Brian Picchi MHA, MIS

To follow up on Dede Ainbinder recent post: If we use the current EHR data to build a AI clinical decision support tool it is unlikely to capture our clinical decision making process. EHR's are inherently designed to maximize billing and minimize risk of litigation. A clinical decision support tool based on this data will likely do the same. There is a large sunken cost fallacy here where we continue to hang on to garbage data. Just because the data gathering and storage process was capital and time intensive doesnt mean the data is valuable. To truly capture the clinical decision process we need to capture data which sits outside billing and litigation. Its hard to imagine a future where this data isnt used for billing and cannot be called upon during litigation. #EHR #healthdata #clinicaldecision

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Because AI is fueled by large volumes of data, HI professionals are positioned to take the helm as ethical stewards as tools are developed and deployed. https://lnkd.in/ebzrpHMw

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A regulation is nothing more than entranchment of error into a system. CON laws? Administrative regulatory bodies? Value systems decided in closed door sessions? Healthcare has so much entrenched error it has limited innovation. Is this by design? Wanna see the $2 imaging exam? The $.35 cancer drug…remove entrenched error.

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Wow, another week, another bombshell of an HHS-rule. In my HTI-2 write-up I noted that while that rule expanded certification criteria to include functionalities of payer software and public health software, it remained voluntary: "Only EHR developers really have a regulatory reason (via the CMS Promoting Interoperability and MIPS programs) to feel that they must certify their software in order to help their customers. Without the CDC or CMS giving public health and payer software vendors a reason to certify, many may avoid that, especially since that certification would bring them under information blocking provisions." Similar, in the full HTI-2 thread (https://lnkd.in/g_8Ape3x), I said: "HTI-2 really gives off a "we think CDC is going to put out a rule to incentivize public health agencies and we're getting ready for it" vibe." Looks like ONC isn't waiting for CMS and CDC. This new rule (which is actually a collaboration coming out of HHS’ Office of the Assistant Secretary of Financial Resources (ASFR)) now means all grantees or programs with a connection to HHS funding have to use certified programs or, where certification doesn't cover things, at least adhere to ONC standards. One example - the CMS contracts with Medicare Advantage plans. These contracts will now need to include stipulations for certified tech / use of standards. This means vendors like Edifecs, Cognizant, 1upHealth, Inc. and others will be required to certify. This certification will pull them into information blocking provisions (although payers themselves would not be actors unless they make the certified health IT). This is a big deal that I fully expect people to push back on. Assuming it's legal and within the authority of the HHS (which is the big question), I do think it's a good idea. As Flexpa and I noted in the spring's State of Patient Access APIs report, payers and their vendors largely failed to implement the CMS mandated APIs when left to their own devices. This resolves that and makes the standards...standard. https://lnkd.in/gMgSdBhT

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This is an interesting article because EHR companies, like Epic and Oracle's Cerner, have made siloing data a major part of their business model. Overall, I like EPIC’s ability to review records from other EPIC shops. It also has a nod to interoperability with its “Care Everywhere“ feature. However, this is often a disorganized and outdated collection of information. Using it requires a ninja level of both tech expertise and medical knowledge possessed mainly by younger physicians and chief residents. I am a fan (and advisor) of companies like Zus Health focused on user-friendly, comprehensive, and up-to-date interoperable health care data tools.

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Elon Musk’s xAI, Which Just Raised $6 Billion, Has Significant Potential To Disrupt Healthcare via Sai Balasubramanian, M.D., J.D. "The most obvious entry point for xAI is similar to what other large, technology companies are attempting to do: increase task automation, improve clinical workflows, and optimize clinician productivity. Technology giants are investing billions of dollars creating and training foundation models so that they can easily fit into the day-to-day healthcare workflow."

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Oracle Health announced plans to launch a next-generation EHR platform in 2025, incorporating advanced cloud and AI capabilities. This new EHR will feature Oracle's clinical AI agent, voice-activated navigation, and Health Data Intelligence, which integrates patient data from over 300 sources to enhance clinical workflows and improve patient outcomes. The platform aims to replace traditional EHRs, which often dictate rigid workflows, with a more dynamic system that allows for personalized care plans. Oracle Health emphasizes that the new EHR is a complete reinvention rather than an upgrade of the previous Cerner system. Additionally, Oracle plans to become a Qualified Health Information Network to facilitate standardized data sharing across the healthcare ecosystem. Executives at Oracle also unveiled new cloud applications to improve patient management and streamline front-office operations, reinforcing the company's commitment to enhancing healthcare accessibility and data utility while addressing interoperability challenges in the industry.

