< + > Stop Waiting on Mandates: CMS Challenges Health IT to Act Now

“We’re the government and we’re here to help.” That’s a common punchline, but based on recent IT announcements from CMS, this line may turn out to be no joke. From interoperability to provider directory to patient identification, CMS is working on several initiatives to tackle systemic IT challenges in healthcare.

Healthcare IT Today sat down with Amy Gleason, Strategic Advisor to the Centers for Medicare & Medicaid Services (CMS). She is tackling the massive challenge of slow progress on interoperability, provider identification, fraud, and clipboard-based care. Her mission is to drive immediate action across the healthcare ecosystem.

What This Conversation Revealed

• Breakdown: Seven years of waiting for rules to take effect left data trapped in silos. Process: CMS launched a voluntary tech pledge for immediate collaboration. Outcome: Industry players actively execute data sharing milestones within months.
• Breakdown: Maintaining thousands of inaccurate provider directories wastes billions of dollars annually. Process: CMS is consolidating internal databases into a single public framework. Outcome: A reliable National Provider Directory restores data accuracy and reduces administrative burnout.
• Breakdown: Rampant fraud bleeds the system of necessary funds. Process: The government released massive troves of claims data to the public. Outcome: Sharp minds in the private sector track down malicious patterns and claim bounties.

Voluntary Action to Accelerate Change

Mandates move at a glacial pace. For example, a rule written in 2020 on interoperability will not take effect until 2027. To bypass this sluggish timeline, CMS launched a pledge to unite the industry right now.

“At CMS, we tried to take a step last spring. We asked, how can we really get interoperability to work and how can we do it in a way that doesn’t take seven years to go into effect,” explained Gleason.

After a series of listening sessions, “CMS launched an ecosystem, and the idea is to get industry to come together voluntarily”. This idea became the CMS Health Technology Ecosystem where participating organizations (vendors, providers, payers) pledge to make their systems and data interoperable.

The goal? “To work together to actually see this stuff [interoperability] happen in six months or a year,” stated Gleason.

A Single Source of Truth Stops the Waste

According to Gleason, the healthcare industry burns billions of dollars trying to keep provider information accurate.

“There are over 5,000 provider directors in the US. Providers answer between 20 and 60 requests every month to validate their information. Yet none of the directories are accurate and not very helpful,” detailed Gleason.

To stop this financial drain, CMS is building a National Provider Directory. “If we can just have people update one place, then we can all get the benefit and stop wasting so much time and money,” she stated.

Identity Verification Fixes the Trust Gap

Data sharing does not fail just because of bad technology.

“One of the main reasons we heard from people about why interoperability doesn’t work today is that it’s not a technology problem, it’s a trust problem. And so we’re putting identity on front of the provider directory,” observed Gleason. If a provider cannot verify who is asking for records, the data stays locked down.

CMS is baking strict identity checks directly into its infrastructure. “So a provider can use things like CLEAR or ID.me or login.gov to validate their identity and then do that one time, and then others can query to see if that provider has validated their identity,” she explained.

Killing the Clipboard

Patients are tired of filling out the same forms at every visit. CMS wants to eliminate this frustrating bottleneck entirely with their kill-the-clipboard initiative. The vision is for patients to control their data securely and easily.

They should be able to do this “without having to log into all these portals into whatever app I choose, then I can share that with my doctor with a QR code,” shared Gleason. “So it will move into more stages after that. But a simple scan, just like you do at a concert or the airport, here’s my QR code. Take my data,” she noted.

Open Data Exposes Malicious Actors

Fraud and waste cost the system dearly. Bad actors slip through the cracks because the government simply cannot spot every anomaly on its own. To combat this, CMS is crowdsourcing the fight.

“The idea of releasing data is to let people have access to this data and help us find patterns and issues with the data,” Gleason explained. Opening the vault allows sharp minds in the private sector to track down waste. “And there are bounties. If you find things that we’re able to enforce, then you can get a cut of that money as well.”

CMS recently release another large batch of data to assist with machine learning.

The Health IT Reality

By focusing on voluntary pledges, centralized directories, and secure identity verification, CMS is pushing the industry to execute right now. Organizations that cling to siloed operations will be left behind. Although policy and compliance do motivate the healthcare industry to move in a particular direction, these voluntary and problem-solving IT initiatives from CMS will hopefully boost adoption quicker.

What Healthcare IT Leaders Are Asking

What is the CMS Health Tech Ecosystem pledge?
The CMS Health Tech Ecosystem pledge is a voluntary initiative bringing together electronic health record vendors, payers, providers, and tech companies. Instead of waiting years for federal rulemaking to take effect, participants agree to actively collaborate and execute data sharing milestones within six to twelve months.

