Jeff Fuller, MS, FACHE

As I've continued to reflect on the recent Nashville Health Care Council Data and AI event, I found myself considering the intersection of data interoperability and the need to leverage healthcare data in a compliant way for AI to truly live up to its promise. At Integral, where we focus on automating regulated data compliance to enable collaboration and AI innovation, questions often arise about HCOs' data challenges, interoperability vs. collaboration, data quality impacts, and balancing innovation with risk. To gain some guiding thoughts on these topics, I phoned a friend Leigh McCormack, the co-founder and CEO of Platypus, and the former Data Science Lead for BlueCross BlueShield of Tennessee. Here's what she had to say: "Over the past decade, our progress in improving data quality for healthcare AI has been minimal, and we have significantly overlooked the importance of data collaboration. It's important to distinguish that collaboration goes beyond just interoperability. While interoperability focuses on the technical aspects of data sharing, primarily for operational needs, collaboration emphasizes the people and purpose behind utilizing that collective knowledge. As we work to overcome challenges in AI, data quality and interoperability remain crucial, but they can only take us so far. To truly advance, we must also adopt collaborative strategies and mindsets, allowing our foundational knowledge to evolve and enhancing our ability to use these technical tools for the benefit of the entire healthcare ecosystem." What are your thoughts on the evolving landscape of healthcare data, collaboration, and AI? #RegulatedData #DataInteroperability #DataQuality #DataCollaboration

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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 However, this is often a disorganized and outdated collection of information.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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The healthcare industry continues to see significant funding activity as companies prioritize innovation in analytics and benefit management solutions. These investments reflect the growing opportunities in healthcare data management and benefits innovation. Merative, the data and analytics company formed from IBM's Watson Health assets, secured $25M from Morgan Health. This funding will help scale its products and expand offerings for self-insured employers, focusing on enhanced data-driven insights. Meanwhile, Soda Health raised $50M in a Series B round to advance its work in managing Medicare Advantage supplemental benefits, simplifying administration, and improving member engagement for health plans.

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Here’s your recap of last week’s health IT news 🗞️ 👇 🤖 AI Clinician Assistant • Oracle Health announced the release of its AI-powered clinical digital assistant, which integrates “clinical automation, conversation-based note generation, and proposed clinical follow ups” directly within the EHR. • NextGen Healthcare released a version of their Ambient Assist designed for small practices, which includes Spanish support and specialty-specific workflows.    • Community Health Network has begun a multiyear Microsoft implementation including Nuance Communications Dragon Medical One and DAX Copilot. 🧑‍💻 Virtual and At-Home Care • Hackensack Meridian Health partnered with Medically Home to implement their hospital at home program. • Cleveland Clinic is integrating Masimo’s wearables in a new partnership focused on hospital-based RPM. • eVisit acquired UPMC Enterprises' inpatient teleconsult technology and an investment from UPMC’s innovation and investments arm as part of their $45M Series B funding. • PatchRx released an API-based tool allowing providers to sync data directly into their existing care platforms. 📊 Data & Analytics • Atropos Health added two new partners and a data scoring system to allow users to select the most appropriate datasets for their queries. • Xealth launched a metrics tool that allows customers to measure and track patient engagement with their digital health programs. 📋 Patient Administration • Fabric acquired MeMD from Walmart. 🔄 RCM • Inovalon joined MEDITECH’s interoperable product marketplace. • RevSpring released an update that integrates a lockbox solution for check processing within its existing payment platform. • Solventum Revenue Integrity (fka 3M Health Care) released its new AI CDI software powered by Sift Healthcare, Solventum Revenue Integrity System, which uses machine learning to predict denials before they happen. 🍎 VBC Data & Analytics • Arcadia acquired CareJourney leveraging their cost, quality, and benchmark data to enhance Arcadia’s data, analytics, and workflow tools. • Adventist Health selected The Garage In's population health management platform to support its VBC operation. 🧠 Food For Thought •  Coalition for Health AI (CHAI) released its draft standards guide for public comment. https://lnkd.in/eMUXGfvz • We really appreciated Daniel Yang, MD’s post about a recent article on the emergence of a new leadership role: the Chief Health AI Officer (CHAIO) https://lnkd.in/ejZxnJCj --- Reminder: you can sign up for the Elion Briefing to get the latest healthcare tech news delivered to your inbox each week 📬 👉 https://lnkd.in/e2UJ3ckP

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What day-to-day analytics inspire you? How could they be applied elsewhere? Analytics in healthcare have been underutilized. We invest so much effort to analyze data but fall short on maximizing the impact of our learnings. We need to better use insights in ways that end-user’s benefit. I often find myself looking at technologies in my day-to-day life thinking about how we could use these for inspiration. Here are some of my favorites: ☕ Based on my pods, my coffee machine recommends new brews I might be interested in. 🛍 My online shopping apps use my shopping history to alert me to items I may be interested in or need to replace. These also thoughtfully summarize reviews of other products I might be interested, making it easy to learn from other experiences. 🚗 My car app tracks and reminds me when to complete maintenance tasks so these don’t go overlooked. Share your favorites below!!

