Sam G.

Efforts are underway to establish a #FHIR standard for healthcare information sharing. While leveraging APIs using data standards like FHIR is a step in the right direction, it's crucial to acknowledge the wider implications in today's healthcare landscape. Achieving #healthequity is hindered by the challenge of transferring data between providers with varying technological capabilities. Ensuring seamless data flow is essential for improving outcomes, especially in underserved rural areas where data #interoperability gaps exacerbate health disparities. Addressing this is key to enhancing #healthoutcomes for marginalized groups. Learn more in this new article by Bevey Miner: https://okt.to/yiFfBN

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📄✨ New Guide for Implementing Prior Authorization Requirements This paper explores key aspects of implementing the Centers for Medicare & Medicaid Services (CMS) 0057 Final Rule to help stakeholders meet regulatory requirements and enhance healthcare interoperability. It provides guidance based on CAQH’s extensive experience with industry standards, collaboration with key stakeholders, and the development of operating rules through CORE and Insights initiatives. Key focus areas include: 🌐 Establishing common connectivity and exchange protocols ⚙️ Adding optional steps to make prior authorizations smoother 💰 Assessing the return on investment for these changes Whether you're a healthcare provider or plan, this guide is your ticket to regulatory compliance and operational excellence. Ready to streamline PA? 👉 https://hubs.li/Q02D9Ld50 #Healthcare #Interoperability #PriorAuthorization

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The emergency department (ED) is where #hospital efficiency and #patient outcomes are truly put to the test. Traditional #triagesystems struggle to keep up with rising patient numbers and increasingly complex healthcare needs, leading to slower response times, misprioritization, and added strain on already overburdened care teams. Typically, triage nurses assess patients based on symptoms and vital signs to prioritize care, but this manual approach can be inconsistent due to stress, subjective judgment, and overcrowding. We believe that infusing AI into triage can transform care logistics and lead to better patient outcomes. Here's how: 1. 𝐀𝐝𝐯𝐚𝐧𝐜𝐞𝐝 𝐒𝐲𝐦𝐩𝐭𝐨𝐦 𝐀𝐧𝐚𝐥𝐲𝐬𝐢𝐬: By cross-referencing massive databases of medical records and case histories, AI identifies subtle yet significant symptoms indicative of serious conditions, ensuring critical patients receive immediate treatment and improving their chances of recovery. 2. 𝐏𝐫𝐞𝐝𝐢𝐜𝐭𝐢𝐯𝐞 𝐏𝐚𝐭𝐢𝐞𝐧𝐭 𝐈𝐧𝐟𝐥𝐮𝐱 & 𝐑𝐞𝐬𝐨𝐮𝐫𝐜𝐞 𝐀𝐥𝐥𝐨𝐜𝐚𝐭𝐢𝐨𝐧: AI analyzes historical data, weather patterns, local events, and social media chatter to predict patient influx trends. This enables strategic planning, such as increasing staff and resources ahead of seasonal flu outbreaks, to reduce bottlenecks and improve patient flow. 3. 𝐑𝐞𝐚𝐥-𝐭𝐢𝐦𝐞 𝐃𝐞𝐜𝐢𝐬𝐢𝐨𝐧 𝐒𝐮𝐩𝐩𝐨𝐫𝐭: AI provides real-time prioritization recommendations using constantly updated data and clinical guidelines. It helps staff decide who needs treatment first when multiple critical patients arrive simultaneously, reducing cognitive load and allowing them to focus on delivering care. 4. 𝐂𝐨𝐧𝐭𝐢𝐧𝐮𝐨𝐮𝐬 𝐋𝐞𝐚𝐫𝐧𝐢𝐧𝐠 𝐟𝐨𝐫 𝐄𝐧𝐡𝐚𝐧𝐜𝐞𝐝 𝐓𝐡𝐫𝐨𝐮𝐠𝐡𝐩𝐮𝐭: With each patient encounter, the system refines its algorithms, resulting in more accurate triage decisions informed by the latest clinical evidence. The resulting wealth of data improves overall operations and strategic planning. By integrating AI into your triage systems, you can make smarter decisions, streamline patient flow, and build a more resilient, responsive ED that adapts to changing demands. AI does not been, replacing staff; rather it can help you empower them to deliver faster and more accurate care while reducing their chances of burnout. If you're eager to learn more about how AI can be integrated into your system, I encourage you to book a consultation with our healthcare experts: https://lnkd.in/gmNH3Eyj #DoTheUnthinkable #SoftwareEngineering #Healthcare #AI

