Lyle Berkowitz, MD, FACP, FHIMSS

I’ve been given advice that the fastest way to monetize HER Heard without charging the end user (woman) is trackers and selling data. Instead, I’d like to build something more trustworthy. I don’t want to be in a headline like this. If you are not paying, then you are the product (you/your data are being sold). There are newer ways to deindentify data or even to aggregate things women search for that can be of interest to various stakeholders. In theory that could be okay to sell, but in a post-Roe world with laws encouraging bounty hunting, I am vetting the choices ahead. I am all for moving fast, without breaking things.

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It's wild to think in 2024 we're FIRST seeing the DOJ accuse telemedicine conglomerates of criminal drug distribution. How long have we known about these practices in brick and mortar care...? Answer: decades! Take it from someone who prescribed stimulants and other psychotropics to kids over the years - painstakingly measuring and documenting the need and impact - these appalling abuses by Done and Cerebral mean we need more calls for thoughtful pause when it comes to working with startups. Particularly about funding's role - my favorite topic! 🤑 How did we end up with venture capital and PE financing in healthcare that risk the safety of kids in the name of exorbitant returns? Not that all VC or PE dollars are bad, of course, but they're certainly key drivers who shouldn't be in that seat. Did we underestimate these funders as 'barbarians at the gate', much like the pharma reps of the 90's and early 2000's heyday? Have we not learned from Purdue Pharma's aggressive and deadly Oxoycontin marketing? Purdue pleaded guilty to criminal charges and paid $600 million in fines in 2007. Or TAP Pharmaceutical Products's Lupron kickback scheme for the prostate cancer drug? TAP also pleaded guilty to criminal charges and paid $875 million in fines in 2001. Or Pfizer marketing Neurontin, an anti-seizure drug, for off-label uses, such as treating pain and bipolar disorder, even though the drug was not approved for these purposes, and paying physicians kickbacks. In 2004, Pfizer pleaded guilty to criminal charges and paid $430 million in fines. Cerebral and Done's playbooks were practically the same thing, just with a modern mid-pandemic, low-regulatory scrutiny, digital-platform twist. Will appropriate regulation ever outpace American venture greed? Is it even possible to ensure patient safety AHEAD of tragedies driven by the intersection of innovation and venture funding? If you're keeping score, healthcare regulatory reactivity: 1 million. Healthcare ounces of smartly preventive policy: 3. Blech. 😖 When will we finally own that prevention in-house? #healthcare #overdoseprevention #suicideprevention

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Key trends and takeaways from HLTH 2024: 1. AI's Evolving Role: AI dominated discussions, with executives acknowledging its potential while also recognizing challenges in accuracy and clinician trust. There's a shift towards focusing on the practical applications of AI, with a call for partnerships to ensure reliable testing and implementation. 2. Infrastructure Focus: Beyond the glitzy AI tools, there's a growing emphasis on the "picks and shovels" needed for healthcare data accessibility, including infrastructure, compliance, and interoperability. Executives believe that improving data flow will facilitate the effective use of AI. 3. Middlemen Under Scrutiny: Pharmacy benefits managers (PBMs) faced criticism for their role in rising drug costs, with discussions highlighting misaligned incentives and the need for transparency in healthcare pricing. 4. Women's Health Spotlight: Women's health initiatives gained attention, particularly following government funding announcements and personal stories shared by advocates. However, investment in women's health remains minimal compared to overall healthcare funding. 5. Interest in Psychedelic Medicine: The potential of psychedelics for treating mental health conditions garnered significant interest, with discussions about funding and research moving forward, especially within the Veterans Affairs system. Executive Takeaways: Leaders from various sectors emphasized the importance of consumer-focused strategies, collaboration, and the need for responsible AI usage. There was a consensus on the critical role of addressing healthcare accessibility, improving patient experiences, and fostering innovations that genuinely enhance care delivery.

