As artificial intelligence accelerates across healthcare, wellness, and caregiving, the next phase of innovation is shifting from raw capability to emotional understanding. In 2026, the most impactful AI systems won’t just process information faster—they’ll interact more like humans, responding to emotional cues, adapting to individual needs, and supporting real-world behaviors over time.
Below are five AI predictions for 2026 from Dan Hungerford, CEO and Co-Founder of EverFriends, an AI company focused on emotionally intelligent companion systems designed to support caregiving, mental well-being, and human connection.
Hungerford’s outlook highlights a broader industry move toward human-centered, ethically designed AI that prioritizes trust, emotional dignity, and long-term support—particularly in health and care environments.
1. AI Will Develop Meaningfully Higher Emotional Intelligence
Dan predicts that 2026 will mark a major breakthrough in AI’s ability to recognize, interpret, and respond to human emotions. Rather than relying solely on language inputs, AI systems will increasingly understand tone, facial cues, micro-movements, and behavioral patterns, enabling interactions that feel more naturally aligned with human emotional states.
2. Conversational AI Will Become Indistinguishable from Human Interaction
Dan believes conversational AI will evolve into near-human exchanges that are fluid, responsive, and continuous. AI companions will retain long-term context, remember personal preferences and nuances, and adapt their communication styles to individual users. This evolution will shift AI from a transactional tool into a truly relational interface.
3. Precision AI Will Replace Broad, Generalized Responses
According to Dan, 2026 will usher in a move from generalized AI outputs to scalpel-level precision. AI systems will guide users through complex tasks step-by-step, including physical therapy, skill development, and behavior-change routines, delivering highly personalized, accurate, and real-time assistance.
4. AI Will Become a Foundational Support Tool in Health, Wellness, and Caregiving
Dan anticipates that emotionally intelligent AI will play a growing role in addressing loneliness, supporting mental well-being, reinforcing daily habits, and assisting with caregiving responsibilities. Rather than simply answering questions, AI will support users through routines, provide encouragement, monitor subtle changes, and help improve adherence to health-related activities.
5. Human-Centered AI Design Will Become a Priority Across the Industry
Dan expects 2026 to be a turning point for ethical, values-driven AI development. Emotional dignity, safety, accessibility, and relational consistency will become core priorities for product teams. As a result, AI products will be designed to feel more trustworthy, transparent, and genuinely supportive, not just efficient.
By Lee-Ann Ruf, Senior Vice President of Product, MDaudit.
When the Centers for Medicare & Medicaid Services (CMS) launches its Transforming Episode Accountability Model (TEAM) initiative next year, the aim will be to improve the patient experience by better coordinating care between healthcare providers.
For more than 700 hospitals across the country, it will mean meeting new accountability, cost, outcomes, and quality standards for surgical care.
The five-year, episode-based payment model is one of the boldest attempts yet by CMS to link financial incentives to patient outcomes by focusing on six common, costly procedures: lower extremity joint replacement, surgical hip femur fracture treatment, spinal fusion, coronary artery bypass graft, and major bowel procedure.
The government projects TEAM will generate $481 million in Medicare savings over five years by reducing hospital readmissions, shortening recoveries, and more smoothly coordinating care.
For hospitals, TEAM success will depend on more than deft surgical skills. It will hinge on using advanced technologies to manage each episode of care from beginning to end.
Greater Accountability
Hospitals will continue billing Medicare fee-for-service (FFS) next year, but those that are part of TEAM will receive a target price for certain surgical episodes. If actual spending falls below that target without sacrificing quality, the hospital may earn a reconciliation payment. But if they are over budget, the hospital may end up paying CMS.
CMS will evaluate TEAM’s impact using statistical and multivariate analyses to examine care quality, access, costs, and patient-reported experiences.
To stay ahead of the curve, hospitals will need to move away from retrospective reporting and embrace real-time performance management. The key to success will be treating data as a strategic asset rather than a compliance responsibility.
The Data Asset
For hospitals that will be a part of TEAM, preparation is key. For many, that means identifying and closing data gaps, modernizing analytic capabilities, and creating an integrated view of cost and quality across episodes of care.
This involves:
Integrating and standardizing clinical and financial data. Episode-based models require hospitals to understand the full spectrum of care that contributes to cost and outcomes, from pre-operative assessments to follow-up visits. But in many organizations, data is essentially trapped in electronic health records (EHRs), revenue cycle systems, post-acute care organizations, and payer portals. To succeed under TEAM, hospitals will need interoperable data pipelines that integrate clinical, claims, and cost data in a standardized format. They should begin by evaluating whether their data infrastructure supports these functions today and where any integration or data standardization work is required.
Building advanced analytics and predictive capabilities. CMS will examine which factors drive variation in quality and cost within a hospital. Healthcare providers must mirror this same analytic sophistication internally. Predictive models, for example, can flag patients at high risk of readmission, spot potential cost outliers, and trigger proactive interventions before patient health worsens. Hospitals should use machine learning and AI-driven analytics to forecast total episode costs, simulate performance across different scenarios, and identify which post-acute care settings offer the best balance of cost and recovery speed. Clinical decision support tools, dashboards, and care coordination workflows help translate insights into actions.