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MCG Health Director of Clinical #Informatics, Jason Gillman, MD, FIDSA, has written our latest white paper on the responsible use of #artificialintelligence in #utilizationmanagement. Dr. Gillman explores the evolution of #AI in #healthcare as well as its risks and rewards. Download here: https://bit.ly/3V15sFs

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Many health systems are evaluating AI vendors for RCM. How can they make decisions with confidence? In this new article for Healthcare IT Today, the Fathom team lays out a practical approach to procuring AI in RCM. We outline 6 key criteria for making an informed decision, summarized in plain language here: ✅ Automation rate: the proportion of work that gets fully handled by technology, in simple terms. It's the biggest driver of ROI – see the article for math illustrating this in the context of coding. ✅ Accuracy: the quality of output from the technology. Define accuracy and a baseline in advance for apples-to-apples comparisons. ✅ Compatibility and integration: the degree of fit with existing systems. Close integration with EHRs and other core technologies reduces implementation risk. ✅ Configurability and adaptability: the level of customization available. High configurability – such as incorporating new guidelines quickly – sustains peak performance for your unique needs. ✅ Scalability: the breadth of specialties or departments covered. Broader coverage sets the stage for growth and avoids a proliferation of point solutions. ✅ Vendor support: the quality and behaviors of the support team. A top-notch team simply enhances your entire experience and outcomes. Read the full article – with examples of all of these criteria applied to autonomous coding – here: https://lnkd.in/esdUqc7u How have these criteria shown up in recent vendor evaluations you've made? #MedicalCoding #MedicalBilling #RevenueCycleManagement #ArtificialIntelligence #Healthcare

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HEDIS® to assess the state of the industry regarding FHIR data quality: Although health care organizations are adopting FHIR (Fast Healthcare Interoperability Resources) as the standard for exchanging health information, the quality of FHIR data has not been established for quality measurement. To identify common gaps and challenges limiting organizations from fully utilizing FHIR data, NCQA has launched the Bulk FHIR Quality Coalition. https://lnkd.in/gMxRSQq9 #healthcareit #digitalhealth

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📢 Attention Healthcare Providers: Are You Ready for MIPS 2024 Final Rule Compliance? With the 2024 MIPS Final Rule introducing new performance thresholds, updated measures, and reporting changes, it's essential to stay ahead and ensure compliance. At ReportingMD, we specialize in simplifying the MIPS reporting process to help you meet CMS requirements while maximizing your performance scores. Here's how we can help: ✅ MIPS Reporting & Submission: Our easy-to-use platform ensures accurate data capture and submission. ✅ Expert Guidance: Our team of Dedicated Advisors provides personalized support to help you navigate the latest MIPS Final Rule changes. ✅ Performance Analytics: Get actionable insights to improve performance and maximize your incentives. ✅ Compliance Assurance: We minimize your risk of penalties with comprehensive compliance support. Whether you’re new to MIPS or looking to optimize your strategy, ReportingMD is here to support you every step of the way. 💡 📅 Let's talk! Contact us to schedule a consultation or learn more about how we can help you stay compliant and succeed with MIPS in 2024.

