• Tom Loomis, Enterprise Architecture- Interoperability, Evernorth
• Nancy Bevin, Director, Provider Connectivity, Medica
• Ron Wampler, Executive Director, Interoperability, Aetna, a CVS Health Company

From a December 2025 WEDI virtual spotlight, a panel of health IT leaders break down the current state and the future of regarding information blocking, and how organizations can stay compliant while moving interoperability forward.

The panel:

• Rebekah Fiehn, Strategic Partnership Developer, American Dental Association
• Andrew Tomlinson, Senior Director, Regulatory & International Affairs, AHIMA
• Arna Meyer, Technical Product Manager, Stedi
• Alisa Kuehn, VP, General Counsel & Privacy Officer, Indiana Health Information Exchange
• Chelsea Arnone, Director, Federal Affairs, CHIME
• Sasha TerMaat, EHRA’s Information Blocking Compliance Task Force

The moderator is Jeff Coughlin, Director, Federal Affairs, American Medical Association

From a December 2025 WEDI virtual spotlight, a panel of health IT leaders break down the current state and the future of regarding information blocking, and how organizations can stay compliant while moving interoperability forward.

The panel:

• Rebekah Fiehn, Strategic Partnership Developer, American Dental Association
• Andrew Tomlinson, Senior Director, Regulatory & International Affairs, AHIMA
• Arna Meyer, Technical Product Manager, Stedi
• Alisa Kuehn, VP, General Counsel & Privacy Officer, Indiana Health Information Exchange
• Chelsea Arnone, Director, Federal Affairs, CHIME
• Sasha TerMaat, EHRA’s Information Blocking Compliance Task Force

The moderator is Jeff Coughlin, Director, Federal Affairs, American Medical Association

Participants:

• Jody Denson, CTO, KONZA
• Dennis Sherba, Senior VP, eHealth Exchange
• Nihit Bejaj, Technical Services Team Lead, Epic

• Pam Grosze, Board Chair, the Cooperative Exchange
• Denny Brennan, Executive Director, Massachusetts Health Data Consortium
• Sherry Wilson, Executive VP, Compliance Officer, Jopari
• Crystal Ewing, VP, Product Management, Waystar

Michael offers some quick bites from our top 3 most downloaded episodes of 2025:

#3: Rethinking Value-Based Care: Why Children Can't Be Left Behind (Taylor Beery, Imagine Pediatrics, Ep 219)

#2: Electronic Health Records- An Integral Partner in Health Care Accessibility (Prerana Laddha, Epic, Ep 189)

#1: Bridging the Data Gap- The Role of Standards & Technology in Genomic Data Exchange (Dr Sandy Rolfe, Optum, Ep 188).

Be sure to listen to these episodes in their entirety by visiting our podcast page, www.wedi.org/category/podcasts

Led by moderator Stephan Rubin from Optum, Danielle and Molly dig into the misconceptions that providers and payers often hold about each other and discuss how better data transparency, shared incentives, and policy alignment — including recent CMS rules such as 0057F — can help bridge long-standing divides. The 3 examine the future of prior authorization, the promise and limits of interoperability initiatives like TEFCA and the CMS Aligned Network, and why value-based care still struggles to scale despite years of policy focus. Finally, they look ahead to the role of AI, automation, and emerging data standards in reshaping care delivery and payment, and ask what real payer-provider collaboration must look like to deliver a more seamless, efficient, and patient-centered healthcare system.

They explore how this 100-point model gives leaders a structured way to oversee AI risk, capture opportunity, and ensure responsible use of technology in complex, high-stakes environments like healthcare.

The workgroup’s primary aim is to embed the patient perspective into healthcare business processes and workflows while elevating the patient voice across WEDI’s broader workgroups and initiatives

Michael welcomes Raj Godavarthi, MCG’s AVP of Technology and Interoperability to discuss industry progress on payer-provider compliance work on the CMS Final Rule (CMS-0057-F). After that, Michael addresses artificial intelligence with Dr. Jason Gillman, MCG’s Director of Clinical Informatics. Dr. Gillman is currently involved in the NCQA AI Governance workgroup, and he’s MCG’s representative in the “Clinical Decision Support” workgroup at the Coalition of Health AI (or CHAI).

