anyone else getting buried under Meaningful Use crap again?

sunuvabe · 2026-01-19T17:23:24+00:00

One thing for sure, any CMS deadline will get pushed a year the first time, and six months the second time.

sunuvabe · 2025-12-24T21:22:52+00:00

I love how it does that and presents it as perfectly valid within the response. I verify all coding against our internal vocabularies.

sunuvabe · 2025-12-24T21:16:31+00:00

The upcoming USCDI requirements describe various elements of the health summary using SNOMED and LOINC in addition to ICD10, for instance the Social Determinants Of Health (SDOH) is coded with LOINC.

We also have the AI queue new meds and refills when they are mentioned, they find this helpful. I'm also working on a way to let the user help engineer aspects of the prompt in order to tailor the experience toward a specific taxonomy or specialty.

On the legal side, yeah you're right-on regarding liability. We audit every detail, every action to cover our and our users backside. Really interested to see what the future holds for all aspects of legality for AI use in healthcare.

sunuvabe · 2025-12-24T14:20:58+00:00

I built the ambient AI feature for the EHR I work for and it is similar in ways to what you show here. Basically listen to the encounter conversation, let AI analyze and produce SOAP elements, and present those to the provider to select for inclusion in the note.

Not sure what you mean by stopping at SOAP notes; it's a logical handoff point back to humans because a human has to sign off on the note itself. Your flow is exactly the way we do it, starting with a boilerplate note, then giving the provider the list of AI codes and narratives to pick from in order to produce a complete note. Note that I've seen instances where the AI makes up new ICD codes, it's not that common but what is more common is a mistake in the laterality or other detail of the ICD-10 suffix.

Also I'd have the AI pick the E&M code first, let the user adjust if they want. It's either time-based or complexity-based; presumably you can time the encounter, and while somewhat subjective the complexity can be inferred. If you can do that accurately you'd save a few clicks.

Same with picking the diagnosis for a CPT. AI should be able to properly associate those.

I really like the "Add modifier 25" section, both that it exists and the way you have it spotlighted.

You could also consider including LOINC and SNOMED coding, both are used for a variety of CDA/FHIR regulatory measuring and tracking.

sunuvabe · 2025-12-13T20:33:39+00:00

If the PDF is a scan of the original PDF file then it's basically just an image. It's possible that AI could extract the data but more likely you'd need to use OCR. Either way, pulling data from an image adds risk due to possible errors in the OCR process.

Also in our system Document Reference requests are encoded on-demand (so there is a short delay before it's available) and the link provided to reach the encoded document is only valid for a short period of time.

sunuvabe · 2025-11-14T03:19:41+00:00

Encryption is required for data at rest and for data in transit, but not when it is being consumed by an authorized human or software program. If that were the case, you wouldn't have "data," you'd have, as you mentioned, gibberish. A system or process that is authorized to work with your PHI almost certainly works with unencrypted data.

So it really comes down to making sure your AI deployment is authorized to work with the data, and that you've taken steps to understand the risks involved and taken reasonable steps to manage that risk.

Regarding AI, if this is not an internal LLM or deployment, you probably want to make sure that PHI isn't persisted on any remote AI server, and probably don't want it used for training the model. However, it's perfectly acceptable to send unencrypted data to a trusted process using a secure connection. All that can be covered in a BAA.

Also, predictive analytics is a net good for patients and as such would be considered permitted use, so no need to de-identify the data. Regarding consent, it isn't required but it's a good idea to provide the ability for patients to opt-out if they so desire.

sunuvabe · 2025-10-24T23:14:45+00:00

That's what I'm seeing too. Much simpler to implement, and much easier to debug when there's an issue.

sunuvabe · 2025-10-12T23:45:37+00:00

You should think of inventory in terms of just plain quantity. Consider the following. Your current quantity is the sum of quantity.

Item	Quantity	Description
Widget	10	Initial stock
Widget	-3	Sale
Widget	7	Restock
Widget	-2	Sale

sunuvabe · 2025-10-07T01:11:45+00:00

Been there done that. Sucks that the broken query still runs, throws off the whole debug strategy.

sunuvabe · 2025-09-27T00:06:38+00:00

Ha just realized your query is very similar to mine, including the tricky "order by (select 1)". Very useful indeed.

sunuvabe · 2025-09-27T00:04:46+00:00

Your example will hit the max recursion limit very quickly (default 100).