How will the National Provider Directory reduce costs?
The healthcare industry spends roughly $6 billion annually maintaining thousands of fragmented and inaccurate provider directories. A single CMS-backed National Provider Directory will allow clinicians to update their credentials in one centralized location, eliminating redundant administrative tasks and dramatically reducing operational waste across the entire sector.

Why is identity verification critical for healthcare interoperability?
Many organizations block data sharing because they cannot reliably verify the identity of the requesting provider or patient. By integrating established identity verification tools directly into federal directories and patient portals, organizations can confidently exchange clinical data without fearing security breaches or fraud.

Learn more about CMS at https://www.cms.gov/

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< + > A Simple SMS Improves Medication Adherence for High-Risk Patients

With all the amazing AI innovation that’s happening, sometimes we underestimate the value of simple solutions that make a big impact.  One of the simplest solutions out there is an SMS text message to a patient.  However, when utilized properly, it can create a big impact.

That’s the story that we heard from Ben Long, MD, Director of Hospital Medicine at Magnolia Regional Health Center, in his session at the recent HIMSS conference.  In this session Dr. Long provides a short case study of their implementation of SMS text reminders (SMS nudges) using DrFirst’s prescription engagement solution embedded within MEDITECH to text patients on behalf of their physician minutes after a prescription is sent to the pharmacy. The text includes medication education, price transparency and savings, and reminders to fill their prescription.

Below you’ll find some of the details from the presentation along with our additional commentary.

In a world where we can easily over-architect anything, it’s great to see the value of something as simple as a text message.  It points out a key principle about technology and patients.  They want something that’s simple and fits in their workflow.  An SMS fits that description.

I love that Magnolia Regional Health Center tied this to hospital readmissions.  If they would have just tied their effort to prescription fills, that could easily be pushed aside since prescription fills isn’t a strategic priority for most healthcare organizations.  Hospital readmissions on the other hand is a priority since it’s tied to real dollars and cents.  It’s great that they saw how prescription fills and hospital readmissions are connected though.

For many of us that are relatively affluent and trust our doctors, it’s probably shocking to see these medication fill rates.  Did you know that 20% of medications aren’t filled and 50% of refills are abandoned?  I’d heard of this problem, but it’s pretty stark to see the real numbers.

We know that heart failure patients are one of the most expensive parts of our healthcare system.  It makes sense why Magnolia Regional would make this the focus of their study.  Impacting this group of patients is a win for the patients and the healthcare organization.  It did shock me that 40-60% of heart failure patients don’t take their medications as prescribed.  You’d think a heart issue would wake you up to the need to take care of yourself, but as Dr. Long pointed out, there are a lot of other factors and barriers to patients taking their medications as prescribed.

How many of you have integrated a text message solution into your EHR and prescribing workflow?  If you haven’t, DrFirst offers some great resources on prescription engagement that you’ll likely find helpful.

One of the important topics the past few years has been provider burden.  It’s great to see that Magnolia Regtional Health Center considered this in their solution and designed a workflow that required no extra work for their clinicians.  The SMS nudge just happens automatically.

The focus on the patient workflow matters a lot as well.  While it’s easy to send an SMS message, the real key to making the patient workflow simple is the patient authentication.  The nice thing with this solution is that it doesn’t redirect the patient to a portal that overwhelms them once they get in.  The text is sent.  The patient is authenticated.  The information is given.  That’s the kind of experience a patient wants.

Always great to see the results of these efforts.  A 10% increase in prescription fill rate is a big deal.  Some may look at the 40% that still aren’t filling their prescription and they’d be right that there’s more work to do.  As was mentioned above, remembering to fill your prescription or knowing how to properly take your medication is the challenge for some.  There are plenty of other behavioral, financial, educational, and accessible challenges with prescriptions.  However, it’s great to see that the SMS nudge was able to improve prescription fills by 10%.

While increased prescription fills is great, it’s worth remembering that the real goal wasn’t more prescription fills.  The real goal was reducing hospital readmissions.  With that in mind, it’s great to see that Magnolia Regional Health Center saw a 6% decrease in 30-day readmission odds.  That’s a meaningful impact on a relatively simple to implement solution.

As discussed above, the SMS message can’t solve everything.  It will be interesting to see where they take this program next.  The amazing thing with SMS is that you now have a communication channel open with the patient to do all sorts of creative efforts to improve fill rates even more.

