Epic Lawsuit by Texas AG Paxton

Texas AG is suing Epic

Texas Attorney General Ken Paxton files an antitrust and consumer protection petition alleging that Epic maintains monopoly power. It says that Epic controls more than 90% of US patient records, locks in hospitals through extreme switching costs, restricts competitor access to data, and imposes no-hire restrictions on employees.

The petition also argues that Epic delays or limits access to medical records for providers and patients who are outside Epic’s system.

The lawsuit further accuses Epic of misleading Texas children’s hospitals about its parental access rules, which is likely the key issue of the lawsuit.

The lawsuit seeks injunctive relief to restore competitive conditions, civil fines, and court costs.

Craig Allen Keefner

Patients Using AI to beat AI Medical Claim Denials

Can I use AI to Appeal Medical Claim Denial?

Short answer is yes.  Over 20% of medical claims are denied (ACA marketplace denial rate is ~19% (CMS). 73 million in-network claims in 2023 were denied. And less that 1 percent appealed.

Insurers increase margins through claim-denial workflows.  We are being diplomatic.

AI in healthcare medical claims is very lightly regulated. Generally there is supposed to be real person reviewer and evaluate but how often do they simply sign off on the AI denial.

Some insurer AI systems evaluate likelihood of patient follow-through, raising fairness concerns. Again, diplomatically said.

Are there online companies that use AI to help me fight AI?

Yes, several online companies now use AI to help individuals appeal denied medical claims, making the process faster and more accessible than traditional methods. These services typically generate personalized appeal letters using your specific situation, policy details, and medical records, saving you hours of research and drafting.​

Leading AI Medical Claim Appeal Services

  • Fight Health Insurance offers a free, AI-based tool where you can upload your denial letter and relevant documents. The system then generates a comprehensive appeal letter tailored to your requirements.​
  • Claimable is another service that focuses on AI-generated, personalized appeals. Their process involves a detailed questionnaire and yields evidence-backed letters for a flat fee of about $40 per appeal. This platform specializes in medication-related denials but is expanding its coverage.​
  • Counterforce Health is a nonprofit platform that provides free, AI-based appeal letters for a variety of health claim denials. It can also automate follow-up calls with insurers to reduce the administrative burden for patients.​
  • PenguinAI and Aegis Health are geared more towards clinics and healthcare providers but use similar AI-driven technology to automate the appeal and denial management process.​

What to Expect

  • These platforms ask you to upload your denial letter and any supporting documents.
  • Their AI reviews your case, matches evidence from medical literature and policy regulations, and crafts a multi-page appeal letter.​
  • Some, like Counterforce Health, also use AI to make automated follow-up calls to insurance companies.​
  • Experts generally recommend having a human review the AI-generated letter before submitting, to ensure accuracy and completeness.​

This new generation of AI-powered services can be an effective first step in contesting denied claims, saving you time and increasing your chances of success.

What is the Cost?

The cost of AI-powered medical claim appeal services varies depending on the company:

  • Claimable charges a flat fee of about $40 per appeal, regardless of the outcome. There may be additional charges for shipping the letter if you want them to send it directly to your insurer or regulators.​
  • Counterforce Health provides its AI appeal service completely free to patients, made possible through grants and nonprofit backing.​
  • Fight Health Insurance also offers a free tool where users upload their denial and receive a personalized appeal letter.​
  • Some platforms offer the ability to print or fax appeals for a small fee (for example, $5 for direct faxing or document mailing).​

What About Next Steps and Insurer Reply/Rebuttal?

Most paid services charge a simple per-appeal flat fee rather than ongoing subscriptions or percentages of recovered amounts. Free options are expanding, offering significant value for patients needing help with the appeals process.

Most AI-powered appeal services do not typically handle direct, ongoing conversations with your insurer once you have submitted the appeal. Their main service is generating and preparing your initial appeal letter; after that, you are responsible for sending it in and managing the responses.​

However, one notable exception is Counterforce Health, which introduces an AI assistant called Maxwell. Maxwell can make follow-up phone calls to insurance companies, request updates, check the status of appeals, and document responses. This reduces the patient’s need to repeatedly call or navigate phone systems. Still, this level of automated follow-up is unique to Counterforce Health, and most other services focus strictly on document generation rather than real-time communication or negotiation with insurers.​

In summary, if you want a service that helps automate insurer follow-up and status calls—not just generating appeal letters—Counterforce Health is currently your best bet among AI-powered platforms.

Frequently Asked Questions

Can I use AI to appeal a denied medical claim?

Yes. Several AI platforms can generate personalized appeal letters based on your denial letter, policy details, and medical documentation. These tools simplify the appeal process and often increase the chances of success.