Investing in data governance and team readiness. Analytics are only as effective as the data behind them. Robust data governance programs to ensure accuracy, completeness, and timeliness of data are a must for hospitals that join TEAM. The key is preparing the people who will handle the data, e.g., clinical, financial, and operational teams must understand how TEAM calculates metrics, tracks performance, and interprets dashboards that guide day-to-day decisions. Additionally, investing early in cross-disciplinary education positions hospitals to embed data-driven decision-making into daily practice.
Strengthening Value-Based Care
TEAM participation is mandatory for many hospitals, especially those with experience in bundled payment models, as well as safety-net, rural, and critical access hospitals.
For these providers, TEAM can be a catalyst for broader digital transformation. By building the data and analytics foundation that TEAM will require, hospitals can also create long-term readiness for other value-based care initiatives.
With the beginning of TEAM and with future goals in mind, hospitals should consider:
Evaluating past bundled payment experience.
Engaging post-acute and primary care partners early.
Piloting real-time dashboards and implementing a TEAM “sandbox.”
Benchmarking and scenario-planning using historical claims data to model potential gains or losses under TEAM’s (and other value-based care) target pricing methodology.
Compliance as a Competitive Advantage
TEAM’s varying risk tracks, which range from no downside risk for some facilities to higher risk and reward for others, will let hospitals ease into full participation. But even those in the lower-risk categories should treat TEAM as more than a mere compliance exercise. It’s a chance to mature data capabilities and unlock future opportunities to improve clinical and financial performance.
TEAM also offers the chance to establish a strong foundation for sustained success as the next generation of value-based care emerges. Investing in integrated data systems, advanced analytics, and robust data governance will strengthen a healthcare organization’s position within TEAM and elevate its revenue cycle operations in the long term.
By leveraging revenue cycle analytics to comprehensively track procedural charges, evaluate reimbursement trends, and accurately forecast payments, TEAM organizations will enhance financial performance and compliance through data-driven decision-making.
Organizations that make these investments will be in a leading position as the next generation of value-based care begins.
By Susan Lofton, VP of outcomes & clinical transformation, WebPT.
The recent layoffs at the Department of Health and Human Services (HHS) have far-reaching implications, not just for policymakers and providers, but for patients who rely on rehabilitation therapy services.
With HHS reducing its workforce by 25%, critical functions that support patient access, program funding, and policy guidance are under pressure.
With 300 positions eliminated at the Centers for Medicare & Medicaid Services (CMS), the agency faces a reduced capacity to provide operational support. This affects implementation guidance, billing and coverage clarification, and problem resolution. When new rules take effect, fewer staff are available to respond to therapists’ questions, creating delays that directly impact patient access and timely care delivery.
Impact on Patient Access and Services
The workforce changes have several potential implications for patients who receive rehabilitation services:
Telehealth Access Beyond September 2025
Medicare telehealth waivers that allow rehabilitation therapists to provide services remotely expired on September 30, 2025. Without further legislative action, PTs, OTs, and SLPs are not able to receive Medicare reimbursement for telehealth services billed after that date.
This matters particularly for homebound patients and those in rural areas who rely on remote therapy services. The uncertainty about telehealth creates significant planning challenges for practices that have incorporated telehealth into their service models and for patients who depend on remote access to care.
Service Delivery and Patient Access
When policy guidance is delayed or unclear, and when administrative processes take longer due to reduced staffing, healthcare facilities face challenges in service delivery. This can translate into longer wait times for appointments, delays in starting treatment, and uncertainty for practices trying to navigate new policies with less federal support available to answer questions.
Research and Future Innovation
Changes to National Institutes of Health (NIH) research funding and oversight may affect the timeline for translating new research findings into clinical practice. While research will continue, the reduced capacity for managing research programs could slow the development and dissemination of new rehabilitation techniques and evidence-based practices that ultimately benefit patients.
Impact on Specific Populations
Jill Jacobs, executive director of the National Association of Councils on Developmental Disabilities, commented on the changes to the Administration for Community Living: “People with disabilities are at risk. This isn’t just about shifting funding. They are taking away a federal agency that is for and about people with disabilities and those who are aging.”
Patients from lower-income backgrounds, those with rare conditions, or individuals in rural areas often rely more heavily on federally supported programs. The Administration for Community Living specifically served older adults and people with disabilities – populations that frequently require PT, OT, and SLP services.
Quality Oversight
A smaller HHS workforce means reduced capacity for oversight activities. This includes monitoring of Medicare Advantage plans, which have become the primary Medicare option for many beneficiaries. According to a senior CMS official quoted in Government Executive: “Service standards for Medicare Advantage beneficiaries and Affordable Care Act consumers will suffer with a reduction in the people that handle their cases and with diminished oversight of the Medicare Advantage plans.”
What Rehabilitation Therapists Should Do
Given these changes, there are several practical steps therapists can take:
Stay Informed: Monitor updates through professional organizations – the American Physical Therapy Association (APTA), American Occupational Therapy Association (AOTA), and American Speech-Language-Hearing Association (ASHA). These organizations track policy developments and provide guidance to their members.
