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Artificial intelligence and advanced analytics continue to be the focus of healthcare technology vendors as they introduce new tools to help health organizations strengthen regulatory compliance, enable faster patient interventions and operate more efficiently.
Among the news recently announced: Ambience Healthcare has embedded real-time validation at the point of care in Epic, athenahealth and other electronic health record systems. Qventus, meanwhile, has launched a new program to co-develop AI assistants with health systems. Also: Innovaccer just released a new social determinants of health platform that puts key data in providers' hands, and Meditech has new AI features for its patients and doctors.
And of note for payers: Cavo Health is using AI to help it improve its HEDIS measures.
AI for diagnosis validations
Ambience Healthcare launched a real-time patient clinical documentation integrity (CDI) platform to help organizations ensure that clinician-selected diagnoses are fully substantiated under the U.S. Centers for Medicare & Medicaid Services' Monitor, Evaluate, Assess and Treat documentation standards.
By strengthening CDI, the tool can reduce the provider's audit risks under rising scrutiny from CMS. Improper Medicare Advantage payments exceeded $19 billion in FY 2024, including $1.09 billion tied directly to insufficient documentation, the company said in its Sept. 24 announcement.
"The current audit environment highlights how fragile our healthcare documentation processes can be," Mike Ng, Ambience cofounder, president and chairman of healthcare, said in the statement.
The potential for disruptive queries from CMS and the risks of disallowance if diagnoses are not fully substantiated are significant concerns.
"When records are incomplete or inconsistent, it creates downstream inefficiencies in revenue cycle management, undermines the integrity of clinical documentation and burdens both clinicians and health systems," he added.
Ambience's HCC Compliance Validator assesses hierarchical condition categories so that clinicians can resolve any potential compliance issues during patient encounters. The tool also identifies any other gaps in documentation for clinicians to address before notes are completed so that they are audit-ready and "true to the complexity of each patient's story."
The tool is scalable across multiple EHRs.
Devon Morris, a nurse practitioner with Ardent Health-affiliate Utica Park Clinic, said in the announcement that it validates documentation instantly and reduces documentation burdens.
"Manual audits and Epic in-basket queries slowed our workflows and created constant frustration for clinicians," he said. "It not only improves the clinician experience, but also strengthens compliance across the organization."
Secure SDoH data exchange
Innovaccer, a vendor of population health technologies for value-based care, released a new Social Health Information Exchange platform to enhance coordination and better measure interventions.
The FHIR-native SHIE platform integrates EHR Medicaid enrollment data with housing, behavioral health, criminal justice, food assistance and other community-based external data.
While CIEs have improved outcomes and reduced costs, scaling them has presented challenges like fragmented systems and inconsistent consent management, the company said in its announcement Sept. 29.
With SHIE, agencies can leverage AI insights from Gravity, Innovaccer's unified data platform, to identify gaps, guide interventions and collaborate across sectors by coordinating care.
"We built SHIE because communities deserve better than fragmented systems and manual processes," Abhinav Shashank, the company's co-founder and CEO, said in the statement.
"Public agencies need modern tools that not only safeguard data but also unlock the power of AI to reveal gaps and guide interventions."
Real-time alerts and automated workflows help care teams identify risk signals early and can trigger referrals while outcomes are tracked in referral management, the company said.
Meditech adds AI enhancements
In September, Meditech debuted AI enhancements to its MyHealth patient portal and Expanse EHR at its customer summit held Sept. 17-19 in Foxborough, Massachusetts.
Features include a new chatbot and the debut of Commure’s ambient AI available through the Expanse Now app.
With a new MyHealth chatbot assistant, patients can ask questions about their health data and get help scheduling appointments. Other AI agents for clinicians and billing are in development, the company said in a statement.
"We are building an agentic user experience that will help address many of the industry’s most significant challenges, such as staffing and financial pressures, while enabling organizations to provide more personalized care and better outcomes," said Michelle O’Connor, Meditech president and CEO, in a statement.
"Integrating AI technologies to work together like a team to perform tasks behind the scenes in Expanse improves healthcare delivery holistically."
"This is a period of true transformation in healthcare," added Helen Waters, Meditech's executive vice president and chief operating officer. "We designed Expanse as a cloud-native EHR to establish a foundation for innovation that is scalable and can incorporate future technologies, ensuring our customers’ long-term success and sustainability."
With Commure's ambient technology, doctors can automatically capture and structure their patient encounters. The company said the Meditech integration is saving providers an average of 90 minutes per day and reducing cognitive overload.
Integrating ambient AI directly within the EHR extends AI-driven capabilities to a broader base of clinicians, Ian Shakil, Commure's chief strategy officer, explained in a separate statement on Sept. 16.
"We believe this collaboration will empower Meditech users to achieve greater efficiency and improve the overall patient experience," he said.
Make-your-own AI assistants
Qventus, a vendor of AI technology for hospitals and health systems, said on Sept. 18 that it will co-develop custom AI operational assistants through an AI Solution Factory that engages its customers.
The offering is powered by the company's platform, which integrates with hospital EHRs and uses localized and probabilistic machine learning, behavioral science and conversational AI to automate workflows. Health systems can tap into chart mining, patient risk determination and care gap closure features and many others to create their own tailored operational assistance for overburdened staff, the company said.
With Qventus AI as the engine, the AI Solution Factory becomes a high-speed assembly line, according to Mudit Garg, the company's CEO and co-founder.
"It gives us a systematic way to build best-in-class AI teammates, ensuring they are not just effective, but fully integrated into our clients' daily operations for long-term success," Garg said in a statement dated Sept. 18.
"Instead of chasing hundreds of AI use cases, our vision is to go deep on the ones that matter most."
AI that improves payer quality measures
Abstracting standard HEDIS measures that influence health plan quality ratings, Medicare Advantage Star Ratings and CMS bonus payments is no easy task, according to Cavo Health.
Missing even a small detail, like a lab value, can result in a healthcare payer missing an opportunity, the company said as it announced a rules-based AI engine aimed at helping payers improve accuracy, speed and audit-ready transparency.
"HEDIS performance is both a quality imperative and a financial driver for health plans," said George Witwer, the company's CEO, in a statement on Sept. 9.
Through a rules-based approach that is aligned with National Committee for Quality Assurance specifications, the platform surpasses MLmodels that rely on statistical predictions, said Cavo Health.
"Our Precise Word Matching AI removes the guesswork," Witwer noted. "It guarantees compliant hybrid HEDIS abstraction with speed and accuracy, empowering payers to strengthen Star Ratings, reduce audit risk and deliver better care to their members."
Andrea Fox is senior editor of Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS Media publication.
