Poking fun at AI became so easy. A good craftsman will never blame their tools pic.twitter.com/K6I3okeje7

— Toily Kurbanov (@ToilyKurbanov) June 9, 2026

We would never do this with AI in healthcare…would we?

Humor, AI, the future.

(Actually, I wonder when AI-written books will become the norm, and accepted and enjoyed by society.)

Art by Dave Coverly, @speedbumpcomic, https://t.co/NJz2h49oWh, Used with permission. pic.twitter.com/d32yGNCyBo

— Cliff Pickover (@pickover) June 8, 2026

This is about books, but it certainly could apply to LLMs in healthcare too.  Do you want to trust the crowd?

This is from an IBM Manual in 1979!

We should be thinking about this daily with AI taking over everything. pic.twitter.com/WsrkISDViZ

— Men’s Humor (@MensHumor) May 25, 2026

What’s old is new.  Trusting technology always takes time for the technology to mature.

Have a great weekend!  See you back here next week for more great healthcare IT content.

Check out the main topics of discussion for this episode of the Life Sciences Today podcast:

• Tell us about your journey to the Sheba Medical Center.
• What does a typical work week look like to you?
• What does value creation mean to you? Is it a clinical outcome, workflow efficiency, operational cost reduction, or something else entirely?
• How does the Cancer Center think about capturing value from the innovation that you develop?
• What are three concrete things an oncologist should try out with AI this year?
• What is the biggest anti-pattern in your industry today?

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Along with the popular podcasting platforms above, you can Subscribe to Healthcare IT Today on YouTube.  Plus, all of the audio and video versions will be made available to stream on Healthcare IT Today. As a former pharma-tech founder who bootstrapped to exit, I now help TechBio and digital health CEOs grow revenue—by solving the tech, team, and go-to-market problems that stall your progress. If you want a warrior by your side, connect with me on LinkedIn.

If you work in Life Sciences IT, we’d love to hear where you agree and/or disagree with our takes on health IT innovation in life sciences. Feel free to share your thoughts and perspectives in the comments of this post, in the YouTube comments, or privately on our Contact Us page. Let us know what you think of the podcast and if you have any ideas for future episodes.

Thanks so much for listening!

The implementation of technology in healthcare has driven incredible scientific discoveries and improved outcomes. However, the rise of connected devices and integrated systems has also created increasingly complex environments to manage.

Historically, healthcare technology management has treated clinical devices as static assets, focusing on inventory and routine servicing. This approach offers limited visibility into real-time device performance and how risks evolve over device lifecycles, resulting in inefficiencies and security vulnerabilities.

Meanwhile, healthcare organizations are under pressure to do more with existing resources while delivering consistent, high-quality care. As healthcare technology evolves rapidly, traditional approaches can no longer keep pace with today’s scale and complexity.

Many hospitals and care providers are turning to more integrated approaches to better manage the tools that power patient care. As healthcare systems evolve to meet current needs and combat increasing demands for more results with fewer resources, healthcare should consider implementing a modern clinical device management (CDM) solution to prioritize patient safety, improve access to consolidated device performance data, and ensure a strong auditability posture.

Enterprise Asset Management Versus Clinical Device Management

With more connected technology in hospitals than ever before, teams are responsible for monitoring operations across their ecosystem. To do so, organizations traditionally looked to enterprise asset management (EAM). EAM focuses on tracking assets and scheduling maintenance, but it lacks the clinical context needed to understand how devices impact patient care in real time and the regulatory environment attached to those devices. Clinical device management (CDM) offers a comprehensive lifecycle view of healthcare equipment by merging medical engineering with information technology to ensure more effective patient safety and treatment management.

Managing modern healthcare devices requires a system that fully understands healthcare, not just assets. CDM enables healthcare organizations to fully harness the growing volume of data generated across their device ecosystems and hosts a comprehensive understanding of the healthcare space to support patient care.