Plan Financially: With the 2026 final rule expected in November, practices should prepare for potential scenarios. Reduced CMS staffing may affect both the timing of the final rule and the availability of implementation guidance. Plan conservatively until the final rule provides clarity on actual reimbursement rates. Consider payer mix strategies that reduce dependence on any single payment source.
Document Thoroughly: Maintain thorough documentation. With reduced federal staffing and potential delays in policy clarification, clear records become increasingly important for managing audits and payment disputes.
Advocate: Contact congressional representatives to share how policy changes or delays affect your practice and patients. With the September 30 telehealth deadline lapsing, this is particularly urgent. Specific examples and concrete data are most effective. Participating in future public comment periods on proposed rules provides an opportunity to share your clinical perspective and concerns about policy changes.
Continue Professional Development: Stay current with continuing education and evidence-based practices, even as research funding patterns may shift.
Looking Ahead to 2026 and Beyond
There is debate about whether these workforce reductions will achieve the HSS stated efficiency goals or whether they will compromise service delivery. Public health experts have noted that maintaining current service levels with a significantly reduced workforce will be challenging; however, some proponents suggest the changes could lead to greater emphasis on chronic disease prevention, an area where rehabilitation therapists play an important role through mobility training, functional rehabilitation, and prevention of secondary complications. Whether reduced federal staffing will support or hinder initiatives in this area remains to be determined.
The Bottom Line
The HHS workforce reductions represent a significant change in federal healthcare administration. For rehabilitation therapists, this means navigating uncertainty around payment policies, adapting to potential delays in policy implementation and guidance, and managing possible changes in program funding. For patients, particularly those who depend on federally funded programs or Medicare services, there may be impacts on access timing and service availability.
The rate of payer audits accelerated in 2025, with hospital inpatient and outpatient average denial amounts that increased by 14% and 12%, respectively. Denial volumes were also up overall, led by a nearly fivefold increase in Request for Information (RFI) and medical necessity denials for Medicare Advantage plans.
The total at-risk amounts, number of claims and average amount per claim increased by 30% in payer audits. Denials related to outpatient coding increased by 26%. These trends send a clear signal to providers that successfully navigating today’s complex financial and regulatory landscape requires prioritizing billing compliance, coding integrity, robust denial prevention strategies, and redefining revenue integrity to ensure sustainability.
These were among the key findings of the 2025 MDaudit Annual Benchmark Report released today by MDaudit, an award-winning cloud-based continuous risk monitoring platform for RCM that enables the nation’s premier healthcare organizations to minimize billing risks and maximize revenues. The central theme of this year’s report is the evolution of revenue integrity from a defensive stance to a proactive discipline that unites charge capture, coding, billing compliance, and denials management within a connected, data-driven framework.
Ritesh Ramesh
“Reactively fixing denials after they occur or addressing compliance findings after the fact is costly and unsustainable,” said Ritesh Ramesh, CEO, MDaudit. “This year’s Benchmark Report clearly demonstrates the urgency behind adopting a unified approach to billing compliance, coding integrity, and denial prevention wherein data intelligence and automation are shared across revenue functions, allowing finance leaders to efficiently shift from managing crises to protecting revenue with foresight and confidence.”
Key Takeaways
The new Benchmark Report reveals several trends provider organizations should act on now, and identifies where to focus their attention, investments, and process improvements to safeguard income and manage risk as they enter 2026.
1. Rising Denial Rates
The upward trajectory of denial volumes and amounts signals the need for providers to sharpen denial prevention strategies. In 2025, the average denied amount for hospitals rose from $4,730 in 2024 to $5,390 (14%) in outpatient settings, and from $504 to $565 (12%) in inpatient settings. This includes a 70% increase in average denied amounts from RFI and medical necessity denials across all settings. Telehealth-related denials were up 84% in 2025, due primarily to missing information, errors in claim submission, non-covered charges, or duplicate claims
To reverse these trends, provider organizations need to take steps to monitor denial trends by payer, setting, and claim type and reinforce root-cause analysis of denials, such as coding, documentation, and charge capture. Investing in early-warning tools and audit workflows that catch high-risk claims before submission is also recommended.
2. Payer Audits Increase
External payer audits surged again in 2025, with total at-risk amounts and audit cases per customer rising by 30%, and the average amount at risk per claim growing 18%. Of the top payer types, 45% of the at-risk amount was driven by commercial payers, while Medicare and Medicaid accounted for 28%. The average at-risk amount for a payer audit in a hospital setting was approximately $17,000, whereas the average at-risk amount at a professional setting was $1,172.
Intensified payer scrutiny necessitates faster response times, stronger documentation, and proactive risk management. This can be accomplished by mapping current audit exposure by payer, audit type, and service line, and prioritizing the highest dollar-at-risk claims for review and remediation. Additionally, providers should build robust workflows to manage audit requests, capture documentation, and respond within deadlines to retain revenues.
