• Cardamom Health moves to new offices in downtown Madison, WI.
• The Norwegian healthcare region Helse Nord RHF will expand its use of Sectra’s enterprise imaging solution to include digital pathology.
• Agfa HealthCare recaps its team’s experience at RSNA with daily updates.
• Arcadia publishes a new report, “The current state of healthcare analytics platforms.”
• Availity promotes Sujin Park to senior marketing operations manager.
• Capital Rx releases a new episode of The Astonishing Healthcare Podcast, “What’s Hot In and Around the Pharmacy Supply Chain, with RSM’s Tom Evegan.”
• Cardamom Health moves to new and expanded office space in downtown Madison, WI.
• CTG publishes a new whitepaper, “Optimizing the Epic Journey: Workflow Alignment as the Cornerstone of EHR Success.”
• Divurgent publishes a new success story, “Integrating Project Portfolio and IT Operations Management at the Child Mind Institute (CMI).”

Blog Posts

• Succeeding in Value-based Care: Part 2 (Tegria)
• Flipping the script: Why nurses stay (Altera Digital Health)
• VA Hospital Fall Prevention: A Pathway to Zero Falls (AvaSure)
• Navigating the HIPAA Privacy Rule for Reproductive Healthcare: Compliance Essentials Before the December 2024 Deadline (Clearwater)
• Physician CIO Advice: Scaling Health IT in Rural America (CereCore)
• Speeding Access to Specialty Meds in Oncology: How Electronic Prior Authorizations Make It Possible (DrFirst)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
Send news or rumors.
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Contact us.

Morning Headlines 12/10/24

CompuGroup Medical enters into an investment agreement with CVC Capital Partners

CVC Capital Partners offers to acquire German health IT company CompuGroup Medical in a take-private deal valued at $1.2 billion.

Attorney General James Secures $550,000 from Hudson Valley Health Care Facility Operator for Failing to Protect Patient Data

HealthAlliance, a health system in New York’s Hudson Valley, will pay a $550,000 fine for its failure to prevent a cyberattack in July 2023 that exposed the information of 243,000 patients.

Security Alert: Munson Warns of Possible Employment & Financial Scam

Munson Healthcare (MI) warns people of a scam involving bad actors posing as Munson HR staff offering job applicants false jobs and sending them fraudulent checks for equipment purchases.

Curbside Consult with Dr. Jayne 12/9/24

It’s definitely a slow time in the healthcare technology universe. The HLTH conference is in the rearview mirror and HIMSS is still a couple of months away.

CES will happen in January, although on the healthcare side, I see more entrepreneurs there than I do those who work for hospitals and health systems. I’m looking forward to seeing cool consumer products and wearables announced at CES, although I have low expectations for anything that will truly transform healthcare. Even if there’s something useful for patients, cost is still a barrier for the majority of patients I interact with. Many of them struggle to afford their medications, can’t afford to take time off work for a physician visit, and aren’t going to pay hundreds of dollars for devices that may or may not improve their health.

One physician I spoke with recently is working extra hours trying to fit in patients who want to proceed with non-urgent procedures because they’ve met their deductibles for the year and can now afford them even though they couldn’t do so earlier in the year. He’s been in practice for a while and this isn’t a new phenomenon for him, so he avoids scheduling family vacations during November and December so that he can accommodate the needs of his patients. It creates a bit of a burden on his office staff because he has to limit their ability to take vacations as well, but that’s not an unusual situation for staff members working in a small private practice.

Several of my physician colleagues are planning to cut back on their working hours in 2025. I’m happy for them because at least one of them is experiencing severe burnout and it’s been difficult to see all that she’s gone through in the last couple of years. Depending on how physician employment agreements are structured, many physicians don’t take enough time off to allow themselves to recharge from drain caused by physical and psychological stressors on a daily basis. Some physicians don’t take time off because they don’t have appropriate coverage for patient care tasks. Others take the time off but end up working because they don’t have coverage for inbox messages or other patient care needs, and therefore don’t get a real break.

Lack of adequate coverage for physician time off is a pervasive issue and causes enough issues that the AMA recently released a module under their STEPS Forward series to address it. The webinar reviews various barriers to physicians taking time off and strategies for organizations to address them. Some of the strategies are straightforward, like making it easy for employees to track their time off and understand how much they have used versus how much remains. Especially if your organization has a use it or lose it policy for time off, this is important. Another strategy is to block physician time off well in advance so that it’s not a surprise. I’d go one step farther with that one and recommend that when the physician schedule is blocked, the scheduling team creates buffers around those blocks so that physicians can manage last-minute issues before their time out of office as well as to have additional capacity available for their return.

Other strategies are more subtle but might be more challenging, like having physician leadership model expected behavior. That might be easier said than done depending on the organization. Another example is ensuring that leadership isn’t celebrating the fact that team members are working while they’re supposed to be off. If your organization wholeheartedly endorses hustle culture, it’s unlikely that they will be making that change. Another significant change called out in the module is making it the organization’s responsibility to find coverage for clinical matters while a physician is out instead of making the physician find their own coverage, which can be a disincentive to taking time away.