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Been reading a fair bit this week about the entrances of exits of large organizations in the healthcare technology sectors. To me, it keeps coming back to how healthcare is truly different from the typical private investment model of business and why those of us that have been in healthcare for decades keep saying that healthcare math "is different." Millions . . . no BILLIONS of dollars are being invested and lost in healthcare. Buildings built and empty. People hired and laid off. Companies stood up and folded. Service lines expanded, then shelved. All in search of the next big ROI. In the end - we care for people. Yes, we need to be capitalists and there is no mission without margin. But we need to keep patients and caregivers in the forefront of our decisions. Not profit and loss. Pick a service. Do it exceptionally well. Double and triple down on consumer, physician, and employee experience, be strategic and relentless in contracting for reimbursement for that service, and own that space. You will make money. You will make a difference.

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As promised here are my thoughts from Day 2 at the FDA's Digital Health Advisory Committee meeting on "Total Product Lifecycle Considerations for Generative-AI Enabled Devices." I have pretty much focused my thoughts on the talk and remarks presented by Dr. Keith J. Dreyer as he summarized it all very eloquently. He was truly inspiring! Here are my top 5 takeaways: 1️⃣ Continuous Clinical Validation is a Must: AI devices, especially in radiology, need ongoing validation to ensure they remain accurate and effective in real-world settings. 2️⃣ Regulating Generative AI for Patient Safety: There's a pressing need for clear regulations to guide the safe deployment of GenAI in healthcare, focusing on transparency and human oversight. 3️⃣ Expanding the FDA's Role: Keith emphasized that the FDA should look beyond manufacturers to include device users for better monitoring. As he put it, "We have to keep the data pristine to make sure these devices are working, independent of what the manufacturer makes." 4️⃣ Cost-Effective Monitoring Solutions: Recognizing that monitoring and validation can be costly, we need innovative solutions that make this feasible for all healthcare settings, big or small. 5️⃣ AI's Potential to Boost Efficiency: Generative AI could greatly enhance efficiency in radiology. Keith noted, "If there was a way to improve our efficiency through AI, and I think Gen AI has a way to be able to do that, then you're going to see availability, much broader availability of even specialists, to do more work and to work beyond the scope of what they can do today." I'm thrilled to be part of these vital conversations and can't wait to continue exploring how we can responsibly harness AI to transform healthcare! Here is the link to Dr. Keith J. Dreyer's talk: https://lnkd.in/gFisjcXW #GenerativeAI #AIinHealthcare #DigitalHealth FDA #PatientSafety #ClinicalValidation HOPPR American College of Radiology

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How can we leverage Patient Experiences to Drive Health and Care Outcomes? What is "Authentic" Value-Based Care? In our recent Health Data Management article, Rachel Biblow and I discuss transforming health and care delivery by prioritizing “authentic” value, which emphasizes patient experiences and health outcomes (in relationship to financial results). This approach requires healthcare providers to focus on what matters most to patients. Read the full article: https://lnkd.in/e7fQihgw Initial Steps to Drive Authentic Value: 🌟 Adopt a human-centered culture by prioritizing individual health needs and goals >> Partner with individuals across the health and care continuum to support progress toward achieving goals. Operationalize experiences that enable better outcomes. 🌟 Develop an integrated data strategy and utilization plan >> Implement tools to capture patient perspectives on health status and healthcare experiences, ensuring that care aligns with patient needs. Integrate data for continuous improvement through collection, analysis, and intentional change to transform experience and health outcomes. 🌟 Leverage technology innovations >> Adopt relevant digital tools, including, AI for personalized care, improved communication, and operational efficiency. Determine pragmatic applications of technology that enable outcomes that matter to patients. By focusing on these elements, health and care organizations can earn trust, strengthen partnerships, enhance health outcomes, and achieve a more sustainable system. ************ SIGN-UP: Free monthly digest:  “Transforming Health and Care Experiences with Research and Actionable-Insights" https://lnkd.in/eWG5XSEd ************ ATTEND: Patient Experience Symposium, Boston, Sept 16-18, 2024 https://lnkd.in/eNKSpJ8G ************ PUBLISH: in the Special Collection on "Exploring the Relationship between Patient Experience, Health Outcomes, and Value-based Care" https://lnkd.in/ew4gEgz7 (A Collaboration between Journal of Patient Experience and International Consortium for Health Outcomes Measurement (ICHOM) ************ #PatientExperience #PatientReportedOutcomes #PatientEngagement #HealthCareExperience #ClinicianEngagement #PREMs #PROMs #VBC #VBHC #ValueBasedHealthCare #ValueBasedCare