3. Outpatient Coding Worsens
Outpatient coding-related denials increased in 2025, rising 26% after a 126% spike in 2024, signaling their critical vulnerability. To slow this escalation, providers must begin treating coding integrity as a foundational risk area rather than an afterthought. This includes conducting targeted risk-based coding audits in outpatient service lines, focusing on training, review, and oversight of outpatient coding workflows, and ensuring that coding tools, documentation support, and coder oversight align with the heightened scrutiny, governance, and human oversight requirements.
4. Technology Unlocks Outcomes
There was a silver lining in the 2025 Benchmark Report: technology- and data-driven approaches are gaining traction and delivering measurable improvements, and revenue integrity teams are increasingly adopting data- and AI-driven approaches to unlock revenue opportunities and mitigate risk. Risk-based audits within the MDaudit platform increased by 25%, and pre-bill audits increased by 30%.
“Provider organizations that leverage data-driven platforms and deploy real-time, continuous risk monitoring can stay ahead of payers by better understanding real-time billing, coding, and payment trends,” said Ramesh. “This allows them to take proactive action to educate providers and coders while addressing other issues.”
Looking Ahead
Technology-including the responsible integration of artificial intelligence (AI) and real-time performance data shared across multiple functions-will continue to play an outsized role in driving competitive advantage and assuring financial resiliency in the year ahead. Integration of autonomous coding, predictive audit sampling, and workflow automation is expected to expand across the industry. Meanwhile:
Continuous risk monitoring tools will reduce payer audit response times by half and maintain tighter oversight of at-risk revenue through automation and centralized audit tracking.
Pairing automation with intelligent human oversight will drive measurable gains in accuracy, compliance, and speed.
AI-powered revenue integrity platforms will result in exponential lifts in operational efficiency and denial overturn success rates.
“The 2025 benchmark data makes clear that the margin for error in billing, coding, and audits has shrunk, and technology is becoming a differentiator,” said Ramesh. “Organizations that adopt analytics, proactive audit/pre-bill workflows, and coding integrity will have a distinct advantage.”
About the Report
The MDaudit 2025 Annual Benchmark Report is a comprehensive examination of real-world data representing the first three quarters of 2025, from a network of more than 1.2 million providers and over 4,500 facilities across 40+ states.
Few in the healthcare industry question the need to modernize the HIPAA Security Rule, the proposed overhaul of which is expected to be finalized in 2026. But even if the final rule is modified to scale back requirements or lengthen timeframes, compliance will be a heavy lift for many physician practices, hospitals, and health systems.
That reality, coupled with the common-sense need for robust security around protected health information (PHI) and other patient data, makes procrastination a compliance strategy that is doomed to fail.
Cyberattacks have reached unprecedented levels in the two decades since the HIPAA Security Rule was passed. The first, and last, major update to the rule took place in 2013, a year when healthcare organizations experienced just 269 data breaches. By 2024, that number had skyrocketed to 734 incidents involving more than 500 records each. Based on current trends, 2025 could experience 750–800 large breaches and analysts warn that more than 300 million records could be compromised if mega breaches continue.
Also at play are covered entities (CEs) and business associates (BAs), which raise healthcare’s risk profile with the threat of unintentional and nefarious events that can endanger electronic PHI and other sensitive data.
Thus, OCR determined that it was time to update the rule to address technological advancements and evolving breaches and cyberattacks. The proposed rule also acknowledges OCR’s greater enforcement experience, improved guidelines, best practices, methodologies, procedures, and processes for protecting ePHI, and various legal decisions that have impacted enforcement.
It also re-addresses one of OCR’s most significant challenges when it comes to regulating security: the rapid advancement of both health IT and the methods employed by malicious actors.
Too-prescriptive mandates would necessitate updating the rule more frequently than is realistic. Previous iterations of the HIPAA Security Rule attempted to address this by being flexible with compliance and classifying many security measures as “addressable implementations,” meaning they were strongly recommended but not explicitly required.
For example, the current rule requires any organization touching ePHI to conduct a security risk assessment to evaluate potential risks and vulnerabilities, resolve any identified vulnerabilities, and document the steps taken. OCR even provides a tool for use in conducting the evaluation. But beyond that, there is no prescriptive guidance. As a result, many healthcare organizations that lacked the resources or technical knowledge to conduct a comprehensive risk assessment wound up taking shortcuts.
While industry support for the HIPAA Security Rule overhaul is broad, so are concerns that the compliance burden will be too high for many organizations it affects. There was a consensus throughout the nearly 4,750 letters submitted during the proposed rule’s public comment period that many requirements would be almost impossible for some organizations to meet without assistance.
Additionally, the proposed rule converts many addressable implementation specifications to required, eliminating a core flexibility aspect of the rule. Finally, for many, compliance with the updated HIPAA Security Rule will not be feasible with their existing technical infrastructure. It would necessitate significant investments in new technologies capable of protecting ePHI as mandated by the rule.
Lessening the Burden
The good news is that compliance does not have to come at the cost of financial ruin. Small steps toward anticipated mandates can be taken now to lessen the compliance burden—many of which are common-sense protective measures that should be implemented with or without regulatory dictates. For example:
Multifactor authentication (MFA) is a highly effective yet reasonably priced protection against phishing and other forms of infiltration.