The module also addresses physician compensation programs and how they might be adding to the pressures that make physicians less likely to take time off. They recommend that organizations construct productivity models to reflect appropriate time off including holidays, educational time, and sick time. As someone who has managed a consulting team, I know how important this is, because if you calculate productivity expectations based on 40 hours a week for 52 weeks per year, you’re going to make your team crazy with unrealistic expectations. In addition to time away from work, you also need to consider productivity losses for mandatory training (fraud, waste, and abuse, anyone?) as well as office and hospital closures due to holidays.

The module also challenges organizations to look at how physicians are taking time off as part of their organizational scorecard. New research has shown that physicians who have adequate time off are less likely to leave an organization, so it would make sense to look at that data in conjunction with turnover data. Especially for larger organizations that are using human resources systems to track time off, looking at this data should be fairly easy. For those of us on the administrative side, many EHR/practice management systems have stock reports that let you look at scheduled clinic hours and blocked hours, and if you’re a physician leader and you don’t have access to that data for your team, I’d recommend you track it down – you just might see some interesting trends.

As far as my colleagues who plan to cut back their working hours in the coming year, it will be interesting to see how their organizations support them in those efforts. I know of a number of physicians who are supposed to be working at 75 or 80% of their previous full time schedules, but who end up working nearly as much as they did previously due to the same kinds of organizational barriers that keep people from taking adequate time off. At least a couple of them have gone back to full time work so that they at least get full time compensation for their efforts. It’s something to think about for those looking to reduce hours.

What are your plans for time off in the coming weeks? Will your workplace be a dead zone as everyone struggles to use up their vacation time? Leave a comment or email me.

Email Dr. Jayne.

Readers Write: AI Meets the Front Lines: The Contact Center of the Future

AI Meets the Front Lines: The Contact Center of the Future
By Bill Smith

Bill Smith is director of Epic practice at Cordea Consulting.

Hospitals are always striving to deliver a better patient experience. Unfortunately for many health systems, the front line of patient interactions, the contact center, is often the weakest link in the chain. Burned-out agents, lengthy hold times, and frustrated patients are the norm.

What if AI and the cloud could turn the tide? What if health systems could reduce call volumes, capture valuable patient insights, and drive down operational costs by using AI-powered contact centers?

Practical, cloud-based AI tools are ready to make life easier for agents, patients, and healthcare execs alike. This is the low-hanging fruit of AI in healthcare, delivering results today while paving the way for tomorrow’s tech innovations. As it turns out, AI-powered contact centers are the low-risk, high-reward solution health systems need right now.

Every day, hospitals handle countless calls: appointment scheduling, prescription refills, billing questions, you name it. Patients expect quick, accurate, empathetic responses, but most contact center agents are working with outdated tools, incomplete patient data, and scattered knowledge bases.

Throw in staffing shortages and fluctuating call volumes and it’s no wonder long wait times and unresolved issues are the norm. Today’s patients also expect to connect through multiple channels — phone, chat, email — but many hospitals just don’t have the infrastructure to keep up. And those legacy systems? They’re buckling under the weight of modern demands.

Now for the good news.  AI and cloud-based contact centers can tackle these problems head-on with minimal disruption and cost. These technologies aren’t pie-in-the-sky aspirations. They are operational game-changers that are already delivering these kinds of quick wins:

• Automating the everyday. AI-powered chatbots and voice assistants can handle routine tasks like appointment scheduling and FAQs, freeing up human agents for more complex cases. Interactive voice response systems (IVRs) use natural language processing to direct patients to the right department without the endless “Press 1 for…” menus.
• Smarter triage. AI can assess patient symptoms through virtual tools or integrate data from remote monitoring devices, alerting clinicians to potential red flags. Patients get quicker answers, and fewer calls are escalated to clinical teams unnecessarily.
• Personalized interactions. By analyzing patient data, AI can tailor responses to individual needs. It can even pick up on emotional cues, like frustration in a caller’s tone, and prompt agents to respond with extra empathy.
• Streamlined workflows. No more toggling between five systems to answer one question. AI unifies data and tools into a single interface, cutting down call times and improving first-call resolution rates.
• Data-driven insights. With AI monitoring of call trends and patient sentiment, managers can identify bottlenecks, predict call surges, and optimize staffing in real time. Agent training becomes more targeted and precise, with AI creating simulations based on actual patient scenarios.

Imagine this. A patient calls to reschedule an appointment. Instead of waiting on hold, they’re greeted by an AI assistant that offers new time slots in seconds. If the issue requires a live agent, the AI assistant hands it off to an agent with all the relevant information already on-screen, saving time and reducing stress. After the call, the system updates the EHR automatically, reducing admin work for clinicians.

Now multiply that scenario across thousands of interactions daily. Patients are happier, agents are less stressed, and hospitals save money. Everybody wins.

One standout solution is Amazon Connect, a cloud-based, AI-powered contact center platform. Its pay-as-you-go model appeals to cost-conscious health systems, and its integration capabilities make it a natural fit for EHR and ERP systems. Features like sentiment analysis, real-time agent guidance, and automated follow-ups are helping hospitals improve patient satisfaction scores, reduce costs, and boost agent productivity.