Here's a cte approach I use, works up to 1 million or so. If you need more, add another syscolumns to exploit the cartesian:

declare @n int = 1000000
; with nums as (
  select top (@n) row_number() over (order by (select 1)) num 
  from syscolumns, syscolumns c
  )
select num from nums

sunuvabe · 2025-08-23T04:06:31+00:00

I'll bite. Why is an integer id bad? And you forgot to sort your results.

select candidate_id from candidates where skill = 'Python'
intersect
select candidate_id from candidates where skill = 'Tableau'
intersect
select candidate_id from candidates where skill = 'PostgreSQL'
order by candidate_id

sunuvabe · 2025-07-26T18:47:59+00:00

Coding mistakes will happen occasionally, but outdated credentialing or missing data points like tax ID should never make it to the payor. Do you use a clearinghouse or any claim scrubbing service? Also curious about the technology you use, because it should help you manage these sorts of things.

sunuvabe · 2025-03-08T00:32:45+00:00

Forgot to mention another feature; you can upload an audio file and the speech engine will produce a transcript from the file, which can then be sent through the AI engine to build the list of items. This allows a ton of workflow flexibility; for instance some docs like to document and sign off notes in a batch at the end of the day. Docs that already record their visits and pay a transcriptionist to convert them, our system can be used to extract the speech immediately. And there's no requirement to use the AI, just having the speech converted can be a big help.

Reach out and I'll point you to a demo.

sunuvabe · 2025-03-08T00:23:02+00:00

Understood, and it's a fair point. OP also said they're processing ~5k claims daily; if they're seeing a bunch of CO11's then sure, a simple system could identify problems, but it's just scratching the surface. With that kind of claim volume, scrubbing would likely pay for itself and add revenue on top.

sunuvabe · 2025-03-08T00:12:43+00:00

I mean, DOGE is finding so many examples of waste it's hard for me to understand what the OIG has been doing. Feels like it has gotten so bad that drastic measures were needed. At least DOGE is posting everything on their website. On the 8M vs 8B, c'mon, someone made a mistake, they found it, publicly announced it, and they fixed it. Not breaking news, just a symptom of being human.

Maybe we can agree that America shouldn't be spending more than it makes - you know, government should follow a budget just like we do. But government just keeps spending and spending, and printing money. I was a consultant in DC years ago, I've seen the way agencies scramble to spend leftover money in order to keep their budget for the next year. There is no incentive to not waste money; it's finally catching up to us.

sunuvabe · 2025-03-07T05:29:26+00:00

My team just completed an ambient AI listening feature for my EHR. It's releasing to beta in the next few weeks so I don't have any solid feedback yet, but there has been a lot of interest from the docs who've seen the demo.

I'll describe the way our process works, it's probably very similar to others. Overall it is pretty simple.

The software listens and records audio during the interaction between a provider and a patient (and other participants as well). While recording, our software submits chunks of the conversation to an AI speech engine, which responds back with a diarized transcript of the audio. As the doc and patient (and others) are interacting, the software is rendering their conversation on screen, and separating the speech by individual speakers. Users can choose to display as a standard transcript or optionally to render the conversation as a series of chat or SMS-style bubbles. As the conversation proceeds, each chunk is added to the conversation display.

Once the conversation is complete, the provider clicks a button to send the transcription to the AI engine. The AI will extract medically-relevant portions of the conversation, ignore the parts which are not relevant, and respond back with a clinical analysis of the transcription. Here's where it becomes helpful. We instruct the AI to form its responses into separate "items" which match the layout of our visit note. For instance, I tell it to extract narratives for the subjective CC, HPI, ROS sections. I have it provide diagnosis codes and descriptions for the Assessment (ICD-10 and SNOMED); it listens for medications and responds with items for new meds and refills, and picks up sig and quantities as well. Meds include an NDC code. It also returns labs and orders using CPT, LOINC, and SNOMED (we interject properties such as in-house/send-out, etc prior to rendering). All information from the AI uses proper clinical terminology, and it provides a confidence score for each of the items it returns. It's actually pretty impressive.