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AI in Care Delivery – It’s Here…Sort of As with many new technologies in healthcare, <insert name here> is going to “disrupt” and/or save healthcare from itself. “The next new widget has arrived” and will "bend the cost curve." Many of these technologies, though, are one-dimensional and fail to recognize, or adequately address, the disparity and multivariate inputs of the healthcare delivery ecosystem. In many instances these technologies are doomed to fail before they leave the nest. That said, with reduced payments to clinicians (especially from Medicare/Medicaid) coupled with the rising cost of delivering care, providers and health systems find themselves in a prickly position: how do we maintain, let alone grow, our margins? I’ve been a bit…cautious…about AI in healthcare for what should be obvious/glaring reasons. I’ve also been optimistic understanding that AI should, and will, play a greater role in future healthcare delivery/analytics/ decision making. Some emerging technologies show actual care-delivery promise. Lately I’ve noodled “ambient voice” or “clinical conversation” platform technology at the point of care. Ambient voice converts natural language (e.g. discussions) between clinicians and patients into clinical documentation. I’m interested in this technology primarily because it may help clinicians dig out from under the mind-numbing amount of documentation they perform which is, without argument, unproductive. While a little way to go (nothing in IT is ever “100%”), the benefits of clinical conversation can be: ·  assist in note/documentation clarity/accuracy ·  improve submission timeliness (e.g. reduced lag days from date of service to date of submission – cash acceleration) ·  enhance provider satisfaction/lifestyle (no finishing notes at midnight) · improve patient interaction/satisfaction (Dr. not staring into a computer while chatting with the patient) ·  provide, if desired, the opportunity to see more patients due to efficiencies ·  integration with current EMR vendors (some voice recognition services are integrated into EMRs like eCW and Epic) · per click, low cost (relatively speaking), and ·  some offerings are, or are heading to, a multilingual packages Shortcomings: · possible audio issues due to room set up, etc. (cleaned up with minor tweaks) ·  trial/error effort: > not unlike Dragon Naturally Speaking when it landed in the early 2000s. · Early adoption; some hiccups While no new (or maybe old, for that matter) technology is perfect, this AI-enhanced tech is certainly rowing in the right direction. With proper IT connectivity and “training” the new and upcoming offerings may go a long way to assisting clinicians at the point of care and maybe mitigating clinician burn out. Theoretically, the benefits may be immense in terms of coding/charging, human capital savings, accuracy, revenue cycle, and patient communication/satisfaction. Chalk one up for the tech that may have grown its wings! 

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100% satisfaction in birth metrics! What is the secret? Cleveland Clinic achieved 100% satisfaction across five birth metrics, a notable feat that Becker's Hospital Review highlighted. Cleveland Clinic adopted TeamBirth in October 2022. TeamBirth is a care delivery model jointly created in 2021 by Harvard Pilgrim Health Care, Ariadne Labs and UMass Memorial Health. It emphasizes routine check-ins with all patient care team members and family at key points to streamline communication about birth preferences and patient status, using a whiteboard as a key tool. Since adopting it, the health system saw the rate of C-sections for Black mothers go down from 41% to 22%. Rates also improved for white mothers, dropping from 27% to 23%, bringing the outcomes for its patient populations to a more equitable level. ▶ Satisfaction went up across five categories in 2022 to a perfect 100% for: ➡ Friendliness/courtesy of the unit — up 10% from 2022. ➡ Staff concern, information about progress and baby’s condition — up 12% from 2022. ➡ Nurse promptness in responding to patient call — up 12% from 2022. ➡ Nurse's attitude toward patient requests — up 13% from 2022. ➡ Doctor and staff working together during birth — up 15% from 2022. Patient satisfaction grew by 23% — from 72% in 2022 to 95% in 2024 — for how well they felt Cleveland Clinic managed their pain during labour. Transparent communication is important to promoting safety and reliability in high-risk organizations. ♻ How is the communication in your organization? #healthcare #communication #reliability

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One key reason why healthcare technologies like AI, telemedicine, and software haven't structurally lowered costs or broadened access for the entire system after decades of experimentation (excluding pure financial engineering of payer contracts) is the limited reimagining of care delivery itself, with asynchronous telemedicine as a notable exception. In the same way that digitizing physical paper failed to exploit the capabilities of a new computing medium for word processing, hosting physician-patient conversations over video does not transform the actual delivery of care. In telemedicine, many of the inputs (e.g., clinician time) and therefore cost structures of in-person care persist, which is why we often see fee-for-service telemedicine companies struggle to achieve economies of scale (i.e., growing revenues non-linearly while growing costs linearly). Until we deconstruct the components of a medical appointment – from intake and triage, to chart review, history gathering, physical examination, diagnosis, treatment, and follow-up – we will continue to be underwhelmed by the disconnect between the transformative potential of these technologies and real-world patient/system impact. I’m optimistic that the emergence of reliable and performant medical AI agents will urge us to perform this deconstruction and redesign the fundamental building blocks of a “medical appointment.”

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What does the future hold for retail medicine and virtual care? Walmart is the latest to announce their health center closure. https://lnkd.in/geZpMTkS. This following Optum news, VillageMD closing in Nevada, Teladoc Health problems, etc. What comes next? This is another in a long line of examples that technology and even consumer willingness are not enough when the reimbursement environment does not support particular care models. Are we getting ready to lose all the lessons painfully learned during the pandemic? Or will new virtual care models emerge following this round of closures?