• Dr. Sandy Rolfe, WEDI’s Genomics Workgroup Chair Clinical Content Lead, InterQual, Optum Insight
• Lesley Berkeyheiser, WEDI's Privacy & Security Workgroup Co-Chair, Assessor with DirectTrust
• Thanh Thien Nguyen, WEDI's Privacy & Security Workgroup Co-Chair, Executive Director, Kaiser Permanente

to discuss their workgroups working together to spotlight the intersection between direct to consumer (DTC) genetic tests and some different privacy and security issues associated with these types of tests. The two workgroups collaborated to develop a Fact Sheet to help consumers take action to protect their data, available here- https://www.wedi.org/2025/07/12/direct-to-consumer-genetic-dna-testing-actions-consumers-can-take-to-protect-their-health-data/ 

Current regulations and requirements Thanh Thien references in the episode

• HIPAA Privacy Rule- https://www.hhs.gov/hipaa/for-professionals/privacy/index.html
• HIPAA Security Rule- https://www.hhs.gov/hipaa/for-professionals/security/index.html
• Genetic Information Nondiscrimination Act of 2008- https://www.govinfo.gov/content/pkg/PLAW-110publ233/pdf/PLAW-110publ233.pdf
• Federal Trade Commission Act- https://www.ftc.gov/legal-library/browse/statutes/federal-trade-commission-act
• California Consumer Privacy Act of 2018- https://oag.ca.gov/privacy/ccpa
• California Privacy Rights Act- https://thecpra.org/
• State Privacy Law Tracker- https://iapp.org/resources/article/us-state-privacy-legislation-tracker/

Melissa Kotrys, Chief Executive Officer, Contexture (Colorado and Arizona)

Phil Beckett, Chief Executive Officer, Texas Health Services Authority

Stephanie Brown, Executive Director, CRISP DC

Jolie returns to moderate another interesting HIE panel at WEDI's National Conference, November 3-6 in Washington DC and Zoom (virtual pre-conference on October 31). Visit https://members.wedi.org/event-calendar for more information

Michael welcomes Matt Spielman, Senior Director of Product Management with Edifecs, to discuss the latest and greatest regarding the industry's ongoing progress with CMS-0057F, the rule aimed at improving prior authorization and interoperability. What is Matt seeing from his customers and others, and what is the present and future of FHIR?

Michael welcomes back (Episode 174, Oct 2024) the co-chairs of the Sequoia Project's Payer to Payer API Implementation Workgroup, Nancy Beavin (Medica) and Bob Oakley (Evernorth), to discuss their new work product, a downloadable tool designed to help payers assess their readiness for compliance with the payer-to-payer components of CMS-0057-F. Along with the workgroup's project manager, Jim Adamson (Point of Care Partners), Nancy and Bob offer updates on the workgroup meetings, the origin of the checklist, and their plans for the future. 

Michael welcomes Brian Hanley, Vice President, Public Sector, with Edifecs. Brian discusses the current state of health care consent management framework, granular consent framework, patient consent management transformation, challenges, and Edifecs consent management solutions. 

The panel:

• Jared Staal, Executive Director, Intelligent Automation & AI, Mayo Clinic, Mayo Clinic
• Newar Shara, PhD, Chief, Research Data Science, MedStar Research Institute. Chief of AI Application in Health Data Science (AI CoLab). Co-Director, Center for Biostatistics, Informatics, and Data Science
• Frederick Chen, MD, Chief Health and Science Officer, American Medical Association

• Robert Laumeyer, CTO, Availity
• Nick Marzotto, Product Informaticist, Epic
• Andy Chu, SVP of Product and Technology Incubation, Providence
• Peter Clardy, MD, Senior Staff Clinical Specialist, Google Health
• Merage Ghane, PhD, Director of Responsible AI in Health, Coalition for Health AI (CHAI)

The two discuss trends in virtual care post-pandemic, lessons learned by health systems regarding virtual care delivery, and key factor for successful virtual-first care models. They discuss the power of patient and provider trust, integration with existing health systems, and the impact of AI and other emerging technology in hybrid care.  

Neal and NRHA will have their NRHA Rural Health Policy Institute in Washington DC in February. Click here for more information

The moderator is Denny Brennan, WEDI Board Member, Co-Chair of its Education Committee, and Executive Director of the Massachusetts Health Data Consortium. 

The panel:

• Anna Taylor, AVP, Population Health & Valiue Based Care, Multi Care Connected Care
• Ben Pollock, PhD, Senior Associate Consultant II, Division of Health Care Delivery Research, Mayo Clinic
• Semira Singh, Director Population Health, Providence
• Brian Wallace, Vice President, Data Analytics and Reporting, Centene Corporation

The moderator was Denny Brennan, WEDI Board Member, Co-Chair of its Education Committee, and Executive Director of the Massachusetts Health Data Consortium. 