Consolidated Device Performance Data

In addition to tracking assets and scheduling maintenance, CDM integrates device data, services device histories, and provides operational insights in a unified view that reflects actual usage and risk. By connecting devices and centralizing insights, healthcare professionals can move beyond static scheduled inventories and better understand device performance, identify patterns, and anticipate failures. The result is a more informed, predictive approach that improves reliability and ensures critical equipment is consistently available.

Healthcare workers rely on a wide range of critical equipment, including infusion pumps, ventilators, anesthesia machines, and imaging systems that directly support patient care and clinical decision-making. Any failure, misconfiguration, or delay in servicing can affect patient outcomes. Reliable device performance is not just an operational concern; it is essential to ensure clinicians can act quickly with the tools they need to save lives.

Prioritization of Patient Safety

CDM plays a critical role in increasing efficiency and speed across healthcare operations by introducing more nuanced classification systems rooted in patient safety. Instead of applying uniform processes to all devices, CDM prioritizes patient safety by classifying devices based on clinical risk, patient impact, and potential harm. This system ensures that the most critical equipment receives the highest level of visibility, prioritization, and response, fundamentally changing how maintenance and escalation are handled.

Combined with real-time monitoring and more automated workflows, this risk-based approach allows IT teams to focus on the most critical patient issues first, reduce unnecessary maintenance on low-risk equipment, and streamline service delivery overall. This minimizes downtime, shortens repair cycles, and helps healthcare organizations make better use of limited staff and resources.

Compliance and Audit Readiness

CDM also strengthens risk management and supports strategic, long-term planning by embedding compliance and audit readiness into everyday operations.

Devices like infusion pumps, ventilators, and CT machines are subject to strict regulatory, accreditation, and manufacturer maintenance requirements. CDM natively captures maintenance records, tracks updates, and ensures that devices can be aligned with required standards. This creates a consistent, transparent system of records that simplifies audits and reduces the burden of manual documentation.

In addition to compliance, it enables healthcare leaders to make more confident, data-driven decisions about capital planning and their hospital’s overall technology strategy; all while maintaining a focus on patient safety.

With CDM, healthcare organizations can break down silos between operations, access real-time visibility, and gain critical, predictive insights to ensure that the machines and systems that keep people alive and healthy are always available.

Healthcare organizations should look to adopt CDM to not only strengthen patient care today but to better achieve their principal outcomes of patient care, minimizing risk, and leveraging technology to positively impact the patient experience.

Ilant Health, the value-based obesity treatment company working with employers and health plans to deliver clinical outcomes and reduce the total cost of care, announced it has raised $15 million in Series A funding, bringing its total funding to over $22M to date. The round was led by Cornucopian Capital, with participation from naturalX, Peakbridge, Semcap AI, Evidenced, Operator Partners, as well as existing investors Celtic, LifeX, and AlphaLab.

Founded by Elina Onitskansky (formerly McKinsey and Molina Healthcare), Ilant works directly with employers and health plans to deliver comprehensive, clinician-led care for obesity and related conditions. Ilant delivers measurable clinical and financial outcomes, versus solutions focused on access or cost control, or fragmented solutions that look at obesity and weight loss in isolation from broader health.

Early results show that members achieve 15% weight loss on average — well above 5.8% reported in real-world settings – alongside measurable gains in broader biometrics and overall wellbeing, including an average of two additional mentally healthy days per month. These results highlight Ilant’s success improving outcomes in clinically meaningful ways. The company does this while managing both treatment costs and total cost of care for employers and payers, creating a uniquely compelling value proposition.

The Rise of AI-Enabled Healthcare Services and Precision Care

The company delivers these results through clinician-led care with treatment that is precision-matched to individual member needs based on clinical, behavioral, and personal data, and continuously optimized based on how each individual responds in practice. Treatment includes behavioral therapy, medication (including both GLP-1 and non-GLP-1 therapies), and surgical options as delivered in a comprehensive model that address nutrition, physical activity, and stress alongside medical care.