What’s interesting about this shift in patient engagement is that patients are almost demanding it.  They’re experiencing this kind of convenient “where they are” experience in the rest of their lives that they want it in healthcare as well.  The good news is that the tools and technology are there for this to be their experience in healthcare too.

This is so beautifully said, “When the right action becomes the easiest action, adherence naturally improves.”  This really is the key to having patients follow the care that’s prescribed.

Kudos to Magnolia Regional Health Center and Dr. Long for this kind of leadership in their organization.  Communicating the shared goal of better patient outcomes is sometimes hard to do.  The nice thing is that Dr. Long and his team paired that with a solution that didn’t add more burden to the providers.  That’s an amazing recipe for success.

If you want to learn more about this solution, you can also check out this article “Improving Medication Adherence for CHF Patients in Rural Communities: Lessons From Magnolia Regional” which outlines more details and even includes access to a webinar on demand.

< + > Could Gaps in Unified Communications Deployment Pose a Risk to Frontline Healthcare?

The following is a guest article by Nick Muir, General Manager for EMEA at Spectralink

Platforms Such as Microsoft Teams May Aid Organization-Wide Collaboration, Yet Many Frontline Healthcare Workers are at the Mercy of a Communication Infrastructure That Isn’t Suitable for Their Needs

Too often, when healthcare organizations calculate the payback of unified communications (UC) deployments, they aren’t thinking of the high volumes of critical frontline workers who are continuously moving between patients, departments, and critical care areas. This can prove to be a risky mistake.

In the wake of the COVID-19 pandemic, many healthcare organizations migrated administrative staff to modern UC platforms, such as Microsoft Teams, to keep staff connected wherever they are. But those provisions weren’t typically deployed with frontline clinical staff in mind. 

Standard desktop or mobile clients aren’t generally suitable for clinical environments with their strict hygiene protocols, complex building structures, integration requirements, and patient safety regulations. Most frontline healthcare workers communicate largely by voice, meanwhile. If network connectivity drops, infrastructure is breached, or core functionality isn’t fit for purpose, their ability to provide continuous quality care is compromised.

The Risk of Disruption to Clinical Processes

In healthcare, communication devices serve as an aggregator for the entire clinical process, linking prescriptions, treatment protocols, surgeon schedules, patient monitoring, and nursing procedures on a patient-by-patient basis. 

Devices that aren’t purpose-built for healthcare environments may fail under the demands of clinical work, be stolen, or become damaged during cleaning with hospital-grade disinfectants. 

Communications coverage must remain reliable throughout complex building structures, including basements, reinforced areas, and locations with historically poor wireless connectivity. Integration with nurse call systems, patient monitoring platforms, and electronic health records is essential for clinical workflows. Location services are particularly acute in a healthcare context.

Resilience Matters

Recent roundtable discussions our organization has held with healthcare providers confirmed just how worried their frontline workers are about communication resilience, for example, in the event that primary networks fail or are breached. When organizations invest heavily in cloud-based UC platforms, it is often with an assumption that communication capabilities will remain available when needed. But when broadband outages occur, standard UC infrastructure can be compromised. This can pose a real patient safety risk if it affects clinical staff on the frontline.

DECT (Digital Enhanced Cordless Telecommunications) technologies are a viable option here because they create dedicated communication channels that persist irrespective of Wi-Fi or LAN status, while also enabling peer-to-peer calling and full UC platform integration during normal operations. DECT systems are also inherently more difficult to compromise than Wi-Fi or cellular networks. This is because they operate on dedicated frequencies and use their own authentication protocols. In an era of increasing cyber threats to critical infrastructure, this architectural separation provides an additional layer of security.

Regulatory Expectations

The risks for healthcare organizations are amplified by evolving worker safety regulations and public and patient safety requirements, including those that specify how emergency alerts should be handled.

In the U.S., Kari’s Law mandates that notifications are routed simultaneously to internal security and emergency services, while RAY BAUM’s Act requires dispatchable location information, including specific room and floor data, not just building addresses. Organizations that fail to comply could be penalized. 

Robust safety measures, on the other hand, can help to drive down workplace violence incidents (a growing concern in healthcare) and accelerate crisis response, while making tangible the organization’s duty of care to staff and patients.

Technical Barriers to Frontline Continuity

Today, almost two-thirds (65%) of frontline workers use Microsoft Teams, according to research by Cavell on workforce mobility. Healthcare organizations are increasingly standardizing Teams as their primary collaboration platform. This creates both an opportunity to finally include clinical staff in UC and a challenge. That’s because extending Teams capabilities to mobile workers in specialist environments can present a range of practical issues.