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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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Learn about ethical and practical integration of AI, focusing on creating systems that improve patient care without compromising physician autonomy or patient privacy from speaker Jesse Ehrenfeld MD MPH at AIMed24. He advocates for responsible AI use that supports clinical decision-making, enhances patient safety, and alleviates administrative burdens on healthcare providers. #AIMed24

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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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Digital health leaders should be *hoping* for an investment boom this year instead of *bracing* for one... One statistic jumped out at me: 46% are *still* working to achieve meaningful product-market fit. Doesn't seem to bode well for fundraising? Don't get me wrong - I'm hopeful that digital/virtual care options as part of the continuum of care can help people improve their health and finally start to bend the cost curve in healthcare. But a crowded market, with operating cash stretched and less purchasing activity suggest consolidation this year. Any investors care to weigh in? https://lnkd.in/gtG8uz6d

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Here’s your recap of last week’s health IT news 🗞️ 👇 🤖 AI Clinician Assistant • Avaamo launched an AI ambient scribe solution with support for over 50 specialties with pre-trained models. • Wound AI, an AI clinical decision support solution built by VANTIQ, Telemedicine Solutions, LLC, and NTT DATA, launched and is now available 📞 AI Contact Center • Premier Inc. awarded a group purchasing agreement to TeleVox Healthcare. 🏥 AI Facility Management • Medely has integrated with Oracle, allowing users to leverage Oracle’s Cloud HCM capabilities. 🌡️ AI Remote Patient Monitoring and Triage • The Alliance for Smart Healthcare Excellence—established by care.ai, now a part of Stryker, and developed with assistance from CHIME—was established to promote the Smart Hospital Maturity Model (SHMM). 📈 Data & Analytics • Epic expanded its set of APIs available to developers to support USCDI v3. • Health Catalyst will acquire Intraprise Health, a cybersecurity provider; it was also selected for analytics and interoperability by CyncHealth, Iowa’s health information exchange (HIE). • Health Commons Project acquired OneHealthPort • Socially Determined released a new application that helps organizations access data for minors. 🧾 Orders & Fulfillment • Surescripts is expanding its Medication History for Populations product to health plans, enabling care management teams to identify gaps in care and improve outcomes. 🧑‍💻 Virtual & At-Home Care • Mass General Brigham launched a partnership with the New England Center and Home for Veterans to provide hospital at home services for veterans experiencing homelessness. • MedStar Health expanded its partnership with DispatchHealth to support care transitions.    🍎 VBC • i2i Population Health is partnering with CureMD to surface actionable data to providers at the point of care. 🧠 Food For Thought • Brendan Keeler shared an interesting post differentiating AI solutions across augmentative vs. autonomous and then further breaking down each. One take we found interesting was, “Active interfaces are fun, but ultimately have some of the same problems as Siri - they require explicit engagement and cognitive overhead to use. This means their adoption and impact often fall short of expectations - users must actively remember to use them and overcome the friction of engagement.” https://lnkd.in/eR39qFpK --- Want the latest healthcare tech news delivered to your inbox each week? Sign up here 📬 👉 https://lnkd.in/e2UJ3ckP

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If health systems master the art of delivering a world-class consumer experience in urgent care, they can replicate this success across their entire operation, becoming market leaders and thriving in the long term. This is the core thesis of what we do at UCP Merchant Medicine. For nine years, UCP Merchant Medicine has partnered with 68 healthcare operators, most of whom are health systems, to create internal capabilities that allow them to thrive in consumer experience excellence. This isn’t just about having a world-class urgent care platform, this is about owning the future and the capabilities to expand these experiences across the broader health system. As healthcare shifts towards a consumer-driven model, the need for health systems to adapt is more critical than ever. Patients now have unprecedented freedom to choose their care providers, with 45% researching providers and costs before choosing a health plan, and 44% before making an appointment, according to McKinsey’s consumer Health Insights Survey. These improvements are not just numbers; they're about real people getting better access to the care they need when they need it in a way that they will love. This is what we stand for at UCP Merchant Medicine. Join us as we continue to innovate and lead the way in making healthcare more responsive, efficient, and patient-centric. Together, we can transform the future of healthcare! #HealthcareInnovation #PatientCare #UrgentCare #HealthcareLeadership #UCPMerchantMedicine Intellivisit Solutions

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I get Dr. Yang's concern about large, wealthier health systems adopting AI sooner than smaller, poorer organizations, but this is actually a good thing...unless your time horizon is myopically short. Big organizations, with much larger budgets and sophisticated IT teams, can afford to take risks, make mistakes, and test out exciting (but still unproven) emerging tech while smaller organizations certainly can't (for the most part). So let the behemoths take all the risk, do the heavy lifting first, and then smaller organizations get to adopt truly proven solutions at lower risks/prices...once these have run the Kaiser, Mayo, Intermountain, etc., gauntlet. It's all part of the plan... #healthcare #startups #startup #ai #generativeai #digitalhealth #emergingtech Kaiser Permanente Cleveland Clinic Mayo Clinic Risant Health Intermountain Health https://lnkd.in/gckgQB_q