The approach focuses on initiating with the best treatment and consistently enhancing outcomes over time, delivering life-changing clinical results while avoiding unnecessary or ineffective care.

Early Traction and Demand Signal Rapid Growth

Ilant is already working with leading employers and healthcare partners to deliver measurable improvements in both outcomes and cost, reflecting strong demand for models that move beyond point solutions toward integrated, outcomes-based care.

“What stood out with Ilant was their precision-based, data-driven approach to obesity care, not a one-size-fits-all model centered on medication only,” said Kenneth L. Gardner, Director of Growth, Benefit Operations at SEIU 775 BENEFITS GROUP. “Ilant conducted a detailed analysis of our population and identified the members most likely to benefit clinically and financially, giving us confidence in both improved outcomes and meaningful ROI. Just as importantly, the members consistently share positive feedback about the care, support, and personalized attention they receive from the Ilant team.”

As part of this approach, in November 2025, Ilant announced direct contracting and transparent pricing solutions for obesity management medicines available through Lilly’s Employer Connect program; the company is also working with Novo Nordisk. These manufacturer contracts enable Ilant to provide transparent prices for medications with flexibility in design, giving employers greater visibility and control over one of the fastest-growing areas of healthcare spend.

Recent results from Eli Lilly and Company, reported by the Financial Times, highlight the scale and speed of demand for GLP-1 weight-loss drugs, with revenues surging as adoption accelerates. As more employers face pressure to offer coverage while managing rising pharmacy spend, the need for models and infrastructure that can bring predictability and control – while delivering outcomes and experience – has never been higher.

“Employers and health plans are facing a real dilemma right now — they are faced with either expanding access and watching pharmaceutical costs rise dramatically, or restricting access and risking rising chronic disease and cost,” said Elina Onitskansky, Founder and CEO at Ilant. “That’s not a sustainable model. If we don’t change how care is delivered, we’re just paying more for the same broken system, and we risk a crisis where both chronic disease and costs are spiraling out of control. Ilant’s model focuses on delivering real value with manageable treatment costs and clinically meaningful care that actually bends the cost curve.”

Investors see this shift as defining the next phase of obesity and cardiometabolic care.

“We believe the next generation of category-defining companies will be those that deliver outcomes as a service, not just tools or access,” said Aryeh Ganz, Founder and Managing Partner at Cornucopian Capital. “Ilant is applying that model to one of the most important and costly areas in healthcare. The company understands that the future of obesity and cardiometabolic care will not be defined by access to a single class of drugs, but by the ability to deliver the right care to the right patient at the right time. Their model aligns clinical rigor with economic value in a way that we believe will define this category over the next decade.”

About Ilant Health

Ilant Health is an obesity and cardiometabolic health company focused on increasing access to treatment while reducing the total cost of care for employers and payers through value-based care. Ilant Health provides the single front door for individuals with obesity, delivering end-to-end evidence-based solutions (bariatric surgery, medication, intense behavioral therapy) through a technology-enabled and analytics-driven obesity medicine practice. To learn more about Ilant Health, please visit their website at ilanthealth.com.

Originally announced June 2nd, 2026

Jeffrey Oliver, MSN, RN, CCNS, CNOR – Clinical Support Specialist and David Owen, Chief Product Officer at LiveData were the presenters.

Key Takeaways

• Goodbye, Post-Its: Real-time dashboards eliminate the OR “black box” by replacing outdated manual communication tools.
• Visibility Drives Value: Transparent OR tracking improves both hospital operational efficiency and the patient family experience.
• Actionable Analytics: AI elements and tight MEDITECH integration turn raw OR data into smarter, data-driven decisions.

Creative engagements kept the audience attention

Right from the start it was clear this was not a typical lecture-style presentation. Attendees arrived at a room full of yellow post it notes. On each note was a handwritten note that mimicked messages that surgeons and OR nurses might leave for each other before, during, and after a procedure.