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💡Part 2 of Steve Gravely and Gravely Group's ongoing #HTI2ProposedRule series delving into the Proposed Rule for Health Data, Technology, and Interoperability: Patient Engagement, Information Sharing, and Public Health Interoperability. _______________________________________________________________ See Part 1 here: https://lnkd.in/esuG2yVV vi. New exception- #ProtectingCareAccess. This new exception is specific to EHI related to “reproductive health” as defined under #HIPAA. The exception would protect practices to withhold EHI about reproductive health services based on the Actor’s good faith belief that sharing the EHI could expose the patient to legal risk. This exception is specifically targeting situations in which a woman obtains reproductive health services in a state where such services are legal but their information is requested by someone else. In order to assert this exception, an Actor must demonstrate its good faith belief that the practice is no broader than necessary to protect the patient from legal risk. In addition to this threshold requirement, the Actor must show that the practice satisfies either the patient protection condition or the access to care condition: 1. Patient protection condition requires that EHI being withheld shows that patient obtained reproductive health services or inquired about them or EHI has specific demographic information that implicates reproductive health.   2. Access to care condition are practices that actor takes to limit exposure of providers to legal liability. vii. New exception- #RequestorPreferences. ONC notes that sometimes, a requestor of EHI will state specific preferences that limit the EHI it wants. This could be a date range, a specific type of care or anything else. ONC states that a requestor often does not want all of the EHI that an Actor has in its system. 🎙️Steve Gravely says, "Apparently, ONC has heard concerns that honoring these limitations could be an information blocking violation. I am skeptical, since information blocking is about fulfilling a request and if the requestor limits the scope of the request, I do not see how complying with this could be information blocking. Creating a new exception seems way over the top and makes me wonder if something else is going on." viii. #TEFCAMannerException - ONC is seeking input in HTI-2 about the new TEFCA Manner Exception that it created in HTI-1. Specifically, ONC wants feedback about the “carve-out” related to FHIR APIs. The TEFCA Manner Exception, as adopted in HTI-1, did not apply if the request for EHI was made using the standards adopted in 45 CFR 170.215 which include the FHIR API standards. ONC is seeking comments on whether specifically referring to the standards at 45 CFR 170.215 is too limited. Stay tuned for more insights!

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KLAS Recognizes 2024 Emerging Solutions Top 20 at HLTH 2024: AI and Interoperability Key Themes - KLAS Research KLAS Research unveiled the 2024 Emerging Solutions Top 20 at HLTH 2024, spotlighting innovative healthcare companies poised to disrupt the industry. Key themes include AI and interoperability, essential for achieving the Quadruple Aim: improved outcomes, reduced costs, enhanced patient experiences, and better clinician experiences. Recognized solutions range from Redivus Health's Code Blue to Abridge and care.ai, addressing critical healthcare challenges. As Steve Low noted, while AI drives innovation, integrating these technologies with existing systems remains a hurdle. The future of healthcare is here—let's embrace it! #HealthcareIT #Innovation #AI #Interoperability #PatientExperience #ClinicalExcellence #HLTH2024 ai.mediformatica.com #healthcare #klas #hlth #report #research #cost #insights #awards #miion #outcomes #costofcare #delivery #digitalhealth #healthit #healthtech #healthcaretechnology @MediFormatica (https://buff.ly/3NRroOV)

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A Friendly Reminder that December 1 is the Drummond Deadline for two regulations requirements based on the HTI-1 Final Rule. Both the Decision Support Intervention (DSI) Update and the Standardized FHIR Endpoints Requirement are part of the ONC's updated certification criteria for #HealthIT developers. Submit all requirements by then to ensure Drummond has enough time to support your organization before the end of the year. https://loom.ly/bz5vpIc #HTI1 #DSI #b11

