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E-Newsletter • March 2025 |
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Editor's E-Note
There is overwhelming interest in using artificial intelligence (AI) to assist in health care, but finding the most effective ways to use it is a work in progress. For example, the American Medical Association recently released a study that looked at how AI affects prior authorization. See below for more details.
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— Dave Yeager, editor |
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Physicians Concerned AI Increases Prior Authorization Denials
Many physicians fear the health insurance industry’s use of unregulated artificial intelligence (AI) automation and predictive technologies will increasingly override good medical judgment and systematically deny patients coverage for necessary medical care. According to a new survey from the American Medical Association (AMA), three in five physicians (61%) are concerned that health plans’ use of AI is increasing prior authorization denials, exacerbating avoidable patient harms, and escalating unnecessary waste now and into the future.
Burdensome prior authorization requirements that conflict with evidence-based clinical practices and create hurdles to patient access to safe, timely, and affordable treatment have been a major impediment to patient care for decades. More recently, health insurers have turned to AI decision-making tools that generate prior authorization decisions with little or no human review. These AI tools have been accused of producing high rates of care denial—in some cases, 16 times higher than is typical.
“Using AI-enabled tools to automatically deny more and more needed care is not the reform of prior authorization physicians and patients are calling for,” says AMA President Bruce A. Scott, MD. “Emerging evidence shows that insurers use automated decision-making systems to create systematic batch denials with little or no human review, placing barriers between patients and necessary medical care. Medical decisions must be made by physicians and their patients without interference from unregulated and unsupervised AI technology.”
To that end, the AMA firmly believes that AI must augment decision-making, be referred to as “augmented intelligence,” and not remove humans from patient care, coverage, or treatment.
Notably, the AMA’s Augmented Intelligence Research released recently found that nearly half of all physicians (49%) ranked oversight of payers’ use of AI in medical necessity determinations among the top three priorities for regulatory action. Moreover, recently passed AMA policy identifies significant concerns with insurer use of AI.
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AI Lightens Administrative Burden on Nurses
Cedars-Sinai has recently begun testing an artificial intelligence mobile app called Avia Nurse Assistant. Nurses spend 40% of their shift on documentation, which can contribute to burnout. Nurses can use a mobile phone to document patient information through voice dictation. The app then transcribes the data and files the information into the patient’s EMR after clinician validation.
AI Computer Vision Enables Efficiency Gains for Houston Methodist Hospital
Houston Methodist Hospital recently adopted Apella, an artificial intelligence (AI) surgical operations platform, to improve operating room efficiency. The platform combines ambient sensor technology with deep learning AI to improve scheduling, planning, and coordination, Healthcare IT News reports.
VA to Resume Oracle EHR Deployments in Mid-2026
After pausing the roll out in April 2023, the VA is looking to resume deployments of Oracle EHR. The VA will roll out to four facilities in Michigan in mid-2026. |
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eHealth Technologies Announces Customer Advisory Board
eHealth Technologies, a health care technology company, just announced its 2025 customer advisory board. The board will examine what patient-driven experiences look like for both health care organizations and patients and will discuss strategies for using advanced technology solutions to help organizations increase satisfaction with both providers and patients. Learn more »
Technology Integration for Radiology Billing
Konica Minolta Healthcare Americas Inc and ImagineSoftware recently announced an integration agreement. Imagine’s artificial intelligence platform for automated radiology billing will join Konica Minolta’s Exa PACS|RIS solution. According to Konica Minolta, customers will benefit from automated and streamlined revenue cycle management operations that decrease costs. |
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