Healthcare organizations often approach AI with caution, fearing high costs and uncertain ROI. But contact centers offer a low-risk AI entry point. The stakes are manageable, the technology is already being used with great success in healthcare, and the benefits are immediate. In an era of tightening margins and growing patient expectations, AI-powered contact centers are the rare innovation that checks all the right boxes.

The contact center of the future isn’t just about answering calls. It’s a hub for patient engagement, seamlessly integrating with clinical and administrative workflows. It captures real-time insights to improve operations, outcomes, and experiences across the board.

Here’s the bottom line. Healthcare doesn’t need to wait for AI to revolutionize clinical care. The revolution can start today, in the contact center, with tools that deliver immediate, meaningful improvements for patients, providers, and staff alike.

Morning Headlines 12/9/24

HHS Office for Civil Rights Imposes a $548,265 Penalty Against Children’s Hospital Colorado for HIPAA Privacy and Security Rules Violations

HHS OCR fines Children’s Hospital Colorado $548,000 for HIPAA breaches involving phishing and cyberattacks.

New Dashboard to Track Progress Toward 50 Percent Reduction in Patient and Workforce Harm

The HHS National Action Alliance for Patient and Workforce Safety develops an online patient and healthcare workforce safety dashboard incorporating hospital data from CMS and AHRQ, with plans to expand to clinic and nursing home data.

Kareo is Now Tebra – Website Transition Effective December 5

Ambulatory health IT vendor Kareo, which merged with PatientPop in 2021, officially takes on the Tebra brand name.

Monday Morning Update 12/9/24

Top News

HHS OCR fines Children’s Hospital Colorado $548,000 for HIPAA breaches involving phishing and cyberattacks.

In the first incident from 2020, an IT help desk technician disabled two-factor authentication for a physician’s account and forgot to turn it back on. The 2020 breaches occurred when two employees accepted phony multi-factor authentication requests.

Multi-factor authentication attacks usually involve sending a user a phishing link to a phony login page that looks like the real thing, using the login credentials that they enter to initiate a password reset, and then getting them to divulge the 2FA code that they receive by text message.

HIStalk Announcements and Requests

Most poll respondents expect HHS to change for the worse under the new administration and leadership. I intentionally didn’t qualify what “better” or “worse” means, allowing respondents to make their own interpretation.

New poll to your right or here:  What OS runs your primary personal cell phone?

Listening: a dazzling remake of Pink Floyd’s “Comfortably Numb” by Body Count, rapper Ice-T’s 35-year-old heavy metal band. The Tonight Show video shows how good he and his band are at reworking a legendary song after obtaining unlikely permission from the perpetually feuding David Gilmour and Roger Waters. His wall of guitars is searing on Fallon, but the official video features the 80-year-old Gilmour himself – who approved Ice-T’s request and then asked if  he could get involved — reprising the song that he and Waters wrote 50 years ago with a full six minutes of his unmistakable guitar. A lyrical snip:  “You’ve got a TV, a computer, so you don’t care; A roof, some clothes, some food, that’s right, it’s all there; Lock yourself in your house, try to forget about; The millions dyin’ from wars, starvation and drought.” Also deep from life’s experience: new from Nick Cave and the Bad Seeds (live video here). Cave has pushed through the deaths of two sons to turn grief into hope and reflection on “Wild God,” which takes exuberant advantage of his full band and a choir compared to some sparely accompanied poetry on his last couple of albums.

Pet peeve: websites that won’t let you look at a page until you disable your adblocker, after which it then throws up a paywall lockout.

Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present or promote your own.

Acquisitions, Funding, Business, and Stock

Cardiac imaging Cleerly raises $106 million in a Series C funding extension. The company applies AI to heart CT scans for early detection of coronary artery disease.

Sales

• Four Interim HealthCare agencies will implement Netsmart’s CareFabric EHR in their post-acute care settings.

Announcements and Implementations

Oura enhances its smart rings with Symptom Radar, an “illness warning light” that watches for changes from the wearer’s long-term baseline of pulse, heart rate variability, temperature, and respiratory rate.

OnMed unveils CareStation, a “clinic in a box” system that targets underserved communities. The company says that its product, which offers real-time clinician consultation and tools for measuring vital signs, is being used in five locations. It will be officially introduced next month at CES, where zero attendees have the slightest clue about underserved communities or the systemic health equity problems that a doc-in-a-box can’t overcome.

Other

The Guardian reports that a hospital in Malawi saw stillbirths and neonatal deaths drop by 82% three years after implementing AI-powered fetal monitoring software. Just 10% of the hospital’s delivery doctors have been trained to perform traditional electronic monitoring, so the software automatically alerts them of potential problems. The perinatal solution was donated by PeriGen in collaboration with the global women’s health program of Texas Children’s Hospital.

A HLTH conference expert AI panel unanimously suggests that health systems resist the trend of hiring a chief AI officer. Baptist Health Medical Group CMIO  Brett Oliver, MD believes that organizations need to raise their AI literacy before putting someone in that role, which might send the message that only that person is responsible for AI deployment. His group established a broad AI oversight committee to create a governance structure.