The integration challenge isn’t trivial. Connecting DECT systems with platforms such as Teams requires sophisticated technical implementation and platform certification. Where executed properly, the extended rollout enables clinical staff to participate fully in the Teams environment, receiving messages, joining group chats, and accessing shared resources while using devices optimized for clinical working conditions. Where this is not the case, hygiene control could become problematic, battery life could falter during a long shift, and noise levels in busy departments might render standard audio unusable.

Recommended Remedies

Ideally, clinical UC deployment will include native integration and maintain a single identity and presence across all staff personas. This helps to ensure seamless communication irrespective of device or location, as well as consistent administration. Certainly, in 2026, the priority should be to ensure that clinical and frontline staff (the core of healthcare delivery) are no longer an afterthought in digital transformation. 

Practical recommendations to overcome current gaps in frontline continuity include:

• Understanding Clinical Workflows: Appreciating specific operational requirements will help clarify which technical capabilities matter
• Evaluating Infrastructure Honestly: Rather than force-fitting inadequate solutions, acknowledging where purpose-built, healthcare-specific alternatives are required
• Prioritizing Interoperability Over Uniformity: The goal shouldn’t be identical devices for every staff member, but rather that every staff member can communicate effectively within a unified system 
• Building for Resilience, Not Just Capability: Communication systems become most critical during disruptions — precisely when they’re most likely to fail if not properly architected; in healthcare, ensuring redundancy is fundamental risk management

About Nick Muir

Nick Muir is Spectralink’s General Manager for EMEA. He is a leader and innovator with more than 25 years of customer experience, consumer electronics, and telecoms, specializing in strategy, sales/business development, and scale-ups. Nick has held board, executive, C-level, VP, management team, and director roles across a diverse range of tech-enabled businesses. Nick currently also serves as a non-executive director at RIPtec and at Blackfinch Ventures, providing strategic guidance and oversight on its invested portfolio. Spectralink gives frontline workers the same tools and connectivity as desk-based workers – so they can move faster, work smarter, and serve customers better.

< + > Amigo AI Raises $11M Series A | $150M Investment Validates Grow Therapy

Check out today’s featured companies who have recently raised a round of funding, and be sure to check out the full list of past healthcare IT fundings.

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Amigo AI Raises $11M Series A to Train Clinical AI Agents Like Doctors

Platform Pioneering “Digital Residency” for Clinical AI Reaches 3M+ Autonomous Patient Encounters with 100% Safety Pass Rate

Amigo AI, the platform for building and training patient-facing clinical agents, today announced an $11M Series A led by Madrona with participation from Optum Ventures. The company has now raised $17M in total funding, including a seed round co-led by General Catalyst and GSV Ventures. The raise comes amid growing momentum for the application of AI in healthcare, fueled by regulatory shifts toward technology-enabled care delivery (e.g., CMS ACCESS model) and growing provider demand for clinical agents.

Amigo builds and trains AI agents that interact directly with patients across clinical use cases such as intake and triage, personalized care navigation, and 24/7 patient support. By handling high-value clinical workflows, Amigo agents enable healthcare organizations to improve patient outcomes and meaningfully expand the reach and impact of their existing care teams.

In just the last six months, Amigo agents have completed over three million patient encounters around the world with zero safety incidents. The company now powers clinical AI for leading healthcare organizations around the world, including Eucalyptus, Diverge Health, and The Care Clinic.

“Amigo is addressing one of the hardest problems in healthcare AI, deploying autonomous systems where trust and safety are non-negotiable,” said Sabrina Albert, Partner at Madrona. “Their simulation-first approach to clinical safety positions them to define the standard for patient-facing AI.”

By 2030, the world will face a shortage of 11 million health workers. Clinical agents offer a promising path to closing this gap, but only if they can deliver care as safely as human clinicians.

“We train our agents like doctors because mistakes can cost lives in healthcare,” said Ali Khokhar, Founder and CEO at Amigo…

Full release here, originally announced March 10th, 2026.

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$150M Investment Validates Grow Therapy as the Trusted Choice for Health Insurers, Employers, and Health Systems

With $150 Million in New Funding, Grow Therapy is Expanding its Platform to Connect Insurers, Employers, and Health Systems to Integrated Mental Health Care

At Grow Therapy, we recognized a hard truth: when Americans need mental health care most, the system too often fails them.

It asks people to navigate a maze of disconnected providers, insurance gaps, and long waitlists. So we set out to clear the pathway to effective care by breaking down those barriers.