Oliver and Owen also made unique use of the in-house hotel telephone to illustrate how OR staff can get interrupted during a procedure and a set of stacked imaging CD boxes to show how many different sources of information OR staff need to access.

The point? Without an electronic system for the OR, these manual methods (post-it notes, phones, and CDs) are the only way for staff to communicate and get the information they need.

There is a better way through the solution that LiveData provides.

OR Visibility is Needed

At many healthcare organizations, the time a patient is wheeled into the OR until the time they are in recovery, is a black-box – meaning that no one outside of those in the room know the exact status of the procedure.

Why is visibility into the OR during a procedure important? Oliver and Owen point to patient experience and operational efficiency as compelling reasons.

That is what drove LiveData to create their real-time display boards.

Not only do LiveData’s display boards help internal departments stay alert to what is happening in the OR, but it is also connected to the Family Waiting Board which helps families and caregivers feel a little less anxious (don’t worry the board is HIPAA-compliant).

More than a Digital Whiteboard

Oliver and Owen went on to show that LiveData’s solution is more than just a dashboard. By listening to customers, they incorporated sophisticated analytics that track OR usage, procedure mix, and operational efficiency.

…and naturally LiveData has incorporated new AI elements into their solution.

LiveData Integration with MEDITECH

Since we were all at the #MUSEInspire conference, Oliver and Owen spent time speaking to the tight integration they have with the MEDITECH EHR. The data captured by LiveData can be fed into MEDITECH to aid with decision-making.

LiveData Offers a Snapshot Service

At the end of the presentation Owens and Oliver offered the audience a chance to “try” their solution through a free snapshot service. This read-only report will give hospitals the chance to see what LiveData’s analytics uncovered on their own data.

Final Note

After the presentation Oliver and Owen had this to say.

Learn more about LiveData at https://www.livedata.com/

LiveData is a proud sponsor of Healthcare Scene.

Both Brockington and Wagner stress the importance of applying AI and analytics to specific business problems, what Brockington calls “MBA 101.” Wagner says that he wouldn’t be interested in AI unless it can “make money, save money, or reduce risk.”

Wagner thinks that the technology is available today to extract the value that health care providers need, and that the old problems of interoperability and data movement are solved. The key issue is the financial incentive to share data.

Salient Health’s key asset, Wagner says, is their proprietary in-memory database, which they have integrated with an analytic engine to analyze billions of data points in real time. Salient’s platform is also trained on the specific nomenclature and nuances of its partners.

One partner Wagner mentioned is the Department of Health of the state of New York, which has stored every claim in the state since 2005. Now 35 agencies can query data in its totality.

Brockington’s alliance accepts EHR, billing, and next-generation sequencing (NGS) data from alliance members, building up billions of rows of structured data along with unstructured data in the form of physician notes, patient observations, lab values, and NGS testing. Their members are concerned with quickly extracting key aspects of the patient journey, such as age range, stage of the cancer, and treatments, from both structured and unstructured data. They identify cohorts that they can track through their patient journeys.

Brockington says that it’s time to move beyond pre-canned data and dashboards and allow clinicians or administrators to run sophisticated interrogations of their data. Salient Health helps them run such queries instantaneously, not relying on IT staff to spend days coding queries.

Watch our interview to learn more about how ONCare Alliance and Salient Health have partnered together to turn data into action.

Learn more about Salient: https://salienthealth.com/

Learn more about ONCare Alliance: https://www.oncarealliance.com/

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The following is a guest article by Steve Sutherland, SVP Information Systems at CERIS

Payment integrity often lives at the end of the claims line, with teams measuring success by how much they can win back after payment. While recoveries matter, most payer and program leaders know the hidden cost of that model.

That is why more organizations are now “shifting upstream” in payment integrity. This trend of shifting upstream or left means being proactive and moving detection, validation, and decisioning upstream, closer to claim intake and adjudication. The goal here is to catch issues earlier in the claim lifecycle, before funds go out the door, and when problems can be clarified, corrected, or resolved with less disruption.