I ran across this magazine cover from 100 years ago, which is even more notably prescient given that TV itself wasn’t invented until a couple of years later. Editor Hugo Gernsback also predicted the next year the use of the “teledactyl,” a feel-at-a-distance device that he described as, “The doctor manipulates his controls, which are then manipulated at the patient’s room in exactly the same manner. The doctor sees what is going on in the patient’s room by means of a television screen.” Gernsback created science fiction as a genre right after this issue ran with his launch of Amazing Stories magazine. Smithsonian Magazine’s 2012 story about him, which features fascinating illustrations, is worth a look for sure.

Sponsor Updates

• Healthcare IT Leaders sponsors the Third Annual Golf Classic benefiting the Florida Cancer Specialists & Research Institute Foundation.
• PerfectServe integrates Five9’s customer experience platform and Intelligent Virtual Agent technology with its Operator Console for improved contact center operations.
• Tegria publishes a new case study, “Automated Estimates Increase Accuracy and Transparency.”
• King Abdullah Medical City Makkah in Saudi Arabia upgrades its EHR to the latest version of InterSystems TrakCare.
• Nordic and Benevolence Health partner to support healthcare organizations with the new CMS TEAM bundled payment model.
• Rhapsody publishes a new customer story, “Axia Women’s Health saved $300,000, replacing a standalone API engine with Rhapsody Corepoint.”
• Surescripts offers a new whitepaper, “The Current Landscape of Pharmacy Interoperability.”
• Visage hires Victoria Hibbits as executive enterprise sales director.
• WellSky publishes a new case study, “Client value: The story behind $2M in recovered aged receivables.”

Blog Posts

• Lessons learned from operating Medicare Advantage Clinics (MACs) (Notable)
• The Power of AI: Fueling Organizations and Elevating People Part II (Netsmart)
• 3 Ways to Manage Your Data Like an Asset With the ServiceNow Platform (Optimum Healthcare IT)
• Transforming Healthcare with AI: Current Innovations and Future Opportunities (PerfectServe)
• Financial Benefits of Optimized Cardiology Scheduling: Reducing Costs with Efficient Utilization (QGenda)
• Top 6 States for Travel Nursing in 2024 (SnapCare)
• 5 Conversations on QHINs and the National Data Exchange Framework (Surescripts)
• Operations: The Power of Revenue Cycle Management Automation (TruBridge)
• Revenue cycle 101: AI + generative AI in healthcare payments (Waystar)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
Send news or rumors.
Follow on X, Bluesky, and LinkedIn.
Contact us.

Morning Headlines 12/6/24

Cleerly raises $106M from Insight Partners for AI heart health early detection

AI-powered cardiovascular imaging company Cleerly raises $106 million in its latest funding round.

An HHS OIG analysis of simulated cyberattacks finds that the IT system of the of the Organ Procurement and Transplantation Network

The HHS Office of Inspector General recommends that the federal Organ Procurement and Transplantation Network ramp up cybersecurity efforts after simulated cyberattacks uncover 22 vulnerabilities within its IT system.

Schneider Hospital Reports Second “Cybersecurity Incident” This Year

Schneider Regional Medical Center in St. Thomas, USVI, deals with a cybersecurity attack discovered over the weekend, its second in six months.

News 12/6/24

Top News

Apple CEO Tim Cook repeats his previous assertion that health apps will define the company’s legacy.

Cook says in an excellent Wired interview that enabling AirPods as hearing aids for moderate hearing loss is “the democratization of health.”

He summarizes that Apple is “pouring all of ourselves” into health, such as real-time biometric data analysis.

HIStalk Announcements and Requests

Two former HIStalk sponsors rejoined the fold this week, in both cases because employee turnover had left them unaware that they had unintentionally departed in the first place. Other potential prodigal sons and potential new sponsors can contact me directly and I’ll either answer your inquiry myself or send you over to Lorre. I can also confirm your sponsorship status if you aren’t sure.

Listening: Teenage Fanclub and 311, both of which having been playing guitar rock for 25 years. I discovered them from my recent infatuation with REM and my request to ChatGPT to find other bands that I would like. I’ve been watching REM concert videos for at least a half hour every night to catch up on their body of work, from which I note the contributions of retired drummer Bill Berry (he played multiple instruments and added another layer of harmony with Mike Mills in addition to orchestral drumming), replacement drummer Bill Rieflin (he died in 2020 at 59), and “fifth member” Scott McCaughey (I can’t get enough of his licks in the live version of one of my favorite REM songs “Supernatural Superserious,” which also has a fine contribution by Rieflin). My favorite concert video is from an appearance in Athens, Greece, although they did a great show at the other Athens in Georgia at the 40-Watt Club. I would choose REM as the best rock band in American history, perhaps nostalgically since now the “band” concept is passé in favor of computers, collaborations, and outsourced songwriting.

If you attended the ASTP annual meeting in person this week, let me know what you thought was important or interesting. They livestreamed it, but the hallway conversations are the good stuff.