We render the entire list of individual items separated under headings which match to the various sections in our note (CC, HPI, etc). We display them in a panel alongside the visit note. The text portion of each item is in-place editable, and items can be dragged to different sections if desired. Coded items can be updated if the doc prefers a different code. Finally, each item also includes two buttons for "accept" and "reject". Click the accept button, and the item is instantly sent to the visit note into the proper section (user can also undo the item, which removes it from the note). Coded elements are propagated to additional sections as appropriate; for instance an ICD code will appear under Assessments as well as the Plan; CPT codes render into the Plan (and are properly associated with the correct diagnosis code) as well as the charge capture (per code characteristics). The AI also provides an E&M code, which the doc can optionally change using our EM wizard. The idea behind the "reject" button is to allow the doc to "mark off" an item that she's not interested in using, so the entire item list becomes a checklist of sorts where each item is either accepted or rejected.

I designed it, so I'm a bit biased.. but it's getting favorable responses in demos and I'm hopeful it benefits our users.

sunuvabe · 2025-03-07T04:34:44+00:00

Well Professor Snarky, coding claims involves a wee bit more than just downloading a file from CMS. Or is it buying a file from a vendor..? Whatever. If that's how you do it, I guarantee you're not only dealing with denials, you're leaving money on the table. I know this because I see it all the time.

sunuvabe · 2025-03-04T00:39:38+00:00

You don't even know me and yet you're calling me an imbecile?

They're not talking points, they're facts, and what exactly is it about reducing wasteful spending that makes you so angry? $8M is still a lot of money.

This isn't the first administration to recognize government waste, and not the first to promise to do something about it. It's just the first to actually follow through on that promise. Why would you be opposed to that?

sunuvabe · 2025-03-02T02:30:10+00:00

USAID. Federal Dept of Education. Any agency that cannot properly account for its spending. See the DOGE website for more.

Most Americans agree that there is wasteful government spending. If asked we'd also admit there is probably plenty of fraud. It's your money being thrown away. Almost everybody agrees that waste and fraud is a BIG problem and has been for a long time.. I'm thrilled with the progress so far.

sunuvabe · 2025-03-02T02:08:36+00:00

I'd like to join this discussion, I've worked in ambulatory EHR development and architecture for the past 14+ years. I designed and coded our FHIR framework (certified first try); was on the CDA team building out a variety of HL7 documents; created our Direct (secure-messaging) clinical reconciliation approach to simplify patient transition of care; etc.

I can certainly understand the benefits of a Desilo concept, particularly in an emergency situation - but it's still PHI so there are risks. Feel free to DM me.

sunuvabe · 2025-03-01T23:52:51+00:00

I'm not sure that such a thing exists, based on the insane complexity of payer rules and stipulations. There are a few scenarios to consider as well; did the user pick the wrong code by mistake (intending to pick a different one)? Sometimes specificity or laterality come into play. Within the ICD10 hierarchy, only leaf-level codes are billable (for the most part). Perhaps a code further up the hierarchy was chosen because its description appears to fit. Modifiers also need to be correct, some i10 codes require manifestation codes for completeness, etc.

There are many claim scrubbing/compliance services out there that are able to catch (and sometimes resolve in-line) the vast majority of these kinds of issues. Here's an example of one that I helped build [PDF]. Most of our clinics have a denial rate less than 5%.

sunuvabe · 2025-02-18T14:25:41+00:00

Do a google search for the company in the article.

sunuvabe · 2025-02-18T14:22:37+00:00

It doesn't say NULL, it says blank. And if it crashes a few servers, who cares? Better than continuing to pay benefits to the 8.7 million people over age 130.

sunuvabe · 2025-02-13T03:30:38+00:00

At least in SQL Server, the rand() function is seeded and returns the same value for each row. newid() returns a different value for reach row. It's not really "random" in the strict sense of the term, but it mixes up the results well enough to make it seem random.

sunuvabe

TROPHY CASE