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had a number of "art of the possible" conversations with healthcare leaders and consultants this week, where the concept of the semantic layer came up. In healthcare, the **semantic data layer** is more than just a tech buzzword. it's become table stakes for any complex analytics work and one of the pillars of a composable data architecture. . By enabling seamless data integration across disparate systems, it ensures that data is not only accessible but also meaningful and actionable. This layer allows healthcare organizations to derive deeper insights, improve patient outcomes, and streamline operations. As we continue to harness the power of AI and big data, the semantic data layer becomes essential in translating raw data into valuable knowledge, ultimately driving the future of healthcare. #HealthcareInnovation #DataIntegration #AIinHealthcare #HealthTech

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Manually entering patient data into your EHR? Duncan McGillivary explores how AI is revolutionizing healthcare, offering solutions that break free from clunky EHRs and deliver more efficient workflows. Check out our latest #AnsaOpenSpaces. #healthcare #AI #EHR #clinicianempowerment

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The 2025 Vizient Trends Report is out! It highlights trends that will drive success: - Accelerating patient access - Leveraging pharmacy advancements - AI enhancements for decision-making - Optimizing Medicare Advantage strategies

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Fundamentally true. Healthcare analytics remains a black box or DYI endeavor for most organizations. Wellstack presents an industry first alternative, full stack, comprehensive solution for data aggregation, integration, and enterprise wide, high impact analytics outside of the EHR and any other transactional applications.

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Newgen Software for HealthCare Payers (P1) + Providers (P2) + Pharma (P3) via Partners (P4)   American HealthCare is both Compliance Centric and Care Outcome Focused. Ask CMS/HHS. No Debate. I am sure this is true across the globe from Regulator’s POV. Yes, in rapidly evolving healthcare landscape, achieving growth, compliance, and operational excellence requires innovative and flexible solutions. Partnering with Newgen Software (https://www.NewgenSoft.com), especially via Team Newgen Health, enables Payers (P1), Providers (P2), Pharma (P3), and Partners (P4) to leverage NewgenONE’s AI-powered, LowCode automation platform. This partnership empowers Global System Integrators (GSI / ISVs), Channel Partners, and Health focused Consulting firms to deliver scalable, tailored solutions for their end clients across Software products and platforms. Why Newgen Software? Newgen Software offers both horizontal platforms and vertical products, nuanced and designed specifically for healthcare firms, to accelerate time to market (GTM), ensure compliance, and drive automation at scale. Horizontal Offerings: NewgenONE Platform for Healthcare Payers + Providers + Pharma-LS firms + P4 1. Workflow Management (BPM) 2. Content Management 3. Communication Management Vertical Product Offerings: Tailored for Healthcare Payers and Health Plans & Health Insurance firms + P4 1. Provider Lifecycle Management (PLM): 2. Appeals & Grievances (A&G): Why Partner with Team Newgen Health? 1. GTM Acceleration: Team Newgen Health empowers partners to bring innovative solutions to market faster, leveraging a proven platform with AI-powered automation and LowCode capabilities. This enables partners to focus on tailored client solutions without the overhead of building foundational technologies. 2. Tailored Software Solutions: Newgen’s vertical products for Healthcare Payers (P1), Providers (P2), and Pharma (P3) combined with horizontal platforms offer comprehensive automation capabilities that can be rapidly adapted to any client’s needs, whether they are focused on claims management, patient care, or regulatory compliance. By partnering with Newgen Software and Team Newgen Health, GSI, Channel Partners, and Consulting firms can unlock powerful solutions for their healthcare clients, built on a platform that ensures compliance, accelerates time to market, and delivers unmatched automation through AI and Low Code innovation. Happy to provide nuanced Software to deliver your vision of Digital Health together. Contact us for a demo or to explore specific use cases.   Manish Jaiswal 646.644.3049 VP & Head – Newgen Health https://lnkd.in/enqMNcPX

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Clinicians need comprehensive patient information to deliver higher-quality care. But how can you unify data from multiple stakeholders?     For answers, look to Dr. Denise Hines, DHA, PMP, FHIMSS, executive director of the Georgia Health Information Network (GaHIN), the state’s nonprofit health information exchange.    Dr. Hines is that rare leader who connects the dots in healthcare. Her deep experience in health systems, physician offices, technology vendors, and state government has prepared her to transform healthcare in Georgia.    How?    She’s advancing healthcare connectivity by expanding the HIE’s focus beyond traditional provider data. Leveraging InterSystems HealthShare, the exchange links to state agency information, historical lab results, telehealth data, and social determinants of health data.    A clinician can consult a patient’s admission, discharge, and transfer history alongside their housing data — all in an effort to treat patients in a more holistic way that addresses their full spectrum of needs.    This is exactly the kind of use case that makes our work worthwhile. It shows how patients thrive when you combine interoperable data with advanced technology and an innovative mission to serve patients and communities. Thank you, Dr. Hines.    Where else have you seen interoperability make a difference, not just in healthcare, but where society as a whole benefitted?    #Healthcare #Interoperability #HEI