Today, I’m excited to share a meaningful milestone in that journey.

Grow Therapy has raised a $150 million Series D, led by TCV and Growth Equity at Goldman Sachs Alternatives, who led our Series B and C, respectively. New investors BCI and Menlo Ventures join existing investors Sequoia, SignalFire, and Transformation Capital.

This round is the direct result of what we’re seeing every day: health plans, employers, and health systems are choosing Grow as a partner to deliver high-quality, affordable mental healthcare to people who need it.

“TCV loves backing great entrepreneurs targeting very large market opportunities. We are excited to continue to partner with Grow on the journey to provide access to, and improvement of, quality mental health care,” said Jay Hoag, Founding General Partner at TCV.

Our Progress

In just five years, over two million people have turned to Grow for mental health care.  In 2025 alone, we facilitated seven million visits, bringing the lifetime total to 10 million therapy and medication management appointments…

Full release here, originally announced March 3rd, 2026.

< + > Ditch the Security Snapshots. Why TripleKey Says Point-in-Time Audits Must End.

Security in healthcare is tough. Threats keep increasing rapidly. The attack surface is expanding. It feels incredibly overwhelming today. A hidden weapon in this battle against nefarious actors is time…or more accurately timeliness. One healthcare organization changed their approach to security and made time their ally.

I sat down with Patrick McGill, President and CEO of Community Health Network, and Jon Brown from TripleKey. We discussed the overwhelming pace of security threats and why moving away from point-in-time security audits to real-time vulnerability scanning better protects operations.

What This Conversation Revealed

• Patient Safety Risks: Large scale attacks shut down critical hospital systems and delay care. By elevating cybersecurity to a clinical priority, leaders protect patient safety and ensure care delivery.
• Outdated Audits: Point in time security audits become obsolete the very next day. By implementing continuous real-time monitoring, health systems spot and address new vulnerabilities instantly.
• Slow Patching Cycles: Waiting months to patch vulnerabilities leaves networks highly exposed to immediate exploits. Using live data to trigger rapid mitigation drastically shrinks the window of exposure.

Cybersecurity Is a Patient Safety Mandate

Security is no longer just an IT problem. It is a fundamental requirement for delivering care. When large scale attacks occur, the consequences extend far beyond exposed data.

“We previously thought that it [cybersecurity] was IT technical security,” explained McGill. However, that compartmentalized thinking is no longer accurate. “When you look at the last few years, the large-scale attacks that have occurred in healthcare, it is clearly a patient safety issue. Patients simply cannot get treated when the system is under attack.”

Ditch the Snapshot for Continuous Monitoring

Annual security audits provide a false sense of comfort. They capture a single moment in time. The reality of modern networks is much messier.

McGill compared these reviews to cleaning a house. “I would see that we would do a security or a technical review, and you get a snapshot in time,” McGill shared. “That’s like coming into somebody’s house and it’s clean and everything’s in place, but the next day the kids have destroyed it and everything’s out of place”.

Healthcare needs continuous visibility. Relying on static security audits no longer works.

Brown agreed, emphasizing the need to leave paper-based assessments behind. “Getting rid of forms and moving to facts all builds the trust that we need for our patients,” noted Brown. He added that the industry must move to a “data driven process and using real-time data to actually mitigate the issues”

Speed to Mitigation is the Only Defense

The traditional patching cycle is broken.

“We’re seeing attackers actually have an exploit the same day that that vulnerability’s announced, but it may take two months to get the vulnerability patched by the health system,” warned Brown.

Organizations must move faster. “By using real time data such as triple key, we know when the vulnerability is there and we know immediately how to mitigate it,” Brown explained. Shrinking that timeline is the ultimate goal.

The Health IT Reality

The reality is that healthcare security is a race against time. The days of relying on periodic assessments and slow patching schedules are over. IT leaders must embrace continuous monitoring and rapid mitigation to protect their organizations. If you cannot spot a vulnerability in a timely manner and fix it immediately, your patients are at risk.

What Healthcare IT Leaders Are Asking

Why is real-time monitoring necessary for healthcare security?
Real-time monitoring is essential because threat actors move incredibly fast. A point in time security audit only validates the environment at that exact moment. By the next day, new vulnerabilities can emerge or configurations can change. Continuous monitoring allows healthcare IT teams to see their true risk posture at all times and respond immediately to new threats.