The panel:

• Anna Taylor, AVP, Population Health & Valiue Based Care, Multi Care Connected Care 
• Ben Pollock, PhD, Senior Associate Consultant II, Division of Health Care Delivery Research, Mayo Clinic
• Semira Singh, Director Population Health, Providence
• Brian Wallace, Vice President, Data Analytics and Reporting, Centene Corporation

The November 7 event is free and open to all healthcare professionals. Register at wedi.org and select Events. 

The workgroup was created to identify practical, implementation-level implications from a business and governance perspective. The guests discussed the workgroup makeup, their mission, what they've heard so far and why a payer, small, medium or large, should join their community of practice. 

To learn more about the workgroup, visit https://sequoiaproject.org/interoperability-matters/payer-to-payer-api-workgroup/

In this episode, Dr. Harris delves into the challenges faced during the transition, culminating in the unfortunate and harrowing experience of being part of the Change Healthcare ransomware attack, revealing the toll it has taken on his practice, and the lessons learned in cybersecurity and data protection.

Hosted by WEDI Privacy and Security Co-Chair Lesley Berkeyheiser, this episode offers a compelling look at the intersection of medicine, evolution, technology, and resilience.

Michael welcomes Paul Anderson (Health Insurance Specialist) and Jamie Lookabill (Technical Advisor, Enforcement Division) with the Centers for Medicare & Medicaid Services to offer an introductory look at the administrative simplification enforcement process. Paul and Jamie offer information on the different types of HIPAA enforcement, how CMS communicates with the industry about enforcement, and the overall enforcement process, from filing a complaint, the use of ASETT (Administrative Simplification Enforcement and Testing Tool), corrective action plans and civil monetary penalties. 

To learn more about administrative simplification, please visit go.cms.gov/adminsimp

Michael welcomes Steven Berkow, Senior Advisor, Value-Based Care with InterSystems. The two discuss Steve's involvement at WEDI's Summer Forum in Chicago, where he served as a moderator for the payer panel on the CMS Interoperability and Prior Authorization Rule. The two discussed the challenges and potential solutions for improving interoperability within healthcare data, and the importance of standardizing APIs for healthcare providers. 

Be sure to read InterSystems' latest white paper The APIs Are the Easy Part: Maximizing Your ROI While Meeting CMS Interoperability and Prior Authorization Requirements 

Health plans should be able to harness the investment in IT infrastructure mandated by the latest CMS rule on interoperability and prior authorization to create the data liquidity needed drive top strategic goals, such as reducing provider abrasion, improving member experience, increasing productivity, and supporting value-based care. The scope of CMS-0057-F, however, is wide ranging. This white paper:

• Summarizes new requirements for the four types of information sharing addressed, namely payer-to-payer, payer-to-provider, payer-to-member, and prior authorization submission and determination.
• Analyzes processes and workflows impacted by the regulation and resulting opportunities for performance improvement.
• Provides key “Questions to Consider” that should inform plan investment decisions.

Designed to be shared with IT, clinical, and operational leaders, the paper will help your leadership team achieve larger strategic returns on mandated plan investment while meeting regulatory requirements.   

Aaron's article in Forbes magazine can be found here- https://www.forbes.com/councils/forbesbusinesscouncil/2024/05/17/combating-threat-actors-in-the-us-healthcare-sector/

Semira Singh, Director Population Health Informatics, Providence Anna Taylor, AVP, Population Health & Value Based Care, MultiCare Connected Care The moderator, from the AMA, former WEDI Board Chair Nancy Spector

• Semira Singh, Director Population Health Informatics, Providence
• Anna Taylor, AVP, Population Health & Value Based Care, MultiCare Connected Care

The moderator, from the AMA, former WEDI Board Chair Nancy Spector

• Heather McComas, Director, Administrative Simplification Initiatives, American Medical Association
• David Delano, Senior Director of Services, Massachusetts Health Data Consortium
• Raj Godavarthi, Associate VP of Technology and Interoperability, MCG Health

The 3 discuss the changes in the workgroup and the industry since the January 2024 release of the CMS Interoperability and Prior Authorization rule, the exciting role of artificial intelligence in PA, and how their unique stakeholder roles offer a full, detailed dialogue during their monthly meetings. 

Tons of Prior Authorization-related education coming to you courtesy of WEDI. Visit wedi.org and click CALENDAR for more information

If you are interested in joining the workgroup, contact Ariana Poole at apoole@wedi.org.