Regularly backing up data ensures continuous access to information in the event of a system outage.
Ransomware or exfiltration protection that goes beyond encryption can prevent bad actors from exploiting vulnerable access points once they are inside a system.
Other actions that should be taken now include conducting a security risk assessment and drafting a mitigation and remediation plan. Doing so allows for the prioritization of limited resources.
It is also likely that even well-resourced healthcare organizations will require third-party support to take these early actions or achieve compliance within the timeframes outlined in the final security rule. As such, now is the time to identify the right trusted IT management firm to assist with enhanced security and, eventually, regulatory compliance.
Look for firms with a deep understanding of healthcare-specific compliance requirements. Prospective partners should also offer comprehensive services to ensure they can address the comprehensive needs related to compliance with the HIPAA Security Rule and other issues that may arise, including the ability to future-proof security. They should also possess advanced expertise and the willingness and ability to leverage cutting-edge tools and processes that can outperform older or less adaptive technologies.
Look for a partner that emphasizes long-term relationships and offers personalized customer support. Other must-haves include flexibility and scale in their approach to services, transparent price structures, and simple contracts with clear and fair service terms. Finally, during the evaluation process, be sure to ask prospects about response times and disaster recovery capabilities and obtain—and check—references.
Ending Procrastination
While the final requirements may differ from what has been proposed, there is little likelihood that OCR will retract its decision to overhaul the HIPAA Security Rule. It is an action that is long overdue and should serve as a reminder that strengthening data protection is the right thing to do, whether mandated by OCR or not.
Taking steps now will significantly ease compliance burdens and protect one of healthcare’s most valuable assets. For provider organizations with limited resources, taking small steps towards compliance now will go a long way toward protecting patient data.
By John Wallace, PT, MS, FAPTA, chief compliance officer, WebPT.
Being efficient doesn’t mean cutting every cost. In rehab therapy, it means knowing where lean systems are enough and where targeted investments pay off. Many practice owners take pride in their resourcefulness, but avoiding necessary spend can be just as damaging as overspending. True efficiency requires discernment, not deprivation.
Invest in Prevention, Not Just Cleanup
Many compliance challenges are preventable and often come down to education. Annual CPT coding refreshers, documentation training, and payer-specific updates help teams avoid the most common reasons for denials. Fortunately, these resources are widely available and affordable.
Associations like APTA, AOTA, and ASHA offer low- or no-cost defensible documentation checklists. Some EMRs also include built-in CPT code training modules that therapists can complete on demand. Even one annual training session can prevent dozens of costly mistakes and appeals.
A practice that spends wisely on education avoids far more costly cleanups later.
Know the Limits of Internal Fixes
Internal reviews, peer audits, and checklists can resolve most routine issues. But when audit denial rates spike, especially over the 50% mark, it’s time to rethink the DIY approach.
If you’ve already submitted records and received a wave of denials, don’t rush into appeals without backup. Bring in someone who can review your submissions, flag weak points, and ensure the full documentation story is being told. Even one overlooked missing element can tank an otherwise appropriate episode of care.
Waiting too long to get help can turn a manageable problem into a financial crisis.
Reevaluate Your Payer Strategy
Some of the most expensive mistakes rehab practices make don’t come from what’s in the documentation but from who they sign contracts with. It’s common for new owners to accept every payer agreement offered, thinking more plans means more patients. But each payer adds administrative overhead. If the reimbursement doesn’t offset the documentation burden, denials, and audit risks, that contract might be a liability, not an asset.
There are large commercial payers known for aggressive takeback audits. Talk to peers, evaluate patterns, and think critically about which payers are worth the work.
Out-of-network models, while not for everyone, offer more control and less regulatory friction. They require more patient communication and claim support but can protect clinical autonomy and reimbursement consistency in the long term.
When You Do Need Help, Get the Right Kind
Not every challenge requires outside support, but some absolutely do. If a payer is demanding a multi-year takeback or you’re staring down potential legal action, you need a healthcare attorney, not the business lawyer who helped set up your LLC. These legal experts specialize in payer appeals and regulatory defense, often working alongside compliance consultants to prepare defensible documentation reviews.
Start your search through professional associations, peer groups, or online rehab therapy communities. Platforms like Facebook and LinkedIn host active forums where practice owners regularly recommend experienced consultants and attorneys.
It’s not about bringing in an expensive expert for every small hiccup. It’s about knowing who to call when the stakes get high and acting early enough to protect your practice.
Efficiency with Intention
Running a low-cost practice doesn’t mean cutting corners or taking on every responsibility yourself. The most resilient clinics are the strategic ones, whose leaders are intentional with their budgets, prioritize staff training, protect themselves from risk, and avoid contracts that aren’t in their best interests.
Lean doesn’t mean minimal. It means strategic. Knowing when to pull in help or walk away from risk is one of the smartest moves a practice owner can make.
Merger and acquisition (M&A) activity continues at a rapid pace, posing a risk to data integrity. As impacted hospitals and health systems seek to consolidate their operations and technologies, duplicate and crossover records surge. While these errors present immediate challenges, the longer-term concern lies in maintaining the accuracy and integrity of patient data across newly merged systems.