This change touches the full healthcare ecosystem. Large health systems and hospitals feel the strain when recoupments disrupt revenue cycle planning. Group practices and solo practitioners experience the drag of repeated record requests and appeal cycles. Government agencies face heightened scrutiny and pressure to demonstrate program integrity. Health IT companies, consultants, and associations are under the impression that integrity initiatives must balance accuracy, access, and administrative burden.

Shifting upstream is gaining ground because it supports a better process, not just tougher policing.

Why Prepay Strategies are Speeding Up Now

Claims keep rising in both volume and complexity. At the same time, many plans and programs run short on staff, and post-pay recovery work can be costly and hard to scale. Even when recoveries are successful, they can come with downstream costs that are harder to quantify but easy to recognize, including strained provider relationships, more appeals, and more time spent resolving disputes than preventing them.

Prepay prevention reduces that churn. The most successful programs focus on clear rules and tight scope, and target common failure points. They also route those claims through steps that teams can explain and providers can resolve.

Prepay work also helps payer information technology and claims teams measure results faster. Intervention is happening in a shorter window, making it easier to track outcomes, compare changes, and refine edits.

What Prepay Prevention Looks Like in Practice

Shifting upstream shows up in a few core moves across the industry, and the following steps are quickly becoming standard as programs mature.

One step is clinical validation, which helps confirm that a billed service aligns with clinical documentation and applicable policy. This often involves reviewing whether the medical record supports the level of care, medical necessity, or clinical appropriateness. Another intervention is coding checks, where payers identify inconsistencies such as incompatible code combinations, unbundling risk, upcoding indicators, and mismatches between codes and documented services. A third is documentation review, which catches missing or unclear details before payment. That timing matters as providers can often respond faster before a claim turns into a formal dispute.

The operational upside is clear: providers still have context, and claims staff can resolve questions without triggering a long recovery cycle. From a technology view, payers can embed edits and workflows where they work best, which leads to clearer routing, stronger audit trails, and more consistent decisions.

Where AI is Making a Real Impact

Artificial intelligence can help payment integrity teams move faster and stay consistent. Additionally, the technology works best when teams pair it with tight governance and human review. AI can help sort incoming claims by risk and provide better triage. It can use signals like pattern fit, dollar risk, and confidence scores to cut through the noise. AI also keeps human review focused on the claims that matter most.

AI also provides faster record review. Modern tools can pull key facts from records and highlight the right sections. Some tools can also draft short summaries for reviewers, which reduces the time spent hunting for details across long notes. Reviewers are moving faster when using AI without lowering the bar.

Lastly, AI can also help with pattern detection at scale, surfacing emerging anomalies across procedures, sites of service, or provider groups. This is particularly useful for identifying where an edit may need to be tuned, where education could prevent repeated errors, or where a new billing pattern is creating avoidable leakage.

The key point is trust. Artificial intelligence helps most when it supports decisions and leaves a clear trail. If teams cannot explain why a claim was flagged, they should not rely on the output.

Where Human Expertise Stays Essential

Even as automation improves, payment integrity still depends on expert judgment. Complex clinical scenarios, nuanced coding situations, policy exceptions, and context-specific documentation issues do not always fit neatly into rules or model predictions.

Humans also protect quality, calibrate rules, and handle escalations. Without those steps, teams risk uneven decisions and weak rationales. Provider trust drops fast when outcomes feel unsystematic.

Clinical reviewers and coding experts add the interpretive layer that keeps decisions fair. They can tell the difference between a true billing issue and a chart that needs one more detail. They also feed what they learn back into edits and models. With mature programs treating this as a loop and automation handling volume, experts are able to handle nuance and oversight.

Earlier Intervention Improves Transparency and Reduces Provider Friction

When a payer flags an issue before payment, the message can be more direct and the policy cite can be clear. The provider can respond while the facts are still easy to confirm. Early intervention also improves internal transparency, because prepay workflows can be instrumented to show exactly why a claim was flagged, what information was reviewed, what was requested, and how the final decision was reached.