You must be a WEDI member to join. To become a WEDI member, contact Bill Allder at ballder@wedi.org

The top 10 list will be available soon on wedi.org

The two offer a fascinating look at the progression from fee for service to value based care, recent models launched by CMS, and the importance of data interoperability and standards in improving value based care delivery and contract administration.

Estenda is holding a webinar; Driving Quality in Digital Health: The Role of Generative AI in Testing, on June 14th from 12pm- 1pm eastern. Find out more below. 

https://www.eventbrite.com/e/driving-quality-in-digital-health-the-role-of-generative-ai-in-testing-tickets-902441475747

Michael welcomes CMS NSG Director Michael Cimmino to the podcast to discuss the who, what, where, when and why of administrative simplification and burden and how a standard becomes a standard. 

This is part 2 of a 2 part podcast conversation with CMS NSG on Administrative Simplification. Coming soon, an episode on enforcement. Learn more about CMS' work on admin simp at go.cms.gov/adminsimp

Review the study at https://endpointecosystem.com/

Our moderator is Nancy Spector, Coding and HIT Advocacy Director at the AMA and former WEDI Board Chair.

Our panel:

• Kristie Clarke, CDR, US Public Health Service, Senior Advisor on Data for Health Equity, Office of Public Health Data, Surveillance, and Technology, US Center for Disease Control and Prevention
• Kelly Cronin, Director, Center for Innovation & Partnership, Deputy Administrator, Administration for Community Living, HHS
• Jawanna Henry, Interoperability Systems Branch Chief, Office of Policy, Office of the National Coordinator for Health IT
• Meagan Khau, Director of Data Analytics& Research Group, CMS Office of Minority Health

Our moderator is Nancy Spector, Coding and HIT Advocacy Director at the AMA and former WEDI Board Chair.

Our panel:

• Kristie Clarke, CDR, US Public Health Service, Senior Advisor on Data for Health Equity, Office of Public Health Data, Surveillance, and Technology, US Center for Disease Control and Prevention
• Kelly Cronin, Director, Center for Innovation & Partnership, Deputy Administrator, Administration for Community Living, HHS
• Jawanna Henry, Interoperability Systems Branch Chief, Office of Policy, Office of the National Coordinator for Health IT
• Meagan Khau, Director of Data Analytics& Research Group, CMS Office of Minority Health

The entire Road to Interoperability and Prior Authorization series can be found on WEDI's Youtube Page, https://www.youtube.com/@wedionline

• Leigh Ann Eagle, Director of Health & Wellness Program, MAC, Chief Operating Officer of the Living Well Center of Excellence
• Stephanie Archer-Smith, Executive Director, Meals on Wheels of Central Maryland
• June Simmons, President and CEO, Partners in Care Foundation
• Monique Powell-Davis, MD. Executive Vice President of Medical Services, Mary’s Center

Akshay discusses the power and potential of AI, how Lyric is improving the healthcare payment process for all stakeholders and the importance of responsible AI and privacy when implementing this emerging technology. 

The Panel:

• Leigh Ann Eagle, Director of Health & Wellness Program, MAC, Chief Operating Officer of the Living Well Center of Excellence
• Stephanie Archer-Smith, Executive Director, Meals on Wheels of Central Maryland
• June Simmons, President and CEO, Partners in Care Foundation
• Monique Powell-Davis, MD. Executive Vice President of Medical Services, Mary’s Center

• Brian Wikle, Principal Sales Executive, SS&C Health
• Amy Sall, Sr Director Strategic Business Consulting Executive Advisory (and self professed "Data Goddess") SS&C Health
• John Novak, CIO & VP of Information Services, Bergen New Bridge Medical Center

The group discusses the data-centric challenges of collecting and analyzing SDOH data and the need for the healthcare industry to continue to collaborate with community based organizations. 

Michael welcomes Shweta Maniar, Global Director, Healthcare & Life Sciences with Google. Shweta shares how early experiences of volunteer service shaped her vision of how technology, along with trust and sense of community, can improve the healthcare ecosystem. Shweta also shares advice for women leaders and others in healthcare, and unveils the secret of how almond milk is made (it's probably not a secret, Michael just didn't know). 

Read Kim's article on how NLP can aid payers and providers when exchanging patient information through continuity-of-care documents.

https://www.ajmc.com/view/contributor-unlocking-the-value-of-unstructured-data-from-continuity-of-care-documents-using-medical-grade-nlp

The two address the inefficiencies in the healthcare system, particularly the high cost of revenue cycle tasks, and how leveraging AI can offer immediately value to hospitals. 