Reader Vicki’s generous donation on Giving Tuesday allowed me to stack up a bunch of matching funds, including the matching money that was donated by my Anonymous Vendor Executive, to fully fund these Donors Choose teacher needs:

• Whiteboards and equation solving supplies for Ms. D’s middle school class in Kerens, TX.
• Headphones for Ms. G’s elementary school class in Pharr, TX.
• Math learning tools for Ms. C’s elementary school class in Brooklyn, NY.
• STEM learning kits for Ms. C’s elementary school class in Chino, CA.
• Geometric transformation supplies for Ms. S’s middle school class in Chicago, IL.
• STEM kits for Ms. B’s kindergarten class in Sacramento, CA.
• Headphones for Ms. N’s elementary school class in Greensboro, NC.
• Podcasting equipment for Ms. P’s high school Podcast News class in Santa Rosa, NM.
• Headphones for Ms. J’s elementary school English as a Second Language class in Fridley, MN.
• A printer for college applications for Ms. N’s high school class in Hollywood, FL.
• Motivation awards for Ms. S’s elementary school class in Ontario, CA.
• Research project tools for Ms. P’s middle school class in New York, NY.

Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present or promote your own.

Acquisitions, Funding, Business, and Stock

Black Book Research lists nine countries that its expert panel says are poised for significant EHR adoption in 2025.

Aya Healthcare, which operates a travel nurse staffing service and job-matching website, will acquire staffing company Cross Country Healthcare for $615 million in cash.

Marketing firm Supreme Group acquires health tech and life sciences PR and marketing agency Amendola Communications. Amendola will keep its name and founder Jodi Amendola will remain as president. I interviewed her a month ago.

Publicly traded Embecta, which earned FDA clearance for its first insulin patch pump in September with plans to add a dosing algorithm, will lay off 118 employees and end that program to focus on its core business of making pen needles and insulin syringes.

Sales

• Moorfields Eye Hospital NHS Foundation Trust will implement Meditech Expanse.

People

Frank Forte, MBA (Anatomy_IT) joins EnableComp as CEO.

Chris Paton, DPhil, MBA is named editor in chief of BMJ Digital Health & AI.

Retired Vanderbilt informatics professor and health tech pioneer Edward Shultz, MD, MS died last week at 76.

Announcements and Implementations

ECRI names the use of AI in healthcare as the most significant health technology hazard for 2025. The patient safety non-profit emphasizes the need to balance innovation with privacy and safety.

Vanderbilt University Medical Center’s IT department goes live on alert tool that can send messages directly to the computer displays of employees who will be affected by upcoming changes. The software is from Lakeside.

University of Central Florida offers students in its Health Informatics and Information Management BS degree program training on Epic, with materials and a simulated environment provided by Orlando Health.

The Joint Commission recognizes Inova as the first health system to earn its voluntary Responsible Use of Health Data certification.

Government and Politics

The Indian Health Service becomes the first federal health agency to go live on TEFCA, selecting EHealth Exchange as it designated QHIN.

FDA publishes recommendations for a smoother process for manufacturers to update their AI-enabled devices.

ASTP issues its first AI contract to Audacious Inquiry, a PointClickCare company, for technology to improve efficiency in its core areas. The reasoning behind using the technology of a care collaboration company to automate back-office government processes wasn’t stated.

Privacy and Security

Mount Nittany Health offers to pay $1.8 million to settle a lawsuit over its use of pixel tracking software on its website and patient portal.

Kevin Holland dives into Meta policy changes that will affect healthcare and health tech advertisers, as the company will restrict tracking of form fills and retargeting based on medical information starting in January. He concludes that condition-specific products or marketing campaigns will face significant restrictions and that direct conversation tracking will disappear as a campaign metric.

The Sequoia Project publishes a free Information Blocking Rule educational toolkit.

Three-hospital PIH Health takes its systems, network, and phone system offline following a ransomware attack Sunday.

In England, two NHS trusts continue their restoration of systems following ransomware attacks.

Other

Only mildly health tech related, but eye-catching as a societal observer. A 22-year-old OnlyFans model earns Internet scorn after sharing a TikTok of herself in the hospital room of her 85-year-old boyfriend, dancing and joking about speeding up her inheritance. She describes their relationship as, “He takes me to Cartier, I take him to pound town.” Meanwhile, a fellow OnlyFans adult content creator has made $43 million so far this year, leading me to ponder society’s valuation of a 20-year-old — who claims that she is a devout Christian and a virgin, which I can see would draw a certain demographic whether accurate or not — as equal to a couple of hundred doctors. She says that one smitten follower has made it rain nearly $5 million for her in the past few months.

Sponsor Updates

• Healthmonix team members support Ann’s Heart in Phoenixville, PA.
• Agfa HealthCare integrates Rad AI’s reporting and FHIRcast solutions with its enterprise imaging platform.
• Meditech Alliance triples its membership to 37 solution members whose products complement, enhance, or extend Expanse.
• FindHelp welcomes CenCal Health, Maryland Physicians Care, BronxCare Health System, and Central Iowa Shelter & Services to its network.
• Commure’s Augmedix achieves Oracle Validated Integration with Industry Healthcare Expertise for its full suite.
• Five9 announces that SVP Jake Butterbaugh has been named a Channel Futures Top UC/Contact Center Leader for 2024.
• Fortified Health Security names William Hicks EOD security engineer.