Rachel Podczervinski
We sat down with Harris Data Integrity Solutions’ executive vice president, Rachel Podczervinski, MS, RHIA, and director of industry relations, Julie A. Pursley, MSHI, RHIA, CHDA, FAHIMA, for an in-depth exploration of the obstacles confronting those tasked with maintaining the accuracy of patient data in a rapidly consolidating healthcare environment.
Electronic Health Reporter (EHR):What are the key components of and best practices for data conversion planning during M&A processes, particularly concerning the Master Patient/Person Index?
A critical component is the meticulous analysis and documentation of an MPI’s “current state” and the envisioned “future state.” This involves a thorough review of database structures for both existing and forthcoming systems, as well as the assessment of current and future medical record numbers (MRNs).
Julie A. Pursley
Additionally, engaging key stakeholders is vital for developing a comprehensive strategy that addresses the diverse needs of the organization. Selecting the right tools for duplicate and crossover remediation helps ensure accuracy and integrity throughout the MPI management process. Clear MPI data extract specifications are essential for capturing all available identifiers for each patient from the system. Finally, conducting a frequency analysis on key demographic data fields can uncover patterns and outliers, reveal the structure of MRNs across facilities, and highlight any structural adjustments needed for the new system.
For testing and validation, verify the accuracy of the extract by cross-referencing patient information and conducting targeted spot checks. Ensure that accounts marked for retirement are excluded from the extract to prevent duplicates from being created during subsequent analysis. This reduces the workload for health information teams and maintains data integrity throughout the extraction process.
Develop strategies to manage duplicate records, safeguarding data accuracy and integrity. Establish clear protocols and guidelines for resolving duplicates and reconciling crossovers. Finally, define a threshold for acceptable error rates and allow sufficient time to rectify errors before that threshold is reached.
Several best practices can be used to ensure seamless integration:
Prioritization – evaluate match criteria, such as weights, to allocate resources efficiently for duplicate pair resolution.
Algorithm optimization – collaborate with the technical team to better understand how potential duplicates are identified and explore opportunities to refine reports.
Audit MPI data – assess the MPI’s current health to identify areas for improvement, whether through retraining, enhanced processes, or enterprise-wide standards.
Identify external resources – many tools can help design improvement strategies, including resources from AHIMA component associations, Project US@ and its companion guide, AHIMA’s naming policy, etc.
Involve the registration team – establish feedback loops and improve training materials to reinforce their critical role in MPI management and organizational success.
M&A activity inherently increases the risk of disrupting the integrity of patient data as organizations merge disparate systems. Strategic planning and best practices that focus on aligning people, processes, and technology can mitigate these risks and help navigate the intricacies of pre- and post-merger MPI management with confidence and effectiveness.
EHR: Why are the Caring Algorithm and the Humans-in-the-Loop model essential aspects of a patient data integrity strategy, particularly during M&A activity?
Caring Algorithms adhere to an AI governance framework that prioritizes safeguards and promotes ethical usage while accurately identifying individuals and supporting fair and unbiased identity decisions across diverse patient populations. Importantly, Caring Algorithms incorporate a human-in-the-loop review mechanism for those matches where the algorithm is not 100% certain. Doing so acknowledges both the limitations of automated algorithms and the potential for automation to impact safety and care coordination by introducing gaps in patient identification.
Ideally, the human-in-the-loop review leverages a variety of tools beyond the matching algorithm to validate discrepancies. These include rules targeting specific matching elements, data standardization tools, and third-party resources that supply historical demographics such as names, addresses, and phone numbers from credit institutions and public utilities.
Harris Data Integrity Solutions (HDI) recently analyzed 137,080 pairs (two patient records) of potential duplicates. What we found highlights how initial decisions made by third-party data can change when a human-in-the-loop review is incorporated into the workflow.
HDI changed the third-party remediation decision in 9.1% of the pairs.
Of “yes” decisions, 7.2% required changes, as did 2% of “no” decisions.
Not changing the third-party decision would have created 512 (0.4%) overlays.
Changes from “no” to “yes” involved 2,490 pairs (1.8%).
These findings clearly indicate that the presence of both Caring Algorithms and a human-in-the-loop oversight mechanism is vital to restoring and retaining data integrity before, during, and after a merger.
EHR: What role do information technology professionals play in properly leveraging AI to resolve duplicate records during M&A activities and mitigate its impact on data integrity?
Automation can reduce the need for human intervention, but it cannot completely replace it. Without clear boundaries, governance, and safeguards, AI’s limitations can create gaps that require human review and intervention. While humans are responsible for many—but not all—patient identification errors, they are essential to identifying, verifying, and correcting them.
AI-enabled technologies such as EMPIs with advanced algorithms, biometrics, MLMs, and predictive analytics with augmented data are powerful but imperfect. They may overlook inconsistencies and cannot make contextual judgments and decisions based on nuanced considerations. These require judgment and decision-making, creativity, innovation, and agility, as well as emotional intelligence and empathy—decidedly human qualities that are critical to handling the complexity of patient data.