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McKinsey & Company emphasizes that adopting advanced technologies and patient-focused innovations will be critical for the healthcare industry to overcome challenges and drive growth in 2025. Key trends across four sectors—providers, payers, pharmacy services, and healthcare services and technology (HST)—include leveraging digital tools, enhancing operational efficiency, and aligning with patient-centered care. - Providers face workforce shortages, inflation, and financial pressures but can improve performance through generative AI and efficiency-focused investments, potentially saving $200B-$360B annually. Growth opportunities lie in ambulatory surgery centers and home health, expected to expand 7% annually through 2028. - Payers must tackle rising costs and regulatory hurdles by focusing on Medicare Advantage, Managed Medicaid, and innovative products like Individual Coverage Health Reimbursement Arrangements (ICHRAs), which are gaining adoption. Cost-reduction efforts using technology could save millions per $10B in revenue. - Inflation, labor shortages, and drug pricing challenges shape pharmacy services. Growth is driven by biosimilars, specialty drugs, and cell and gene therapies, with direct-to-consumer (DTC) models and integrated care offering innovative opportunities. - HST remains a high-growth sector fueled by demand for data, analytics, and AI tools. Companies must address interoperability and customer integration challenges while leveraging advanced technologies to create value.

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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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🔧 61% of healthcare leaders say enabling self-service through data analytics platforms is critical to their teams' productivity.  Arcadia’s CEO Michael Meucci discusses how AI is becoming the new form of self-service, empowering clinicians and staff. See the full study we conducted with HIMSS Market Insights: https://bit.ly/3TQfcS8 #AIinHealthcare #generativeai #dataanalytics

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Key Strategic Insights = A Successful OP CDI Program The challenge of value-based care starts with a collaborative approach, when launching an Outpatient Clinical Documentation Integrity (OP CDI) program. Here are some key strategic insights to success: 1. Engage with Population Health Understand Pain Points: Begin by understanding the specific challenges faced. This fosters collaboration. Tailored Questions: Use customized questions to facilitate productive discussions and ensure alignment with needs. 2. Effective Software Implementation Manage Patient (Pt.) Volumes: Implement software solutions to efficiently handle pt. volumes. OP CDI Calculator: Utilize a calculator to determine Full-Time Equivalent (FTE) needs. Data Analytics and Reporting: Emphasize the importance of continuous improvement via data analytics. 3. Workflow Creation Establish Robust Workflows: Create strong workflows before integrating reviewers. 4. Collaboration & Communication Promote Strong Collaboration: Encourage robust communication between key stakeholders. Leverage Software: Use technology to reduce physician burnout & streamline communication. 5. Patient-Centered Approach Address social determinants of health (SDOH) & ensure accurate documentation of conditions and care plans. Patient Outcomes: Keep patient care at the center of all doc. & workflow processes. 6. Regulatory Compliance Adhere to Guidelines: Follow regulatory requirements such as CMS guidelines on Hierarchical Condition Categories (HCC) coding to avoid penalties and enhance credibility. 7. Measurable Outcomes Set Clear Goals: Aim for measurable outcomes like improved HCC recapture rates, enhanced RAF scores, better HEDIS measures, and addressing SDOH needs. 8. Stakeholder Engagement Involve All Stakeholders: Ensure that executives, clinicians, and other relevant parties are involved in planning and implementation process. Success Stories Recently, I helped several CDI directors validate their cases for OP CDI programs within Accountable Care Organizations (ACOs). By engaging with population health leadership, we identified key issues such as RAF gaps and HEDIS measures, and tailored processes to address them. For instance, a CDI director I guided successfully identified HCC and HEDIS recapture as their biggest pain points. With strategic solutions in place, they are now ready to implement the project for the 2025 budget yr., aiming to improve their HCC recapture rate by 20%, leveraging data analytics for outcomes and improvement needs. Benefits of Implementing These Strategies Align Risk Stratification: Properly align risk stratification with chronic conditions and healthcare needs. Quality Measures: Improve quality measures and address SDOH. Collaborative Team: Ensure success with a collaborative team supported by technology. Overall, these strategic actions will enhance patient care and operational efficiency. #Healthcare #Leadership #CDI #PatientCare #ValueBasedCare #HealthcareInnovation

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As #PDPM expands into State Medicaid programs, aligning diagnoses with your Medical Practice Groups will continue to be increasingly important for compliance. PointClickCare Post-Acute and Long-Term Care Medical Association (PALTmed)

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