For payer information technology teams, that trace supports audit needs and strong controls. For providers, it reduces the feeling that rules change after the fact.

What Shifting Upstream Means for Payer Information Technology and Claims Teams

Shifting upstream is ultimately a modernization effort. It requires payer IT and claims operations teams to treat payment integrity as a lifecycle capability, supported by workflow design, data quality, and disciplined governance.

Teams can make the change with a few practical moves:

• Precision Before Scale – Pick a small set of high-impact use cases and make sure they are defensible and workable in prepay; measure results, then expand
• Tie Every Decision to Evidence – Each intervention should produce a clear rationale and a policy link; it should also point to a consistent path to resolve the issue, and explainability turns automation into trust
• Use Artificial Intelligence where it is Strong – Use AI for routing, record search, summarization, and trend detection; keep expert review for clinical judgment, coding nuance, and quality checks
• Measure Success Beyond Recoveries – Track avoided improper payments, cycle times, touch rates, appeal outcomes, provider escalations, and cost-to-manage, because those indicators reveal whether shifting upstream is improving integrity through transparency

Across healthcare, the goal is to improve billing accuracy by strengthening transparency and integrity. By preventing errors early, organizations reduce waste, minimize rework, and lower friction for everyone involved. The result is a clearer, more consistent, and fairer billing and claims experience.

Novellia, the only real-world data company built entirely on information patients choose to contribute to medical research, today announced an $18 million Series A led by Spark Capital with participation from Khosla Ventures, Acrew Capital, Bling Capital, and TMV, bringing Novellia’s total funding to $28 million. Building on this momentum, Novellia is also launching its patient-facing mobile app, an extension of its award-winning online platform that allows individuals to securely access their complete health history.

Researchers have long depended on real-world data to understand how treatments perform outside clinical trials. But today’s data ecosystem is dominated by third-party brokers stitching together partial datasets from insurance claims and hospital records. The result is a system that costs over $50 billion annually and still leaves out the most important source of truth: the patient.

“Behind every patient is a fragmented, incomplete record of their life,” said Shashi Shankar, Co-Founder and CEO at Novellia. “I watched this up close: first through my grandfather’s cancer journey, and then professionally in pharma, where we were developing therapies without ever seeing the full picture. The system failed patients and researchers at the same time. Novellia changes the course for this whole industry by putting the patient at the center.”

The funding will be utilized to scale Novellia’s AI-powered technology, designed to give patients a free tool to access and organize their complete health history across providers, alongside the opportunity to share it with scientists to advance medical discoveries. Novellia puts this deidentified, anonymized data in the hands of the world’s largest pharmaceutical companies to fuel new cures and treatments, fundamentally changing the course of research and development. Its customers include several of the top 10 pharmaceutical companies and early-stage diagnostics companies.

“I’ve known major pharma companies had data that was too old, too slow, and too disconnected from patients,” said Alex Finkelstein, General Partner at Spark Capital. “For a long time, I looked for a company like Novellia. Shashi understood the problem firsthand and built the solution that benefits patients and research. Since Spark led the Series A, Novellia has signed some of the largest companies in the world to seven-figure, multi-year contracts. This is dramatically changing how medicines are developed.”

“Nearly 70% of patients are open to contributing data for medical breakthroughs, but they expect control, transparency, and privacy safeguards,” said Emma Silverman, Partner at TMV. “That gap between willingness and infrastructure is exactly what Novellia solves by creating a new category of patient-consented data that is both more complete and more actionable for research.”