EHR: How do health information professionals contribute to navigating complexities such as person matching, error management, and collaboration with registration partners during M&A?
A critical role of health information professionals is managing the accuracy and accessibility of patient data across multiple systems, making them vital to successfully navigating the complexities of maintaining data integrity during M&A. Accurate patient identification ensures that health data seamlessly follows the patient across the continuum of care post-merger. Health information professionals are responsible for establishing standardized data capture practices and training staff to ensure that these standards are consistently maintained.
They also safeguard the ongoing integrity of the EMPI, enabling seamless information sharing across systems, a capability that is especially critical for large, multi-facility health systems. As consolidation accelerates across the healthcare industry, health information professionals will continue playing a central role in maintaining data integrity and ensuring that accurate patient information is available whenever and wherever it’s needed across the continuum of care.
EHR: Where is the industry with patient matching IDs? Any movement? Any hope?
While there is no federal movement toward implementing a unique patient identifier (UPI) in the U.S., Congress has introduced bipartisan legislation with the Patient Matching and Transparency in Certified Health IT (MATCH IT) Act of 2025. This bill aims to improve patient safety and privacy by decreasing patient misidentification while promoting interoperability.
AHIMA updated and launched the Naming Policy Framework 2023: Enhancing Person Matching With Essential Demographic Data Elements to help capture standardized data and assist in identifying patients in health IT systems. A national workgroup reconvened this year to update the resource, providing a one-of-a-kind standard in the industry due to the lack of a national patient identification and matching strategy.
Other initiatives are also advancing patient identification. Patient ID Now released a framework for a national strategy for effective patient identification and matching and continues working to remove legislative barriers that hinder the exploration of a unique patient identifier. Additionally, Project US@ published a technical specification for collecting patient addresses, supported by a companion guide from AHIMA that provides operational guidance and best practices.
EHR: What are some of the things that inspire you most about where the industry is going long term, based on what you’re seeing through your work?
We are inspired every day by the opportunity to work alongside exceptional health information professionals, including those on the HDI team and within client organizations and professional associations. Their dedication to safeguarding data integrity directly influences the quality of care delivered to our patients, our loved ones, and ourselves.
By Ashish Singh, Regional Sales Leader, Healthcare Technology, Asia Pacific and Middle East, Rauland.
Across Asia Pacific and the Middle East, hospital digital strategy has been dominated by EHR upgrades, infrastructure refresh cycles, and pilot projects in AI and analytics. Investment capital is chasing complexity.
Yet the fastest, cheapest, and most direct ROI opportunity is hiding in plain sight—and systematically ignored. Clinical communication maturity.
This is not just another technology category. It is the operational substrate on which every other digital investment depends. Without it, EMR data remains retrospective rather than proactive. Without it, AI becomes a dashboard rather than an intervention. Without it, every dollar spent on digital transformation burns at the bedside.
The Hardware Procurement Trap
Most hospitals in ASEAN and GCC countries still evaluate nurse call systems as a hardware procurement decision—not a clinical workflow investment. The system is assessed the same way as a telephone or intercom: Will it ring? Will it light up? Can we hear it? This mindset is a major reason why ROI on digital transformation in our region remains inconsistent.
The data is unambiguous. Research shows that up to 45% of nursing time can be consumed by non-value-added coordination tasks—tasks that could be automated or streamlined if clinical communication platforms were structured as workflow engines instead of hardware endpoints. In one acute care study (Galinato et al., 2015), delays in acknowledgement varied more than three minutes between severity categories, and these delays were linked directly to the communication method used and whether the signal triggered a standardized workflow.
Yet in ASEAN and Middle East hospitals today, we have a strange paradox: modern nurse call equipment is being installed, but workflow outcomes are rarely measured. There is detailed peer-reviewed work globally on response time patterns, escalation trigger behavior, alert fatigue, and the relationship between signal design and time to action. In our region, we rarely collect or report these metrics. Hardware arrives. Workflows remain unchanged.
The Real Problem Is Not Technology—It’s Maturity
The performance gap is not a technology gap. It is a maturity gap. If we adopt a maturity framework, the issue becomes immediately visible—and actionable.
Level 1: Alarm Systems. Hospitals treat nurse call as an alarm—a ring, a light, a sound. The goal is simply to hear and respond. Almost all ASEAN district hospitals and many private hospitals operate here.
Level 2: Structured Request Systems. Communication becomes coded and contextual: pain assistance, toileting needs, medication requests. This begins to change behavior because the signal carries actionable information.
Level 3: Workflow Engines. The signal triggers routing, escalation, and analytics. Response times improve, nurse time is released, and the business case for digital transformation becomes financially visible. This is where measurable ROI happens.
Here is the uncomfortable truth: Most hospitals in our region believe they are at Level 2 or 3 because the equipment they purchased has modern capabilities. But capability is not maturity. Deployment and measurement is maturity. We are not measuring the outcomes that matter.