Panelists:

• Paul Curylo, Vice President and Chief Information Security Officer, Inova Health Systems
• Bezawit Sumner, Chief Security Officer, Senior Director of Security and Compliance, CRISP Shared Services
• Beth Creed, Supervisory Special Agent, Major Cyber Criminal Squad, Federal Bureau of Investigations

Michael speaks with Smile Digital Health's Director of Standards Strategy Bryn Rhodes about Clinical Quality Language, its challenges with large amounts of data and how FHIR helps mitigate data challenges. 

• Kevin Larsen, MD, SVP, Clinical Innovation, Optum
• Derrick Higgins, Head of Enterprise Data Science and AI, HCSC
• Jared Staal, Senior Director, Advanced Analytics and AI, Mayo Clinic

• Ram Rimal, Manager of Data Science Engineering, UNC Health • Jared Staal, Senior Director, Advanced Analytics and AI, Mayo Clinic • John Loomis, Head of Technology, AI, Engineering, Softheon • Laura Adams, Senior Advisor, National Academy of Medicine • Jigar Patel, MD, Senior Director, Oracle Cloud Infrastructure, Product Management for Healthcare, Oracle Cerner

Michael chats with Gregg Church, President of 4medica and Alaap Shah, lawyer with Epstein, Becker and Green and an advisor for 4medica about the importance of data to EMPIs, how artificial intelligence can address some duplication errors and how health care needs to follow other industries and "get the data right."

• Ram Rimal, Manager of Data Science Engineering, UNC Health • John Loomis, Head of Technology, AI, Engineering, Softheon • Laura Adams, Senior Advisor, National Academy of Medicine • Jigar Patel, MD, Senior Director, Oracle Cloud Infrastructure, Product Management for Healthcare, Oracle Cerner

Michael speaks to Georgia Mjartan, Executive Director of South Carolina First Steps and the Early Childhood Advisory Council on her work on this first of its kind comprehensive portal that connects South Carolinians to the full spectrum of state- and federally-funded services available to young children. 

Learn more at https://first5sc.org/ and https://www.earlychildhoodsc.org/what-we-do/first-five-sc/ 

Tammy and Jamie will be presenting at WEDI's 2023 National Conference November 6-9 offering updates on a variety of NCVHS activities. Register to attend at wedi.org

Learn more at www.villagepaths.com

Panelists: Andrew Scholnick (AARP), Melissa Williams (National Patient Advocate Foundation), Anna Hyde (Arthritis Foundation), Dr. Nicole Purcell (Alzheimer's Association). The moderator was patient advocate, influencer, and host of the HITea podcast, Grace Vinton. 

Dr. Steve Waldren, Vice President and Chief Medical Informatics Officer of the American Academy of Family Physicians discusses how AAFP's Innovation Lab has embraced the power of artificial intelligence to aid their physicians with numerous functions and processes. 

We welcomed HEAT's co-chairs, Dr Marshall Chin from the University of Chicago and Karen Dales from Amerihealth Caritas to discuss the group's work and their mission to address and eliminate health disparities while identifying payment models that aid communities. The session was moderated by Michael Pattwell from Edifecs who also serves as WEDI's Payment Model Workgroup Co-Chair.  

Regarding healthcare, collecting data on intersectional social factors like race, ethnicity, gender identity, and sexual orientation can help identify disparities experienced by specific populations in order to develop initiatives that target community’s needs thus yielding (hopefully) positive health outcomes.

Matthew speaks with 4medica President Gregg Church on how incorporating intersectionality and Social determinants of health (SDOH), healthcare systems can improve the quality of data used to address health equity.

• U. Michael Currie, Chief Health Equity Officer, UnitedHealth Group
• Adam Milam, MD, PhD, Medical Director, Office of Health Equity and Inclusion, Mayo Clinic
• Ajay Jayakumar, Director, Strategy and Analytics Diversity Science, Mayo Clinic
• Marquita Davis, Enterprise Director, Office of Health Equity and Inclusion, Mayo Clinic

Michael chats with Dr. Melissa Perry, Dean of the College, on her early motivations and inspirations, the school's importance in teaching, learning, innovation and community involvement and its importance to the state's future health. 

Purchase Dr Sullivan's book, "We'll Fight It Out Here: A History of the Ongoing Struggle for Health Equity", co authored by Dr. David Chanoff, on Amazon

Find out about Chronically Simple on the app store or visit https://www.chronicallysimple.com/

This week, Ed Hafner, WEDI's board chair and Nancy Spector, WEDI's most recent former board chair visit the podcast. Ed is the Associate VP, Payer Strategy with Change Healthcare and Nancy is the Coding and HIT Advocacy Director with the American Medical Association. 