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Somewhat predictably, the headlines of Epic's UGM were mostly focused on AI. In my mind, the ones to focus on got buried as footnotes. Products leveraging Epic's position as the dominant inpatient EHR and selling differentiated products as a wedge into new markets (mostly under Health Grid) should frighten other healthcare vendors more than the AI arms race (which they'll largely win as the default option): - Payer Platform: A Health Grid product for payers. This was decently well covered, but that's because it's a mature product at this point. A lot of outlets covered it as if it was net new, but it was launched in 2019. The most noteworthy piece is Judy's quote saying they’re investigating submitting claims directly through Epic so you don’t need a clearinghouse - this represents a threat to clearinghouses and could represent the expansion from Payer Platform as a beachhead to attack incumbent SaaS, claims processing systems. - Epic Aura (labs): This is a Health Grid product for labs. This was launched previously. I don't see any announcements, but this is a beachhead for Epic to sell to labs that have or built their own LIS, allowing them to eventually replace it over time (or at least have all major labs as customers). This threatens existing LISes even more than Epic's LIS product, Beaker. They also announced a planned Blood Bank module, which increases their appeal as an all-encompassing LIS in this push. - Epic Aura (medical devices): A new sub-category of Aura (and Health Grid) for expanding into medical devices. I was waiting to see if they'd launch a separate category for medical devices or reuse Aura. First devices are cardiac arrhythmia and CGM. This threatens businesses like Redox to some degree. - Per Healthcare IT today, "Judy said they’re working on better surgical device manufacture planning leveraging the Epic schedule." This sounds like further expansion of Aura/Health Grid to surgical supply manufacturers. - I was surprised to not hear any updates about Discovery, Epic's Health Grid program for pharma. I'm curious what shape that will take. - I thought the use of the state of Washington + the Garden Plot model is a smart distribution play. Garden Plot has existed since at least 2022, but using a state for distribution to get to new markets that Epic struggles to sell to (small clinics, behavioral health clinics, correctional medical facilities and tribal facilities) is again another example of their expansionary mode. Health Grid products will be more impactful than the Vendor Services rat races or AI wars. It's worth paying attention to and taking advantage of: https://lnkd.in/gimisDzZ

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As Epic Systems faces a new challenge in the healthcare EHR market, Particle Health has filed a lawsuit accusing the industry giant of unlawfully restricting access to U.S. medical records. The lawsuit, lodged in the U.S. District Court for the Southern District of New York, alleges Epic of anticompetitive practices. Particle Health claims that Epic is leveraging its market dominance to hinder competition and constrain the flow of patient data. Key points from the lawsuit include: - Particle Health filed a lawsuit against Epic Systems on Sept. 23, accusing the company of intentionally impeding its competitor's platform in violation of U.S. antitrust laws. - The lawsuit alleges that Epic is directing clients away from Particle Health's "payer" software, designed to enable health plans to retrieve and leverage medical records stored within Epic's system. - Particle Health argues that Epic asserts control over health data for up to 94% of the U.S. population. Epic Systems has refuted the claims made by Particle Health, dismissing the lawsuit as groundless. Stay informed as this legal battle unfolds in the healthcare tech industry.

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Here’s your recap of last week’s health IT news 🏥 💻 🗞️ 👇 Product updates 👩🏼‍💻 • Augmedix announced public availability of Augmedix Go, their gen AI documentation product, for Emergency Departments.    • Forcura released AI referral summaries for the post-acute market.    • UTM Healthcare and FirstHx are teaming up to provide more robust medical histories.    • AI phone call tech company, Standard Practice, relaunched after pivoting from Nibble Health.    • Revenue cycle management platform, Ensemble Health Partners, is leveraging Microsoft Azure GenAI to enhance their service.    • MRO is extending its clinical data access tool to cover automatic retrieval of continuity of care requests.    • DrFirst, Inc. is partnering with PatchRx to improve medication adherence data. Notable partnerships 🤝 • Brigham and Women's Hospital partnered with FeelBetter to launch a study on the impact of their AI-based population health platform on polypharmacy patient management.    • Community Health Network selected Biofourmis for virtual and at-home care.    • Humana is extending its current use of prior authorizations platform, Cohere Health.    • Louisianan Community Health System deployed Retrieve Medical's Retrieve Dx Smart App to enhance documentation.    • Anne Arundel Dermatology will expand its current partnership with Relatient, adding Dash Schedule. Posts we enjoyed 👏 • Spencer Dorn’s reminder that more mature tech + good process is in many cases the better option than gen AI. (https://lnkd.in/eiK2DNfw) • Graham Walker, MD’s homegrown demo exploring the combination of clinically-informed text search + retrieval augmented generation (RAG) to enable better EHR note summaries. (https://lnkd.in/eDaqCh5H) --- Want to stay in the loop? Sign up for the Elion Briefing to get all of the latest healthcare tech news delivered to your inbox 📬 👉 https://bit.ly/49z6AUW