Within 30 seconds, Novellia helps patients with serious and complex conditions find and unify up to 20 years of medical data from disparate hospital systems, doctors’ offices, and labs across the U.S. The sickest patients carry the greatest administrative burden, spending hours tracking down records and repeating their histories to new providers. Novellia eliminates that overhead with its proprietary, AI-powered platform that pulls the data together into a single, user-friendly source to give patients a free, comprehensive record of their health, something most have never had access to. Novellia then analyzes those records using proprietary NLP models that extract signals from unstructured clinical text, including physician notes, lab narratives, and diagnostic reports. This is often the richest and most overlooked layer of the medical record, where clinicians document their reasoning and researchers finally see why decisions were made, turning raw patient data into anonymized, harmonized datasets ready for research.

About Novellia

Novellia, Inc. is a patient data company that helps people find and unify over 20 years of health data in seconds so they can get better care, while accelerating medical breakthroughs. Named one of Digital Health New York’s 10 startups to watch, a 2026 Fierce Outsourcing Award recipient for Innovation in Drug Development, and a 2026 MedTech Breakthrough Award winner for Best Healthcare Data Repository Solution, Novellia is the only real-world data company built entirely on information patients choose to share with research. Novellia is backed by peer-reviewed research presented at medical congresses, including ASCO and SABCS-AACR. To learn more, visit novellia.com.

Originally announced June 2nd, 2026

Prior authorization is a workflow with the ability to frustrate providers, payers, and patients in equal measure.

Sending and receiving electronic prior authorizations (ePAs) are two halves of the same workflow, but until now, only one half was on a path to a modern standard. That may be about to change with a new proposed rule to fix the broken half of it—bringing potential workflow improvements as well as technological challenges.

A year ago, the Office of the National Coordinator for Health IT (ONC) finalized a rule requiring electronic health record (EHR) vendors to send PA data using HL7 Da Vinci standards. Now, the Centers for Medicare & Medicaid Services (CMS) has proposed a rule requiring that payers use that same standard.

CMS-0062-P would align mandates for both parties, replacing a partially manual workflow with an end-to-end electronic one. It finishes the work started by the Health Data, Technology, and Interoperability (HTI-4) final rule.

Replacing a 30-Year-Old Standard

For the first time since 1996, the industry is moving away from the rigid X12 278 standard for medical ePA, replacing it with a modern, FHIR-first stack built on Da Vinci. CMS describes this transition as a sea change in HIPAA Administrative Simplification.

Here’s the bottom line: Aligning these mandates ensures that when an EHR sends a Da Vinci-based request, a payer on the other end is required to process it using the same standard.

• HTI-4 requires EHRs to support the Da Vinci CRD, DTR, and PAS implementation guides for ePA.
• CMS-0062-P would require impacted payers, including Medicare Advantage, Medicaid/CHIP, and Qualified Health Plan (QHP) issuers, to support the same Da Vinci implementation guides (IGs) for medically billed PAs by October 1, 2027.

What Is Da Vinci?

The HL7 Da Vinci Project is a multi-stakeholder accelerator developing FHIR-based IGs that standardize how providers and payers exchange data. For readers who want the technical details, the three IGs doing the heavy lifting are:

• Coverage Requirements Discovery (CRD): Surfaces payer rules in the provider’s workflow in real time.
• Documentation Templates and Rules (DTR): Gathers the clinical documentation a payer requires to make a decision.
• Prior Authorization Support (PAS): Submits the request and returns the determination.

Together, they form the end-to-end electronic loop for ePA.

Everything Else CMS-0062-P Proposes

If finalized as written, the rule would require:

Expedited timelines: Decisions for standard PA would have to be made within 72 hours, down from the current 15-day window, and expedited PA decisions must be made within 24 hours.

PA transparency: Payers would have to provide specific denial reasons and publicly report PA metrics starting in 2028.

API transparency: All API endpoints would have to be listed in a centralized CMS directory. For vendors, this directory reduces the cost and complexity of discovering and maintaining payer connections.

Medical benefits: The 2024 rule, CMS-0057-F, focused on improving information exchange for medical benefits and notably excluded medications administered under the medical benefit. CMS-0062-P applies to all medically billed PAs, including services and medical-benefit drugs—but not pharmacy benefit drugs, which are governed by separate National Council for Prescription Drug Programs (NCPDP) standards.