How does delayed patching impact patient safety?
When health systems take months to apply security patches, they leave their networks open to immediate exploitation. If an attacker breaches the network through an unpatched vulnerability, they can shut down critical clinical applications. This directly impacts patient safety because clinicians lose access to the tools they need to deliver care safely.

How can health systems speed up their mitigation efforts?
Health systems can accelerate mitigation by moving away from manual compliance forms and adopting data-driven security tools. These platforms provide immediate visibility into where vulnerabilities exist across the enterprise and offer direct paths to fix them. Having a shared, transparent view of the data allows internal teams and vendor partners to collaborate quickly and close security gaps.

Learn more about TripleKey at https://www.triplekey.com/

Learn more about Community Health Network at https://www.ecommunity.com/

Listen and subscribe to the Healthcare IT Today Interviews Podcast to hear all the latest insights from experts in healthcare IT.

And for an exclusive look at our top stories, subscribe to our newsletter and YouTube.

Tell us what you think. Contact us here or on Twitter at @hcitoday. And if you’re interested in advertising with us, check out our various advertising packages and request our Media Kit.

< + > Key Ideas on How to Scale AI with UC San Diego Health and Notable

One of the most important topics at the HIMSS conference was the focus on AI in actual practice versus AI in theory.  Plus, a key part of this conversation was does the AI solution scale to the problem or does it just work as a pilot.

In the session “Build, Deploy, Transform: UC San Diego Health’s AI Playbook” presented by Karandeep Singh, MD, MMSc, Chief Health AI Officer at UC San Diego Health, Jeffrey Pan, Director at UC San Diego Health, and Aaron Neinstein, MD, Chief Medical Officer at Notable, we got a heavy dose of what’s really working at scale with AI.  Plus, they share some key insights into the mindset shift that’s needed to really benefit from the healthcare AI solutions out there.

Here are some of the key insights and perspectives they shared during the session along with some additional commentary.

I love 2 elements of this session.  The idea of reimagining is a really good one.  I know when I first implemented an EHR we replicated the previous workflow.  Then, we went back and redesigned the workflow based on what the EHR could do that we couldn’t have even thought about previously.  I think AI is forcing us to go straight to reimagining workflows because of what’s possible now.

I also love that they approached this as a system wide project.  We’re going to have a lot of shadow AI projects that were done by departments and that can lead to all sorts of drama later.

These stats are a great example of being able to reimagine a process.  When a human is auditing something it’s expensive and time consuming.  The right AI technology can make reviewing everything trivial.

I know many healthcare organizations that still live in this scarcity mindset.  To be fair, it’s a hard mindset shift to make.  The above audit example is a good one to reinforce this concept as well.  When we’re human constrained, scarcity is real.  With technology, we can often change from a world of scarcity to abundance.  That shift in thinking is a powerful one that I’ve seen play out across healthcare organizations.  Can we reach out to every patient?  Can we audit every claim?  Can we follow up on every low balance?  etc etc etc.  All of thse are a challenge with humans, but are possible with technology.

The beauty of healthcare is that we’re all impacted by what happens here.  One thing I love about this story is that the AI technology can adapt to the person regardless of age and tech skill.  However, at its core is ensuring that the patient has the best experience possible.

I’ve often told people that if you don’t want to reach me, send a letter.  I barely check my mailbox.  However, I check my email, texts, phone calls all day every day.  Plus, mailing is expensive.  The AI should consider a patient’s preference, but the opportunity to be able to do outreach to 100% of patients is a powerful one.  Obviously, that’s proven out in the amazing no-show and cancellation rates that they described.  When it comes to surgery prep, this translates to a massive ROI.  Plus, many healthcare organizations have capacity issues and long wait lists.  Improving no-shows and cancellations can help get patients seen sooner.

Another major theme at the HIMSS conference was orchestration.  It was great to see this highlighted in this session as well.  Orchestration really has become key.  Plus, deep integration with Epic is powerful as well since most providers aren’t going to visit another system.

What a powerful idea.  How much time has your organization spent thinking about “should we automate this workflow?”

I find that this shift almost happens naturally once you start implementing AI.  In fact, it’s why every healthcare organization should start implementing AI.  The act of doing something expands the minds of your users and enlivens their creativity for what’s possible.  Of course, the real challenge today is that every few months AI is progressing so that what wasn’t possible 3 months ago is now possible.  That’s the most exciting and also challenging parts of what’s happening with AI right now.

Where are you at in this framework of healthcare AI agent adoption?  Have you started linking agents?  Have you seen the power of linked agents?  What seems clear to me is that you don’t generally jump to linked agents.  You have to start with specific agents and then can link them over time.