The Fastest ROI Route Runs Through Communication
Clinical communication sits at the exact point where nurse time waste is created or eliminated. Every nurse leader knows this. Yet hospital boards continue to funnel digital budgets into the biggest, most complicated projects on the roadmap while overlooking the intervention that could return measurable capacity in a single quarter.
Consider the comparison. EHR upgrades take 12 to 36 months and require clinical adoption campaigns, integration cycles, and vendor dependency. AI pilots take months to years, require data pipelines, regulatory alignment, and uncertain scaling. Clinical communication maturity can return measurable impact in one quarter because it attacks the single most universal bottleneck: delay.
In most hospitals across Asia and the Middle East today, nurses are waiting for acknowledgement, waiting for routing, waiting for escalation. The hospital does not need machine learning to solve this problem. It needs structured signal-to-structured-action architecture and KPI discipline.
The irony is profound. The Asia Pacific nurse call system market is projected to exceed $900 million by 2032. Procurement is happening at scale. Devices are entering wards. If just 10% of that capital deployed into hardware were matched with structured clinical workflow redesign, the impact on response time and escalation accuracy would significantly exceed most AI pilots currently underway in the region.
Three Metrics That Reveal Everything
There is a simple starting point that requires no new technology purchase. Measure three basic communication outcomes:
Time to Acknowledge – How long until a signal is seen?
Time to Respond – How long until a team member reaches the bedside?
Time to Resolve – How long until the request is completed?
These three numbers will immediately reveal whether your nurse call system is a hardware endpoint or a workflow platform. They will also reveal where bottlenecks exist without requiring a full-scale technology overhaul. In fact, most hospitals can begin this measurement within 30 days using existing infrastructure.
The measurement itself becomes the catalyst for workflow redesign. Once hospital leadership sees that average time-to-respond exceeds seven minutes for non-urgent requests, or that critical alerts take more than three minutes to acknowledge, behavior changes. Budget committees start asking different questions. Procurement shifts from price-per-device to workflow outcomes per dollar invested.
Why This Matters Now for ASEAN and GCC Health Systems
Our region stands to gain the most from this shift. ASEAN and Middle East health systems are under intense pressure to scale care capacity without proportional increases in staffing. Clinical communication maturity is one of the few digital strategies that delivers measurable benefit without long-cycle transformation projects.
We also have a strategic advantage: we are not burdened by decades of legacy thinking. Mature Western health systems often struggle to change established workflows precisely because they have been doing them the same way for 20 years. In ASEAN and GCC countries, digital infrastructure is being built now. We can embed workflow maturity from the beginning rather than retrofitting it later.
Yet currently, almost no country in ASEAN or the GCC publishes routine nurse call workflow performance indicators. No system in our region publishes quarterly response time targets. Very few private hospital groups publicly report time-to-escalation metrics for critical alerts. This measurement gap is why digital health ROI remains theoretical rather than operational.
The Path Forward: From Concept to Operating Reality
Investments in EMR, analytics, and AI are necessary—but they are not sufficient. Clinical communication is the operational substrate that makes every other investment usable at the bedside. When that substrate is weak, every dollar of digital spend above it generates friction. When it is strong, even legacy EMR workflows become more productive.
The next generation of digital hospital leaders will not be measured by the size of their data lakes or the sophistication of their AI models. They will be measured by how much bedside time they release back into the clinical day. The highest-performing health systems in the next decade will be defined not by how much automation they deploy, but by how much time they protect.
Until we lift clinical communication from hardware procurement into workflow strategy, we will continue to burn capital on technology that never translates to bedside impact. The maturity model is not academic—it is the difference between digital transformation as a concept and digital transformation as an operating reality.
Clinical communication maturity is the next frontier. The data is clear. The gap is clear. The opportunity is real. Our region can move faster than others precisely because we are building infrastructure now, not replacing it. The question is whether we will seize this advantage or repeat the mistakes of more mature markets by chasing complexity while ignoring the fundamentals.
What Hospital Leaders Can Do Starting Tomorrow
For Chief Nursing Officers: Begin tracking time-to-acknowledge, time-to-respond, and time-to-resolve for one nursing unit this month. Use existing infrastructure—most modern nurse call systems can export this data. Report findings to executive leadership with projected time savings.
For Chief Information Officers: Audit your current nurse call system’s workflow capabilities versus how it is actually deployed. Identify the gap between capability and utilization. Propose a 90-day pilot to instrument workflow metrics in collaboration with nursing leadership.
For Procurement Teams: Shift RFP evaluation criteria from hardware specifications to workflow outcomes. Require vendors to demonstrate not just device capabilities, but measurable improvements in response times and workflow efficiency with reference sites providing data.
For Hospital Boards and CEOs: Request quarterly reporting on clinical communication performance alongside traditional quality and safety metrics. Make workflow maturity a standing agenda item in digital transformation steering committees. Allocate budget for workflow redesign equal to 10% of hardware procurement spend.
The rate of payer audits accelerated in 2025, with hospital inpatient and outpatient average denial amounts that increased by 14% and 12%, respectively. Denial volumes were also up overall, led by a nearly fivefold increase in Request for Information (RFI) and medical necessity denials for Medicare Advantage plans.