Matthew speaks with David Haugen, Administrative Simplification Program Director with Minnesota's Department of Health (https://www.health.state.mn.us/facilities/ehealth/auc/index.html) and Denny Brennan, Executive Director of the Massachusetts Health Data Consortium (www.mahealthdata.org).

The 3 discuss the significance of state data exchange operations, the importance of states learning from each other, the huge topic of prior authorization and how focusing on the patient can help "stabilize the stool" that is healthcare data interoperability. 

What are some common trends and deficiencies that OCR confronts in their investigations? Why the increase in cyber attacks on business associates and what resources and guidance (spoiler alert: there are plenty) does OCR have available to aid in keeping healthcare entities safe and secure?

The two discuss Zoom being in the healthcare arena and the future of telehealth. 

What is the present and future of data analytics in healthcare and how can it remain responsible while also changing the way the industry manages inefficiencies and increases productivity

Michael chats with Phil Englert, Director of Medical Device Security for the Health Information Sharing and Analysis Center (H-ISAC) about the industry's concerns regarding security concerns with third party vendors and medical devices. 

Learn more about H-ISAC at www.h-isac.org

The National Committee on Vital and Health Statistics (NCVHS) Standards Subcommittee hearing took place Jan.18 & 19, examining the new and updated transaction standards and operating rules. Robert testified on behalf of WEDI, presenting the feedback the association received from its Member Position Advisory (MPA) session in late 2022.

The first day focused on the X12 proposal to move to the 008020 version of the Dental, Institutional, and Professional Claim (837) and the 008020 version of Health Care Claim Payment/Advice (835). Day two included the CAQH CORE proposal to move to updated and new operating rules.

Learn more about WEDI's MPA here- https://www.wedi.org/2023/01/20/wedi-testimony-ncvhs-x12-caqh-core-hearing/

Learn more about NCVHS' Hearings here- https://ncvhs.hhs.gov/meetings/standards-subcommittee-hearing/ 

Matt discusses the change in telehealth usage over the past several years and how healthcare must continue to evolve and incorporate emerging technologies to offer patient a more seamless, efficient, equitable and satisfying experience. 

Learn more about HIEs and Civitas Networks for Health at https://www.civitasforhealth.org/

Epic manages electronic health records for more than 250 million patients and is now expanding clinical trials by kicking off a Life Sciences program to help speed up the development of new therapies. Providers across the world use Epic to conduct more than 100,000 active research studies with 4.7 million patients. 

Additionally, they discuss the importance of companies providing data for the greater good of Americans' lives. Large data sets like Epics’ Cosmos can provide health officials with the data needed to enact changes. This allows doctors to learn from thousands of other hospitals and support researched-health needs like adverse trends in healthcare and outbreak detection. 

Learn more about Epic's work below

epic.com

epicresearch.org

epicshare.org

Here’s a link to a fentanyl study referenced in the episode : Only 5% of Overdose Patients Tested for Fentanyl, #1 Killer of Americans 18-45 (epicresearch.org)

Durwin offers his initial thoughts on the PA and Attachments proposed rules, the role of FHIR and a glimpse into the potential discussions that will take place during his Attachments Subworkgroup meetings. 

If you are a WEDI member, participation in any workgroup meeting is a benefit you should take advantage of. If you are not a member, visit wedi.org to learn more about the association. 

Michael has a fascinating conversation with Cloud DX CEO Robert Kaul. Cloud DX is working on developing healthcare within the relatively new and mysterious metaverse, which consists of virtual and augmented reality experiences that we haven't even begun to scrap the surface of. Additionally, the two discuss the role of remote patient monitoring and how it can improve access to care for the chronically ill and those living in rural regions. 

To commemorate Telehealth Awareness Week, Matthew sits down with Robin Farmanfarmaian, a professional speaker and healthcare entrepreneur working with cutting-edge Artificial Intelligence Software, Device and Pharma companies poised to impact 100M patients. Within these companies, she focuses on strategy, business development, revenue and fundraising.

Robin's latest book, "How AI can Democratize Healthcare; Shifting Care from the Clinic to the Point of the Patient", is available this month at https://democratizinghealthcare.ai/ . Learn more about Robin at https://www.robinff.com/

Matthew and Robin discuss the trend in healthcare away from in-person care to at-home delivery, behavioral health, virtual therapeutics and remote patient monitoring. 