I think that this is one of the things that holds many organizations up.  They have fear of the “what if it goes wrong.”  It’s an important question to ask and test.  I love this session’s comment about it not needing to solve everything.  Escalating something it can’t solve can still be a win for your organization without putting anything at risk.

This reminds me of the reality that we often want to compare AI against perfection.  That’s always been a mistake.  We should be comparing AI against the alternative.  The reality is that humans aren’t perfect either.  However, we allow much more grace for humans than AI.  That often holds organizations back from benefiting from the improvement that AI can provide.  Don’t throw out the benefits of AI because it can’t solve everything for you now.

Trust really is the key to any AI implementation.  If they don’t trust it, they won’t use it.  This is a nice framework for building trust in an AI solution at your organization.

What did you think of this session on implementing AI at scale with UC San Diego Health and Notable?  Has your experience implementing AI been similar to there’s?  What else would you add to the conversation?  Let us know on social media.

< + > Continuity Without Workarounds: How Payers Stabilize Digital Mailroom + Paper-to-EDI Intake During Disruption

The following is a guest article by Vidhya Bhat, Chief Product Officer, Digital Transformation, Imagenet

Disruption doesn’t just slow intake—it changes behavior. In most payer environments, operations continue running, but leaders begin reassessing operational risk, redundancy, and long‑term exposure across their intake infrastructure. During that reassessment, teams often introduce “temporary” workarounds to reduce perceived risk or maintain throughput: forwarding emails, routing documents through shared drives, manually tracking exceptions in spreadsheets, or creating side processes that bypass normal checks.

Those workarounds are understandable. They’re also where operational and data‑handling risk tends to grow—because visibility breaks down, exceptions pile up, and handoffs become inconsistent. The payers who manage disruption effectively tend to prioritize control, not just speed. They maintain continuity planning—keeping intake moving without losing governance.

For many organizations, the core dependency isn’t simply physical mail handling. It’s compliant, accurate paper‑to‑EDI conversion and downstream transmission. That’s why continuity planning needs to explicitly include EDI accuracy, validation, monitoring, and traceability—not only channel consolidation.

What Changes During Disruption: Three Predictable Failure Modes

1) Multimodal Intake Breakdowns

When inbound content arrives through too many channels (mail, fax, email, portals, ad hoc uploads, electronic feeds), the organization loses a single source of truth. Tracking becomes manual, prioritization becomes inconsistent, and downstream teams inherit variability.

What it looks like: multiple inboxes, inconsistent naming conventions, unclear ownership, and the classic “I thought your team had it.”

Why it matters: fragmentation makes it harder to manage backlog, enforce consistent handling, and report status in a defensible way—especially when volumes surge.

2) Data Quality Breaks Drive Exceptions

Disruption increases exceptions: missing data, unclear document types, misrouted items, duplicates, and urgency conflicts. Without governed exception handling, exceptions become informal escalations—often through side channels that aren’t trackable or auditable.

What it looks like: “urgent” items jumping queues, ambiguous ownership, resolution happening over chat or email, and aging backlog without clear disposition paths.

Why it matters: unmanaged exceptions drive rework, create quality drift, and introduce compliance exposure because decisions and edits are not consistently captured.

3) Breakdown in End-to-End Visibility (Including EDI)

When teams move fast through workarounds, the organization loses defensible visibility—who touched what, what changed, where it went, and when it was handed off. That’s not just a compliance concern; it’s an operational one.

In parallel, paper‑to‑EDI workflows can become brittle under stress. If validation is inconsistent or acknowledgements aren’t monitored, the organization may not know whether EDI output was accurate, complete, and successfully transmitted.

What it looks like: unclear handoffs, limited reporting, difficulty reconstructing what happened during a surge, and uncertainty about EDI transmission outcomes.

A Practical Framework: Five Design Principles for Resilient Payer Intake

Principle 1: Build a Controlled Intake Pipeline

Resilience starts with consolidation. A controlled pipeline acts as a centralized intake engine, ensuring inbound content is normalized before routing—so channel differences don’t create process differences. This is often the fastest way to reduce fragmentation and regain operational control.

In continuity terms: one governed pathway for intake, classification, routing, and status tracking—rather than a collection of side processes.

Principle 2: Govern Exceptions with Ownership and Escalation

Exceptions are inevitable. Uncontrolled exception handling is not. A governed model includes defined queues by exception type, clear owners, standardized resolution steps, and escalation paths that are traceable—not informal.

When exception governance is designed well, disruption doesn’t force teams to abandon controls; it simply increases volume through a system built to handle it.