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This is an old news item, but still very relevant I think. I have noticed a lot of 'isolated incidents' happening around the country as a result of sub-optimal EPR implementations. This time last year, there was a news article that the U.S. Department of Veterans Affairs had got so fed up with its under-performing #EPR, that it had renegotiated its contract with the vendor to include penalties related to performance management, specifically reliability, responsiveness and interoperability. (I wonder if the new contract is publicly available Neil Evans, MD ?) While this is a $10Bn contract, UK trusts looking to contract with an EPR vendor should still try to include penalties for under performance, and most importantly, safety issues. Especially those that directly affect patients such as the one at Durham (https://lnkd.in/eyQePGip). https://lnkd.in/e6GC4HhC #patientsafety #digitalhealth #EHR #electronichealthrecord #EMR #clinicalsafety #humanfactors #implementationsafety Sam Shah Shane Tickell Simon Swift Adrian Byrne FBCS CHCIO Dr Temi Akitikori Dilshan Arawwawala Jenny Sutcliffe Stuart Harrison CEng FIET MIEEE Apira Ltd Alan Brown Mohammad Al-Ubaydli Masood Ahmed Dr Patrick Lester, PhD 🩺 Dr Gyles Morrison MBBS MSc Dr Penny Kechagioglou Helen Hughes Jonathan Hazan Kiran D Shetty Lisa Goldstone Patient Safety Learning

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EHR vendors, your APIs soon will be more important than your UI! 👇 Great tweet from Paul Graham where he talks about the future of AI doing the work for humans. And in healthcare, we see those signs everywhere: ✅ a whole flood of applications where AI takes notes for the doctors during the visit, extracts medical codes and updates patients profiles ✅ platforms where patients themselves look for available times, book, cancel, reschedule their appointments and get reminders about those ✅ 3rd-party apps where patients gather all their medical notes, lab results, vital params and all the other information about themselves This all happens outside of EHR's UI, purely via API integrations. Interoperability is not just a fancy word now, but something essential for a whole ecosystem to thrive, something that helps practitioners and patients. We know how to build integrations, and we encourage more EHRs out there to take a lead in building open APIs for a greater healthcare ecosystem!

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Very interesting, insightful study. Flare Capital Partners AI in healthcare is hype. Most AI stories for healthcare are tech advancements. Not real clinical advancements or fitting into their workflows, bearing few. MedTech Innovators face these paradox. 1.Adoption requires Evidence. But evidence comes only from adoption. Clinical data can not be synthetic data for good AI. 2.Regulatory, validation requires money. But investors require regulatory, validation. 3.MedTech need faster adoption, but healthcare is slower among every profession, a cut-throat industry. They won't use it, if it is more than 2-3 mouse clicks. https://lnkd.in/gUh8sDHe

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The piece focuses on how these vendors are developing #artificialintelligence tools. However, the data science is only a small part of the equation. You need to also focus on #dataquality, #interoperabilty and a easy path to elegant #usability. I believe Epic will come out on top but also hope that someone emerges as a viable competitor. I am afraid Oracle is slipping even further behind.

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💡 Will AI Agents Redefine SaaS—and Healthcare IT Along with It? Satya Nadella’s recent thoughts on AI transforming SaaS applications raise some compelling questions for healthcare IT. If AI agents can manage workflows, automate processes, and operate across systems, how might that reshape the way we deliver care and innovate? Imagine an AI-native healthcare application that doesn’t just support workflows but redefines them—matching patients to clinical trials, optimizing resource allocation, or even guiding decision-making for personalized care. But here’s the big question: Are we, as IT leaders, ready to rethink our architectures, data ecosystems, and strategies to embrace these possibilities? The potential is massive, but so are the challenges. What are your thoughts—are AI agents the next big leap for healthcare IT, or are we looking at incremental change? Let’s discuss. #AI #HealthcareInnovation #GenerativeAI #Leadership #FutureOfSaaS https://lnkd.in/g4vgBnhJ

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Your HPI isn’t informative—it’s a data dump. Here’s what’s killing it: ❌ Listing every single comorbidity ❌ Burying the chief complaint like it doesn’t matter. You’re drowning out the key details. Your HPI needs to tell a story, not confuse the reader. Write smarter: ✅ Focus on 3-4 relevant chronic conditions. ✅ Lead with the chief complaint—make it impossible to miss. ✅ Keep it brief and purposeful. Your future self (and every reader) will thank you. If you want to know how to write an efficient yet optimized HPI for both you and your patient, check out my 4 newsletters on the HPI: https://lnkd.in/gvwwpPyF

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Our first paper from the Society of Critical Care Medicine (SCCM) Discovery Panel on Data Sharing and Harmonization is available! "Critical Data for Critical Care: A Primer on Leveraging Electronic Health Record Data for Research From Society of Critical Care Medicine’s Panel on Data Sharing and Harmonization" This is the first of many that will be coming out from this two-year effort. Thanks to our lead author Smith Heavner, PhD, RN for doing much of the heavy lifting on this, and to our group leaders Gilles Clermont, Donna Lee Armaignac and with Tamara Al-Hakim M.D. who have done much of the critical cat wrangling, along with contributing. We have another manuscript in process and more on the way after that. This effort is serving as a template for how professional societies in different therapeutic areas can be considering the future with appropriate care. It is an honor to be part of this group. #criticalcare #medicine #technology #data #sharing #harmonization J Perren Cobb, MD Kenneth E. Remy, MD, MHSc, MSCI, FCCM Karin Reuter-Rice Melissa Haendel Yoram Vodovotz Ronald Poropatich, MD, MS Heather Leigh Flannery Chris Regan Sandy Barsky

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