Blog Posts

• EClinicalWorks: The One-Stop Solution for Cutting-Edge AI Tools (EClinicalWorks)
• Understanding the Claims Lifecycle: A Step-by-Step Guide (FinThrive)
• Congratulations To HCTec’s 2024 Accelerate Graduates (HCTec)
• The Importance of Integrating Workday with Your Hospital or Health System’s EHR (Impact Advisors)
• Harnessing data to address SDOH and improve health equity (Meditech)
• Current State of Healthcare IT Staffing: Navigating Persistent Challenges (Med Tech Solutions)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
Send news or rumors.
Follow on X, Bluesky, and LinkedIn.
Contact us.

EPtalk by Dr. Jayne 12/5/24

It’s that time of year, with cybersecurity firm NordPass releasing its annual list of most used passwords. Topping the Hall of Shame list this year: secret, 123456, password, qwerty123, qwerty1, 123456789, password1, 12345678, 12345, and abc123. I didn’t have to scan too much farther down the list to find ones that were more interesting: iloveyou, baseball, princess, football, monkey, and sunshine all ranked within the top 20.

Come on, people, it’s not that hard to have at least a minimally secure password. The list can be sorted by country, and some of the international options are a bit more entertaining: liverpool, arsenal, and chelsea were popular in the UK, but hockey made the list in Canada.

From Cheer Mom: “Re: prescription drug fraud. Wise advice from Mr. H on physicians remaining vigilant around prescription drug fraud. One of our hospital’s providers recently discovered that his DEA number had been used for a number of fraudulent prescriptions for controlled substances. Too bad the patient in question was another provider at the hospital, who had been calling in her own prescriptions under her colleague’s name. The pharmacy didn’t catch the fact that the alleged prescribing physician sent every single prescription using electronic prescribing except for those called in for one single patient.” As someone who has had fraud committed against their DEA number, it’s a terrible thing when it happens. With the widespread adoption of electronic prescribing, it still amazes me that some states still permit certain levels of controlled substances to be phoned in.

A friend sent me this article from JAMA Network Open and asked my opinion on it since I’ve worked in telehealth for quite some time. It’s an original research article and looks at the rates of so-called low-value care services in primary care practices that use telehealth. The authors looked at care performed between January 2019 and December 2022 and used Medicare fee-for-service claims data for practices in Michigan. Practices were stratified as low, medium, or high users of telehealth and the low-value services were grouped as office-based, laboratory-based, imaging-based, and mixed-modality services. Over 577,000 patients were represented in the claims. Some of the low-value services avoided during telehealth visits included cervical cancer screening, PSA testing, and thyroid testing for patient groups where those tests were not indicated.

Non-clinical readers may ask why these services are considered low-value since at least some of them are marketed as potentially life-saving. In reality, it all depends on the patient, their age, and their risk factors as to whether the tests should be done. Sometimes physicians get in the habit of ordering tests across the board even when they’re not truly indicated, which makes them low value since they provide little to no clinical benefit for patients and can even cause harm or unnecessary follow-up testing. Since they require a physical exam or a blood draw, you can’t exactly conduct them during a telehealth visit, and doing so would require either a follow up-visit in office or a trip to the lab.

The authors found that practices that had high telehealth use had lower rates of low-value services performed in the office. There was no association between telehealth use and other low-value services that were not performed in the office. They concluded that, “our findings suggest the potential for telehealth to help reduce office-based low-value care and could reassure policymakers concerned about telehealth encouraging unnecessary or wasteful care due to added convenience.” One of the limitations of the study is the time period during which it was performed, which overlapped the worst parts of the COVID pandemic, when in-person visits were down across the board simply because primary care offices were closed. It would be interesting to perform a follow up on years post 2022 as well as to look at data from various parts of the country, to determine whether the results hold across time and place.

Still, I look at my own recent visit to my primary care physician. Except for a blood draw, it could have been performed via telehealth. The majority of the visit was spent discussing data gathered from home monitoring devices and updating the physician on a recent visit to a subspecialist who is not on the same EHR and who didn’t send a copy of their visit note. The blood draw wasn’t time sensitive and could have been easily done the next day since I would have to drive past the lab on a planned errand. For the labs that were ordered, it would have been easy for my physician to order a broad spectrum of labs, but fortunately he practices evidence-based medicine and only ordered the ones for which I was truly due. But for every physician who practices like that, there are twice as many who just order larger laboratory panels to “cover everything.”

There is still plenty of low-value care being performed, whether via telehealth or in-person visits. Antibiotics for viral illnesses are at the top of my list, and likely the lists of anyone who has ever worked in a primary care, urgent care, or telehealth urgent care setting during the three days leading up to Thanksgiving in the US. The number of patients who are presenting with what are almost certainly viral upper respiratory infections but who are simply seeking antibiotics is staggering. They come in with requests like, “I just want to get ahead of this because I’m having 20 people for dinner on Thursday” or “I just know this is going to turn into a sinus infection” and often haven’t tried any home care or over the counter remedies.

Frankly, writing an antibiotic prescription is a lot easier than a 20-minute conversation on why antibiotics aren’t indicated and how they can even cause harm, so you can guess how those visits often turn out, especially in practice settings where physicians are graded on patient satisfaction. I’d love to see a national public health campaign on appropriate use of antibiotics and why you don’t need to throw them at a common cold, but I don’t see that coming any time soon.