Principle 3: Explicitly Anchor Continuity on Paper‑to‑EDI Controls

Continuity isn’t complete if EDI output quality or transmission reliability is uncertain. A resilient approach includes defined conversion rules, validation checkpoints, and monitoring for downstream transmission status (e.g., acknowledgements) so paper‑originating work can move through compliant, defensible pathways—even under surge conditions.

The objective: protect outbound EDI data quality, reduce preventable exceptions, and maintain confidence that transmissions are accurate, complete, and on time.

Principle 4: Standardize Handoffs Into Payer Systems

A stable intake function isn’t complete until downstream teams receive work consistently. Standardized handoffs reduce variability and prevent operational debt from building up in claims, correspondence, enrollment, appeals, and other back‑office operations.

Regardless of whether an item arrived by mail, fax, email, portal, or electronic feed, downstream teams should receive it in a consistent, workflow‑ready format with the metadata they need to process it—so disruption doesn’t multiply downstream rework.

Principle 5: Embed QA and Traceability Into the Workflow

Speed during disruption can’t come at the expense of accuracy and defensible processing. Embedding validation and QA—especially for high‑risk document types—helps stabilize quality even when volumes surge.

In practice, this means applying business rules and checks, flagging uncertain outputs, routing them into role‑based review workflows, and maintaining end‑to‑end traceability (often via a Document Control Number or equivalent identifier).

The Technical Building Blocks That Make Continuity Scalable

In a modern multimodal intake environment, continuity at scale depends on a handful of building blocks working together. The exact configuration varies by payer, but the components below show up consistently in high‑control models:

• Intelligent Document Processing (IDP): OCR‑driven ingestion, document classification, and data extraction
• Validation workflows: business rules and checks that flag inconsistent or incomplete data
• Confidence‑based routing: low‑confidence fields are flagged and routed into role‑based validation/QC queues
• Unique item tracking: a Document Control Number (DCN) or equivalent identifier to maintain end‑to‑end traceability across channels and work queues
• Secure transport options: controlled portals and secure transfer methods such as SFTP/FTP for inbound feeds (as required)
• Identity and access governance: SSO/MFA and, where required, additional controls backed by audit‑ready logging
• Integration + delivery layer: standardized handoffs and paper‑to‑EDI conversion pipelines that support downstream transmission reliability and audit‑ready traceability

The point is not to “add more technology.” It’s to ensure that when disruption occurs, throughput can increase without governance collapsing—because the workflow was designed to prevent uncontrolled side channels from becoming the default.

To pressure-test your intake readiness against 10 core controls, reference the Digital Mailroom + Paper-to-EDI Continuity Checklist

The Takeaway: Continuity Is Operational Control at Scale

In payer environments, disruption is rarely a single‑point event—it’s a stress test that exposes where intake is fragmented, where exceptions aren’t governed, and where visibility is too fragile. The strongest continuity posture doesn’t rely on heroics. It relies on controls: centralized intake, governed workflows, standardized handoffs, embedded QA, EDI validation, and traceability.

For payer leaders evaluating readiness, a simple question is often the most revealing: Can we maintain throughput under disruption without creating uncontrolled workarounds?

A Practical Next Step

If disruptions are creating backlogs, exceptions, or intake delays, a structured review of intake channels is often the fastest place to start. Map your channels, document exception pathways, and identify paper‑to‑EDI dependencies. Then confirm whether you have a controlled intake pipeline, governed exception handling, embedded QA, and end‑to‑end traceability.

A targeted review can quickly surface single points of failure, EDI exposure, and the controls required to stabilize throughput under surge—without creating new risk through workaround‑heavy processes.

Imagenet works with payer organizations to stabilize digital mailroom intake through centralized intake orchestration, governed workflows, and end‑to‑end traceability—with explicit support for paper‑to‑EDI continuity and downstream transmission reliability. Imagenet is positioned as a lower‑risk, scalable, future‑ready (AI/ML‑enabled) alternative for payers reassessing intake exposure. To talk with our experts about continuity options, visit our Digital Mailroom Continuity page.

About Vidhya Bhat

Vidhya Bhat is Chief Product Officer, Digital Transformation at Imagenet, where she leads the strategic direction, commercialization, and growth of Imagenet’s Digital Mailroom and Print-to-EDI (P2E) solutions. With 20+ years in healthcare technology, she is a recognized subject matter expert in document management, workflow automation, and operational efficiency—helping leading healthcare organizations modernize intake, improve productivity, and reduce avoidable operational friction.