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LeadingAge24: Create Efficient Senior Care Workflows with Interoperability - HealthTech Magazine At LeadingAge24, the focus is on leveraging interoperability in healthcare IT to enhance senior care workflows amid ongoing staffing shortages. With 93% of nursing home providers facing significant workforce challenges, integrated health IT tools can streamline operations, allowing caregivers to focus on patient care rather than administrative tasks. By adopting electronic health records (EHRs) and automating scheduling, organizations can improve job satisfaction and care quality. As we move towards standardized interoperability across states, the potential for better outcomes and staff retention becomes increasingly vital. #HealthcareIT #Interoperability #SeniorCare #EHR #HealthTech #PatientCare #LeadingAge24 ai.mediformatica.com #health #healthtech #healthcare #interoperability #workflows #staff #seniorcare #nurse #tools #nurses #acutecare #postacutecare #digitalhealth #healthit #healthcaretechnology @MediFormatica (https://buff.ly/3Up9Gq0)

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- Navigating the Complexities of Health Technology Assessment in Healthcare Systems - Our latest blog post examines the critical role of Health Technology Assessment (HTA) in the healthcare systems. HTA serves as a fundamental process for pharmaceutical, biotechnology, and medical device companies, assessing the efficacy, safety, and economic impact of new health technologies. This multidisciplinary evaluation is essential for ensuring that new products not only meet clinical standards but also offer cost-effective solutions for healthcare systems. Key Points from the Article: - HTA’s Role: HTA evaluates medical, social, economic, and ethical issues associated with health technologies, influencing decisions on reimbursement and market access. - Methodology Insights: From clinical trials to economic evaluations, HTA incorporates a broad range of analyses to determine the value of new treatments compared to existing options. - Challenges and Strategies: The blog discusses the obstacles manufacturers face during the HTA process and strategic approaches to address these challenges effectively. Understanding HTA is crucial for companies aiming to navigate the reimbursement landscape and achieve successful market access. By demonstrating the value of innovative treatments through HTA, companies can significantly enhance their product's adoption and utilization. Discover how mastering HTA can provide a competitive edge in the market by reading our full article. https://lnkd.in/ehMHBfmQ #HEOR #reimbursement #costeffectiveness #pharmaceuticals #HTA #marketacces #HealthEconomics 

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What's part of achieving HTI-1 Compliance? The HTI-1 Final Rule requires implementing standardized #FHIR APIs by December 2024 to enhance data interoperability. Meeting this deadline ensures seamless, secure access to patient data, improves care coordination, and keeps you compliant with CMS Promoting Interoperability requirements. https://loom.ly/bz5vpIc #HealthIT #Interoperability #HealthcareData #Compliance

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The new #CMS Interoperability and Prior Authorization Final Rule (#CMS0057F) is a game-changer for healthcare data exchange. Feeling overwhelmed? Get clarity and actionable insights by attending our upcoming interactive webinar with industry experts. We'll answer all your questions in an Ask Me Anything (AMA) format. Here's what you'll gain: ✅A clear understanding of the key provisions of CMS-0057-F. ✅Expert guidance on API implementation strategies for smooth compliance. ✅Insights into how the rule impacts the future of value-based care models. Join our upcoming webinar with industry experts to get all your questions answered! We'll cover key provisions, API implementation strategies, and the impact on value-based care. Our panel of industry veterans features: Nikita Ravindran, Product Manager: Nikita will bring her product expertise to explain the technical implications of the rule, including its impact on HL7® FHIR® adoption and API implementation strategies. Mason Burr, VP of Strategy: Mason will share his strategic insights on how healthcare organizations can adapt and thrive under the new regulations, focusing on compliance timelines and opportunities for innovation. Sudheen (Sudheendra) Kumar Kumar, CEO & Founder: Sudheen will offer his leadership perspective on the broader industry trends and the future of healthcare data exchange, discussing the potential impact on value-based care models. Whether you're a healthcare provider, payer, IT professional, patient advocate, or simply interested in the future of healthcare data exchange, this webinar is for you. Register today and don't miss this chance to gain valuable insights! https://lnkd.in/dwBh4pQc #CMSFinalRule #HealthcareDataExchange #Interoperability #PriorAuthorization #Webinar #AMA #HL7FHIR #ValueBasedCare #DaVinciProject

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