Matthew chats with Zack Kimble, Staff Data Scientist for MCG Health about various levels of artificial intelligence that MCG is working on, including machine learning and natural language processing. How is AI aiding healthcare in prioritizing utilization reviews, support appropriate level of care, determine appropriate clinical documentation and so much more. 

Matthew discusses data liquidity and the need for improve healthcare efficiency with Avaneer Health Chief Commercial Officer Ray Jebsen. 

In 2019, Avaneer Health was founded by a consortium of top industry leaders on a mission to unlock the full potential of healthcare by improving transparency and enhancing interoperability.

The consortium included Aetna, a CVS Health company; Anthem; Cleveland Clinic; Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC); The PNC Financial Services Group, Inc.; and Sentara Healthcare. Incorporated in 2020 as the Health Utility Network, they are now known as Avaneer Health. With continuing support from their partners and the biggest players across the healthcare space, Avaneer aims to play a key role in transforming how the healthcare industry operates to address consumers' needs more efficiently and effectively

Learn more at https://avaneerhealth.com/

Helpful links:

Prior Authorization and Utilization Management Principles: https://www.ama-assn.org/system/files/principles-with-signatory-page-for-slsc.pdf

Consensus Statement on Improving the PA Process: https://edhub.ama-assn.org/data/multimedia/10.1001ama.2018.0080supp1.pdf

2021 AMA Prior Authorization Physician Survey- Wave 1: https://www.ama-assn.org/system/files/prior-authorization-survey.pdf

2021 AMA Prior Authorization Physician Survey- Measuring Progress in Improving PA: https://www.ama-assn.org/system/files/prior-authorization-reform-progress-update.pdf

“Convergence 2.0.” The Subcommittee conducted three panels: (i) Advance HIPAA Standards Adoption; (ii) Address Standards Integration and Collaboration; and (iii) Measure the Value of Standards. WEDI Board Chair Nancy Spector represented WEDI on the first panel and joins Matthew this week to discuss more about WEDI's suggestions on when electronic standards should be adopted by the industry

“Convergence 2.0.” The Subcommittee conducted three panels: (i) Advance HIPAA Standards Adoption; (ii) Address Standards Integration and Collaboration; and (iii) Measure the Value of Standards. WEDI Board Chair-Elect Ed Hafner (Assistant VP of Payer Strategy, Medical Network, Change Healthcare) represented WEDI on the third panel.

Matthew chats with Ed on his participation at the listening session and the future of healthcare standards. 

Read Mobile Mentor's study here, Healthcare Endpoint Ecosystem Study — The Endpoint Ecosystem

The two discuss what healthcare orgs should be prioritizing regarding digital health transformation, creating a frictionless digital health experience for all parties and assessing digital maturity in an organization. 

The community develops strategies, resources, best practices and thought leadership to increase awareness and mitigate the impacts of unconscious bias, social determinants of health and lack of inclusion or consideration of racial and ethnic minorities in critical aspects of the product development lifecycle. Learn more at MedTech Color Collaborative Community

Dr Lomis participated in a National Academy of Medicine Discussion Paper titled Artificial Intelligence in Health Professions Education. The paper examines how training in appropriate use of AI will become increasingly important for health professions educators, and highlights AI’s ability to supplement, not replace, health care workers.

Read the paper here- Artificial Intelligence for Health Professions Educators - National Academy of Medicine (nam.edu) and learn more about the AMA's guidance and resources on Artificial Intelligence here- Augmented intelligence in medicine | American Medical Association (ama-assn.org) 

The two shared perspective on the pressure and timing with respect to machine readable files, the challenges organizations face in complying with the requirements, and what issues are their constituents seeing and encountering

To learn more about prenatal advancements discussed in this podcast, click here: PreTRM®

Based on data from the World Health Organization, the US is #6 on the list of countries with the highest pre-term birth (PTB) rates. That places the US higher than Bangladesh and lower than Indonesia. The top 4 countries with highest PTB rates are India, China, Nigeria, and Pakistan. Our guests discuss advancements in prenatal early intervention to improve maternal and neonatal health outcomes of preterm births. 

Holly and Dr Hibay introduced the DREAM BIG (DRiving Equity for All Moms & Babies by Improving Gaps) in Maternal Care Initiative.

Joy will be a special moderator at our Spotlight on Leveraging Data and Technology to Support Health Equity, taking place February 16-17 on Zoom. Register at wedi.org and use the special code HITGIRL for 25% off your registration rate. 