Key takeaway: With HTI-4 compliance deadlines locked in and decision windows shrinking, EHR vendors cannot afford to treat PA as a back-office afterthought. The infrastructure must be ready before the regulation takes effect.

How DrFirst Supports Pharmacy and Medical PAs

CMS-0062-P addresses one slice of the PA landscape, but providers don’t experience PA one slice at a time. A single patient visit can result in PA needs across medical-benefit services, medical-benefit drugs, and pharmacy-benefit drugs—and right now each is governed by different rules, standards, and payer workflows.

This leaves system vendors with two choices. Either spend the internal time, focus, and capital on building solutions to meet multiple, continually changing standards, or find a trusted partner to manage the complexity for you and ensure that your EHR is always up to date and compliant.

For ambulatory and acute care EHRs, the DrFirst Total Benefits tool handles medical and pharmacy benefits in a single interface, routing requests through Da Vinci IGs for medically billed PAs and NCPDP standards for pharmacy drug PAs.

The HTI-4 final rule provided a catalyst for more refined ePA, and the CMS-0062-P proposed rule would standardize data for even more streamlining. This regulatory tailwind is a call to action, and we are helping vendors move beyond mere compliance to lead the next era of healthcare interoperability.

The comment period for CMS-0062-P ends June 15, 2026.

—

Don’t wait to start planning. As a leader in e-prescribing, medication management, and compliance, DrFirst offers turnkey solutions that take the friction off your plate and keep you ahead of shifting regulations. To map your path to compliance with one of our experts, click here.

About Tyler Wince

Tyler Wince, VP of Product & Technology for Specialty Solutions, is a co-founder of Myndshft, which was acquired by DrFirst in 2024, where he led development of the company’s automated prior authorization solution. He’s a software engineer and data scientist who understands the complexities of specialty pharmacy workflows. Check out all the articles in the Healthcare Regulatory Talk series.

DrFirst is a proud sponsor of Healthcare Scene.

Claiming to be a “show me” kind of guy, Goolsby recommends that clients not rely on promises made by potential vendors, but ask for proof and transparency. Check the logs to make sure that the expected antivirus software and other security measures are present. Some hosting providers are now being punished for non-compliance with HIPAA and other regulations. Migration to a new hosting service can take six months, so clients should try to choose a reliable vendor at the start.

Goolsby also says that regular audits, while important, are not enough, especially when a client is rolling out a new service or source of data. An audit is a look at the past, and therefore comes too late to prevent security problems. Clients should do regular checks that anticipate security needs as well as assuring them they’ll pass the next audit: test their backups and restores, make sure everything is logged, and conduct incident response and disaster recovery exercises. Vendors should provide an incident management plan and a post mortem on any incident they have to handle.

Although the hosting provider handles security for the hosts, network, and operating systems, clients are responsible for security for users and applications. They should do “data mapping” so they know exactly where PHI is and what sensitive data is shared with SaaS services.

Clients should make sure to have proper encryption, including their backups, and that data is recoverable in a given timeframe. They have to make sure their antivirus software is up to date, even if the vendor claims to handle updates. When employees leaves, their accounts should be deleted “before they leave the building.”

Goolsby discussed the value of planning important security and compliance features from the start. If you don’t encrypt a data volume at the start or segment your network to allow for future traffic growth, these things are very hard to do later. He’s often seen clients defer such features because fixing something after they go live is too costly.

The question of “shadow IT” came up. New applications are needed constantly in a fast-changing treatment environment, and “you always want it yesterday,” but providers should be discouraged from going around the IT staff and installing their own applications or SaaS services.  IT leaders need to be proactive in providing the secure, HIPAA-compliant tools their users need so that unvetted shadow IT doesn’t become a problem in their organization.

Watch our interview with Kelly Goolsby from Nexcess to learn more about how you can ensure your hosting provider is compliant.

Learn more about Nexcess: https://www.nexcess.com/

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