Like Mr. H, I’m migrating to Bluesky. You can find me there as @Jaynehistalkmd.bsky.social, although I’m slow to get started. I haven’t been much of a user of the platform formerly known as Twitter since its change of ownership, so maybe 2025 will be my year for returning to social media. I’m following Mr. H’s tip sheet for making the transition and looking forward to scrolling again with a more curated feed and hopefully fewer distractions.

A recent article published in Nature Communications looks at the effectiveness of an artificial intelligence system for matching patients with relevant clinical trials. Researchers from the University of Illinois and the National Institutes of Health have developed a solution called TrialGPT that was 87% accurate in matching patients with clinical trial eligibility criteria, which isn’t terribly far off from the performance level of humans. The study was limited by the fact that the system looks at written patient summaries versus lab values and imaging results, but I imagine it wouldn’t take too much work to bring structured data into the mix. I recently enrolled in a clinical trial that I only found out about through a tangential reference from one of my clinicians. It won’t yield results for five to 10 years, so it would be interesting to see what else I might be eligible for.

Have you ever participated in a clinical trial? Was there a technology component or did it involve manual data collection? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 12/5/24

Artificial intelligence tops 2025 health technology hazards list

Non-profit healthcare safety group ECRI names AI as its top healthcare technology hazard for 2025.

Ransomware virus attack on PIH Health leads to network shutdown for hospitals in Downey, LA, Whittier

A ransomware attack first detected on Sunday forces PIH Health (CA) to take its IT systems offline and revert to downtime procedures

First Federal Health Agency Joins TEFCA, Selecting eHealth Exchange as its QHIN

The Indian Health Service adopts TEFCA and designates EHealth Exchange as its QHIN.

Healthcare AI News 12/4/24

News

Non-profit healthcare safety group ECRI names AI as its top healthcare technology hazard for 2025. Organization President and CEO Marcus Schabacker, MD, PhD said in the list’s announcement, “Balancing innovation in AI with privacy and safety will be one of the most difficult, and most defining, endeavors of modern medicine.”

Withings and the government of France launch Project DEEP, which will use AI and non-invasive medical device innovation to detect and prevent cardiometabolic diseases, with a $23 million investment.

Business

AI and precision medicine technology vendor Tempus will work with Northwestern Medicine to explore the use of AI in clinical care and research. Their first project involves cardiology, where the health system has deployed the company’s algorithm that helps physicians identify patients who may have a one-year risk of atrial fibrillation / flutter. The Tempus ECG-AF algorithm received FDA’s 510(k) clearance in June 2024.

Spectral AI completes its analysis of burn center images that will be used to train its AI-powered DeepView System for predicting wound healing outcomes.

Research

New York University Langone Health analyzes use of its private instance of ChatGPT by its employees, of whom 1,000 applied for access in a six-month period. Clinical and research users represented half of those requests, with the most common uses being writing, editing, summarizing, analyzing data, searching for new information, and generating ideas. Examples include creating teaching materials, drafting email responses, generating job descriptions, assessing clinical reasoning documentation, and translating SQL queries. Some users reported that they struggled to create prompts and saw occasional hallucinations.

Other

Politico reports that leading house Republications want HHS to end participation in non-government AI oversight groups, specifically the Coalition for Health AI. The lawmakers said in a letter to HHS that they are concerned about having ASTP’s Micky Tripathi serve as a CHAI board observer, stating that, “help us understand how putting the organization directly in control of market entry for innovative technologies does not represent a significant conflict of interest.”

A Brookings Institution report says that use of AI in healthcare could reduce the annual US budget deficit by 20% while expanding access. The analysts, who point out that every US industry except healthcare has improved productivity in the past 50 years, say that AI could help by automating appointment scheduling, patient flow management, and preliminary data analysis. They also predict that AI could improve preventative care and disease detection.

A developer creates They See Your Photos, which allows anyone to upload a photo to see the private information Google can glean from it. I sent it a HIMSS conference photo that it analyzed well, including a note that “many people are looking down at their mobile devices.”

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
Send news or rumors.
Follow on X, Bluesky, and LinkedIn.
Contact us.

Readers Write: The Future State of AI and Automation in the Revenue Cycle

The Future State of AI and Automation in the Revenue Cycle
By Patrice Wolfe

Patrice Wolfe, MBA is CEO of AGS Health.

Like many heavily regulated industries, healthcare has seen limited progress towards the use of artificial intelligence (AI) and automation, despite the enormous potential they hold for improving productivity, accuracy, care access, and the bottom line. Much of that promise comes from use cases that span the revenue cycle management (RCM) continuum, where legacy automation tools are already having a positive impact through activities like patient reminders, insurance verification, coding, and claims status transactions.

Today, generative AI (GenAI) is poised to upend, in a positive way, healthcare’s approach to front- and back-end financial operations. It has the potential to re-imagine the massive volumes of historical and real-time revenue-related data that is flowing through RCM departments and create entirely new approaches to optimize revenue and minimize financial risk.

AI is an advanced set of tools run by algorithms that use data to simulate human intelligence. GenAI takes things several steps further by leveraging that same data to not only tell the story of what it sees, but to also create entirely new, more effective approaches to RCM.