RxRevu is an industry leader in Real-Time Prescription Benefit services. By partnering with physicians, health plans, IT vendors, and health systems, RxRevu is driving data transparency and better patient care nationwide

Dr. Galvin is the founder of the Protecting to Promote Interoperability Workgroup (PP2PI),  a group that is developing technical standards and policy recommendations to advance interoperability and privacy protections by prioritizing data segmentation development, testing, and policymaking. This work is also expected to also help physicians comply with aspects of the information blocking regulations. 

Learn more about PP2PI from their website, Protecting Privacy to Promote Interoperability (PP2PI) Workgroup – Drummond Group and their interest form- Protecting Privacy to Promote Interoperability (PP2PI) Interest Form (google.com)

Matthew welcomes David Finn, VP with the College of Healthcare Information Management Executives (CHIME) and has a frank discussion about data security in healthcare; where are we failing and what can we do?

David references CHIME's 2021 CISO Survey along with their recent Most Wired Survey, showcasing excellence in the use of digital technology in America's health systems. 

MCG’s transparent assessment of the latest research and scholarly articles, along with its own data analysis, gives patients, providers and payers the vetted information they need to feel confident in every care decision, as well as providing a means to have collaborative discussions about care.

Matthew sits down with Raj Godavarthi, AVP of Technology and Interoperability and Marivie Lanter, Director Product Management and discusses the pending CMS rule on PA and FHIR mandates, MCG's participation in the HL7 Da Vinci Project and how MCG has developed assistive AI and NLP solutions to facilitate the utilization review process,, identify the appropriate level of care for patients, and support evidence-based decision-making

This session is  moderated by John Kelly, Principal Business Advisor with Edifecs, WEDI Board Member and Co-Chair of WEDI's Education Committee and was recorded during WEDI's national conference in October. 

Hans Buitendijk, Director, Interoperability Strategy, Cerner

Tim Pletcher, Executive Director, Michigan Heath Information Network, MiHIN

Danielle Lloyd, Senior VP, Private Market Innovations & Quality Initiatives, AHIP

Upcoming WEDI Educational Events:

• TEFCA Presentation with ONC's Micky Tripathi PHD and Sequoia Project's Mariann Yeager- FREE to the industry, August 26 on Zoom
• WEDI National Conference, October 18-21, 2021 on Zoom. Use the code PODCAST for 15% off your registration fee

Visit www.wedi.org to register

Interested in joining WEDI and/or a workgroup? Visit wedi.org

Recently the center completed its Artificial Intelligence (AI) Health Outcomes Challenge. Listen to the winner of the million dollar challenge, ClosedLoop.ai, at WEDI's annual Summer Forum, July 27-29 on Zoom. Register at wedi.org and enter the code PODCAST for 15% off the registration rate. 

We welcome Dr. Tiffany Avery, Chief Medical Officer for NantHealth for a in-depth discussion on the multi-factor nature of healthcare. Looking at Health Equity through the lens of oncology, Dr Avery calls for the industry to use data to not only serve all patients equally, but to understand that one's environment is also key to ensuring a positive patient experience. 

Helpful Links to Learn More:

https://nanthealth.com/

Their blog: https://nanthealth.com/resources/category/articles/

Follow them on social media:

LinkedIn https://www.linkedin.com/company/nanthealth/

Twitter @NantHealth

Facebook: https://www.facebook.com/NantHealth/

From our National Conference, WEDI's Privacy and Security workgroup co-chairs, Marilyn Zigmund Luke (AHIP) and Tina Grande (Healthcare Leadership Council) host a roundtable discussion on the evolution and challenges of securing patient data in today's healthcare IT environment. The panelists:

• Lina Walker, PhD, Vice President, Health Security, AARP
• Mari Savickis, Vice President , Public Policy, CHIME
• Laura Hoffman, JD, Assistant Director, Federal Affairs, American Medical Association

Matthew welcome CAQH CORE Board Members Tim Kaja (Chair) and Linda Reed (Vice Chair). Tim is Senior Vice President at Optum Care and Linda is the Vice President and Chief Information Officer at St Joseph's Health. 

For more than 20 years, CAQH has created shared initiatives to streamline healthcare administration. Today, CAQH technology-enabled solutions, operating rules and research help nearly 1,000 health plans, 1.6 million providers, government entities and vendors connect, exchange information and operate more efficiently.

Matthew discusses CAQH CORE's origins, their current rule development efforts and latest pilot and measurement activities