Are AI-generated appeal letters effective?

They can be very effective, especially when the denial is tied to policy wording or incomplete documentation. Experts still recommend having a human review the AI-generated letter for accuracy before submitting.

Is it legal to use AI to fight insurance denials?

Yes. Patients are legally allowed to create their own appeal letters, whether written manually or produced with AI. These tools do not replace legal advice—they simply help organize and draft needed documentation.

How much do AI appeal services cost?

Prices vary: Claimable charges around $40 per appeal, Counterforce Health offers a free nonprofit option, and Fight Health Insurance also provides a free AI tool. Some services may add small fees for mailing or faxing.

Do AI services submit the appeal for me?

Most services only generate the letter; the patient submits it. Counterforce Health is an exception—their AI assistant “Maxwell” can place follow-up calls to insurers and monitor status.

Do AI tools help with follow-up after the appeal is submitted?

Most tools do not offer follow-up. Counterforce Health is currently the only platform providing automated insurer phone-call follow-up.

Do I need to upload my denial letter?

Yes. All major AI appeal platforms require your denial letter so they can analyze the insurer’s rationale and reference the correct policy language.

Are AI appeal tools safe to use with medical information?

Reputable services follow HIPAA-compliant data handling practices, but patients should always review the platform’s privacy policy before uploading sensitive documents.

Can AI help with prior authorization denials?

Most tools can handle both claim denials and prior authorization denials. Some services, such as Claimable, specialize in medication-related issues.


Resources

Craig Allen Keefner

Epic Goes AI with AI Scribe

AI Scribe by Epic

Next week is the UGM? Look for the announcement. Why does it take so long to switch from Cobol or perhaps MUMPS? It is always amazing to us the resistance to efficiency that institutions have. Banks, restaurants, and airlines still running on Windows 97 e.g.  Why do I have to type so much stuff?  Try checking in with EpicHealth for Optum.  Exhausted 20 minutes later.

Epic did not make a formal public announcement of a new Scribe AI product yesterday, but multiple credible sources report that Epic is prepping the launch of its own proprietary AI scribe this month, and it is considered imminent. The most recent coverage from August 11, 2025, states Epic is “reportedly prepping to launch its own AI scribe,” which is set to shake up the health tech market currently dominated by startups like Abridge and Nuance.politico+2

Key context:

  • Epic’s AI scribe will automatically transcribe doctors’ notes during patient visits, aiming to reduce clinicians’ documentation burden.beckershospitalreview+1

  • Epic previously partnered with ambient scribe vendors (Microsoft/Nuance, Abridge) but is now joining other top EHR vendors (Athenahealth, Oracle) in developing an in-house scribe tool.politico+1

  • Market watchers and participants (HIStalk, Axios) expect the full official announcement soon, possibly at Epic’s User Group Meeting (UGM) in August.histalk2+1

  • Many industry commentators believe Epic’s vast data resources and integration advantage will quickly give their scribe product a competitive edge, even if initial functionality is basic.histalk2

No Epic press release or official post dated August 10 or 11 is referenced, but coverage from Axios, HIStalk, and Politico confirms that the product’s announcement is both widely anticipated and considered imminent. If you require the full Epic press release or a direct statement, it has not yet been located in major news sources as of August 11, 2025.

The Epic User Group Meeting (UGM) in August 2025 is scheduled for August 18–21, 2025 at Epic’s Verona, Wisconsin campus.caregility+3

This annual event gathers healthcare professionals, executives, directors, and clinicians to exchange insights, learn about new Epic software features, and share best practices. Most announcements and major sessions—including any anticipated launches such as Epic’s proprietary Scribe AI—traditionally occur within these dates, with the opening day often featuring keynote addresses and the official unveiling of new products.

Has Epic Done This Before?

1. Laboratory Information Systems: Beaker Module

  • Partnership history: Historically, Epic partnered with standalone lab vendors (like Sunquest, Cerner, and interfaced with reference labs) for laboratory information systems (LIS).

  • Epic’s own module: In the late 2000s, Epic began developing its Beaker modules (Clinical Pathology and Anatomic Pathology), offering hospitals an Epic-integrated LIS to replace those third-party solutions.academic.oup+3

  • Effect: The release of Beaker allowed clients to leverage tight integration with Epic’s EMR, reducing interfaces, costs, and reliance on external lab vendors.