Already present in many RCM functions, AI and automation represent a continuum of capabilities that can be broken down into four major categories:

• Basic. Rules-based processes for repetitive tasks that typically follow pre-defined instructions without exceptions. Examples include a claim status or transaction query submitted by a provider using a basic bot or ANSI transaction that returns a response based on a predefined set of values.
• Advanced. Leverages more complex algorithms and machine learning to make predictions based on past performance, which allows for proactive intervention based on those probabilities. For example, a machine learning model may be able to identify claims that are likely to be denied and can be corrected before being submitted to the payer.
• Intelligent. Here is where AI enters the continuum with the addition of natural language processing (NLP) that uses unstructured data and human-like reasoning to process ambiguity. An example in RCM would be the use of machine learning, deep learning, and NLP models that recommend “next best actions” to prevent denials from even happening in the first place.
• GenAI. Uses neural networking and large language models (LLMs) with deep learning and other techniques to automate design and do complex problem solving, often aided by visual and written materials. An example would be a human-like chatbot that negotiates with payers to reverse claim denials using the clinician’s notes and imaging studies to develop an argument complete with appropriate medical terminology.

While healthcare remains in the early stages of the AI continuum, more complex and sophisticated Intelligent and GenAI use cases are on the horizon.

While all eyes are on GenAI, earlier-stage AI and automation is already impacting RCM outcomes and efficiencies. Meanwhile, ample opportunity exists to further influence RCM as capabilities grow. In fact, just as AI and automation fall on a continuum, so too do the RCM processes and workflows that can be boosted by their adoption.

Scheduling and Registration

Legacy automation has a stronghold in scheduling and registration with the use of basics like automated patient reminders now nearly ubiquitous among healthcare organizations. Looking toward the future, scheduling chat bots, integrated scheduling across care sites and clinical specialties, and comprehensive scheduling packages for patients that include cost estimates are high-priority investments for their potential to reduce patient friction, enhance the patient experience, and make a provider “stickier” by strengthening the provider-patient bond and improving patient retention.

Patient Access

Insurance and benefit verification are already close to fully automated. RCM’s holy grail of future automation use cases is prior authorization, particularly as payers build more complex and ever-changing policy requirements for prior auth. AI can help manage the prior auth process, maximize the probability of approval, and automate the appeals process if an authorization is denied. The challenge is the enormous amount of information that is required from both providers and payers who have little incentive to be transparent with those details.

Coding/HIM

Computer-assisted coding (CAC) enjoys broad adoption for inpatient coding and billing, delivering reported productivity gains of 10% to 30% for hospitals. Computer-assisted professional coding (CAPC) is beginning to make inroads on the professional side. Future use cases include autonomous coding, which has limited use in a handful of specialties due to the significant amounts of data needed to properly train the specialty-specific LLMs. Early work is also underway around ambient charting, which converts voice dictation into coding and promises to save physicians up to 4.5 minutes per chart by some estimates.

Patient Financial Services

As with prior authorization, AI and automation adoption in patient financial services is influenced by increasingly aggressive payer policies around denials, delays, and underpayments. There is enormous potential for streamlining collection workflows, including touchless A/R. Other promising areas are automated denials management and the movement to a reduced friction patient experience.

Clinical Services

Though farther behind other stops on the RCM continuum, future AI and automation use cases within clinical services include real-time patient status monitoring in utilization management (UM) to ensure accurate reimbursement. Other potential applications include professional fee UM and automated clinical documentation integrity (CDI) that uses NLP and other advanced tools.

Revenue Integrity

Also behind the adoption curve, revenue integrity AI and automation use cases include charge master maintenance, late charge identification, and coding/billing compliance audits. AI and automation are also used to proactively identify and resolve problem areas.

Healthcare has taken a cautious approach to adopting GenAI and other advanced forms of AI and automation within RCM, due in part to the industry’s necessarily risk-averse nature. Also at play are the complexities that are involved with adapting critical workflows to advanced AI and the need to balance the application of limited resources between multiple and sometimes conflicting strategic priorities.

For example, while advancements like ambient documentation are crowd pleasers that promise to deliver improvements in physician productivity and satisfaction, they won’t necessarily improve the completeness of clinical documentation. As such, CDI will remain a critical part of the RCM process.

The reality is that while GenAI and its AI peers hold great promise for optimizing RCM, these technologies can be expensive to use, staff, and support. Health systems and other provider organizations will have to place bets with scarce resources, and it’s more likely that AI use cases that improve physician and patient satisfaction will come out on top.

GenAI and advanced automation also require close collaboration between operating departments like RCM and their IT colleagues to create and test APIs, move/share data between systems, and access datasets to test predictive models and train LLMs and other advanced AI models. This collaboration may be hampered by information and data silos that were created by legacy technologies. This also impacts the opportunity to leverage AI and automation to create a seamless patient experience, which requires integration across multiple settings of care, systems of record, and data siloes.

As GenAI and other advanced automation solutions continue to deliver on their promise, the impact on healthcare RCM has the potential to be transformational. They also have the potential to reduce the challenges that are confronting providers across the RCM continuum, while streamlining patient access, increasing coding and billing accuracy, improving utilization management, and speeding the revenue cycle.

When the productivity and accuracy promises are fully realized, investing in GenAI and its predecessors becomes a true win for the entire healthcare industry.