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As AI becomes more embedded in healthcare decisions, ensuring traceability from algorithmic decisions back to clear guidelines and submitted clinical evidence is critical. Recent findings on companies like EviCore reveal a disturbing gap where AI and algorithms drive treatment denials, often with little transparency. When decisions about patient care are delegated to AI, every outcome should be fully accountable—linking directly back to both the clinical guidelines and the evidence provided by the physician. For AI-driven decisions, transparency is not a nice-to-have; it’s essential. This traceability not only fosters trust among healthcare providers and patients but also ensures that cost savings don’t come at the expense of patient care or quality. As we advance AI in healthcare, let’s prioritize clear, traceable pathways that support both efficiency and patient-centered care. https://lnkd.in/gV-AP8j9 #HealthcareInnovation #AIEthics #PatientAdvocacy #HealthcareTransparency #PenguinAi #Healthcare #PriorAuth #Denials ProPublica Missy Krasner Peter Longo Kishore Ayyadevara

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Healthcare has made improvements but there's still a long way to go to become truly digital-first. While we've seen advancements in telemedicine, electronic health records, and AI-driven diagnostics, the journey to fully integrate these technologies into everyday practice is far from complete. And the “door” to care – patient navigation – needs a lot of work. If we don't evolve, patient's will find others who do! https://lnkd.in/eSJKiHSR #patientcentricity #digitalfirst #digitaltransformation #patientnavigation

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Shifting the financial model alone is not sufficient for the transition - the care delivery, workforce, and many other pieces of the ecosystem with which PCPs interact also need to adjust accordingly. Funding to allow for the startup costs of transformation must be made available. A comprehensive analysis from The Commonwealth Fund: To encourage participation, practitioners say upfront payments, investment in the primary care workforce, and less emphasis on simplistic quality measures are needed, as well as more support for practices to provide accessible, comprehensive care. #primarycare #integratedcare #teambasedcare #healthcare #healthcareonlinkedin

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Walmart joins so many others in quickly entering and leaving or scaling back in healthcare after ambitious plans to scale. This morning, Walmart said it will close all 51 of its health-care clinics, as well as shut down their telehealth virtual care services. This is right after an announcement in March that they wanted to double the size of their clinical operations by opening up over 20 more locations this year and more next year. The reasons they cited? “Like others, the challenging reimbursement environment and escalating operating costs create a lack of profitability that make the care business unsustainable for us at this time.” As a physician, it’s been fascinating to watch over the past few years as so many non-medical companies try to get their bite of the huge percentage of the GDP that is healthcare. They pour money into trying to deliver healthcare at scale, ignoring the many concerns that hospital systems and physician private practices have been citing for years: declining reimbursements, shortages of clinicians, and expensive labor costs. Healthcare is broken, and those that are in it understand why. Patients need - and deserve - quality health care. This requires safe staffing practices, skilled clinicians who can feel good about what they do, and insurance companies that pay their bills. We can’t have a system where insurance companies can get away with record profits while finding more and more reasons not to pay for care and eroding away at the heart of healthcare. You cannot scale your way out of America’s healthcare problem. You actually need to fix the incentives, regulate insurance companies, pay clinicians appropriately, prioritize clinician well being and retention, and focus on the patient. The days of paying lip service to physicians leaving medicine and physician burnout are numbered. Supply and demand forces will necessitate real solutions that move the needle. Companies will come and go in the healthcare space when they realize how hard it is on the ground in healthcare these days. The question for patients and legislators is, who will be left to pick up the pieces if there’s no support for physicians, other healthcare workers, and hospital systems?  The percentage of clinicians leaving healthcare annually because they no longer recognize the heart of why they joined the profession is astounding, with over 1/4 of clinicians looking to leave within the next few years. Relying on the altruism of clinicians and the erosion of quality healthcare to support profits for corporations is just not a sustainable business model in healthcare - not to mention terrifying for public health. #HealthcareOnLinkedIn #PhysicianBurnout #PhysicianShortage #Walmart

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Microsoft has introduced advanced AI capabilities for healthcare organizations through Microsoft Cloud for Healthcare. This includes AI models in Azure AI Studio, which facilitate the integration and analysis of diverse medical data types such as imaging, genomics, and clinical records. Additionally, Microsoft Fabric enhances healthcare data solutions, allowing organizations to harmonize various datasets and perform care management analytics. The healthcare agent service in Copilot Studio automates tasks like appointment scheduling, while an AI-driven nursing workflow solution streamlines documentation, ultimately improving patient care and operational efficiency.

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