2. Telehealth: Telehealth Anywhere & Video Visits

  • Partnership history: Epic originally partnered with external telehealth platform providers, such as Twilio and other major telehealth vendors, embedding their platforms for video visits directly into Epic workflows.beckershospitalreview

  • Epic’s own module: Epic later began offering its own “Telehealth Anywhere” platform and native video visit tools, deeply integrated into its EMR and scheduling systems—reducing the need for third-party telehealth software.epic+1

  • Effect: The new Epic-native telehealth features allowed health systems to keep more workflows inside Epic, simplifying integration and offering new fee structures.

3. Ambient AI Scribe & Clinical Documentation

  • Partnership history: Epic previously partnered with Nuance (Microsoft) and Abridge for clinical documentation and ambient scribe functionalities within its EMR.blogs.microsoft

  • Epic’s own product: Epic is now poised to launch its own AI-powered scribe module, streamlining doctors’ note-taking and competing directly with former partners.

4. Payer Platform (Insurance Connectivity)

  • Partnership history: Epic’s environment enabled data connections and integrations with payer platforms and startups (like Particle Health) for insurance and care management use cases.medicaleconomics

  • Epic’s own module: Epic eventually released its own Payer Platform module, competing directly in the space and becoming dominant due to its integration advantage.healthapiguy.substack+1


Strategic Patterns

  • Epic’s strategy is often to observe successful “adjacent” vendor offerings, initially integrate those via partnerships, and then build competing in-house modules that offer deeper Epic native integration.healthapiguy.substack+2

  • This approach allows Epic to expand its software footprint, reduce reliance on third parties, and extract more value from its existing client relationships.


Noteworthy Partnership-Endings

  • The Xtenity partnership with Philips in the mid-2000s aimed to create a scaled-down Epic offering for mid-sized organizations, but ended abruptly—with Epic hiring the team and taking the product development in-house.clinfowiki+1

  • Multiple ambient and telehealth integrations with Microsoft/Nuance, Abridge, and Twilio are now being reevaluated in favor of Epic-native solutions.blogs.microsoft+1


In summary, Epic’s history is marked by an initial willingness to partner, followed by a long-term preference to develop native modules that eventually compete with, and often overshadow, those third-party solutions. This pattern has repeated in laboratories, telehealth, clinical documentation/scribes, and payer platforms.

More EPIC AI

Craig Allen Keefner

Alexa Patient Check In Self-Service for Hospitals

AI Assisted Healthcare

From KioskIndustry

Alexa Hospital Adoption Rate – Here’s an Alexa Idea I Actually Like

While it’s hard not to roll your eyes at voice assistants getting added to every single thing in the smart home, a Los Angeles hospital is actually putting Amazon Alexa to good use. About 100 patient rooms at Cedars-Sinai will now be equipped with Amazon Echos to help patients and caregivers interact more efficiently.

Editors Note: Originally published on Gizmodo 2/26/2019. This is an excerpt.

The pilot program runs off an Alexa-powered platform called Aiva. Now, patients can easily say things like, “Alexa, change the channel” or “Alexa, tell my nurse I need to use the restroom.” Some requests, like turning a TV on or off, Alexa can handle on its own. Others will be sent directly to a caregiver’s cellphone. And, probably the most helpful feature for healthcare providers is that the Aiva platform will be able to send requests to the appropriate type of caregiver. So while a nurse would get any requests for painkillers, a clinical partner would get bathroom requests. According to Cedars-Sinai, requests that take a while to fulfill would then get bumped up the chain of command.

Read Full Article

Excerpt:

While this might raise concerns about automation stealing jobs from qualified healthcare professionals, I’d argue it actually does the opposite. It does play into automation’s narrative of efficiency, but you’re essentially helping out overworked nurses at already understaffed hospitals. Arguably, if you’re a qualified nurse, the last thing you want to spend your time doing is changing TV channels when a patient elsewhere might be in need of painkillers. Plus, there’s just no way Alexa’s ever going to be able to take your blood samples even if you ask it nicely.

More articles

https://kioskindustry.org//now-available-just-ask-alexa-whats-new-at-redbox/

https://kioskindustry.org//amazon-said-to-plan-premium-alexa-speaker-with-large-screen/

https://kioskindustry.org//kroger-launches-voice-assistant-ordering-for-grocery-ecommerce/

Alexa Use in Hospitals (2025)

The use of Alexa in hospitals has increased notably over the last few years, and its presence in patient rooms is becoming more common. Hospitals often use Alexa Smart Properties, Amazon’s healthcare-focused platform, to enhance patient experience and operational efficiency. Notable systems like BayCare Health and Cedars-Sinai have rolled out Alexa devices in hundreds of patient rooms, allowing patients to control their environment (lights, TV, call nurse, entertainment, etc.) and communicate easily with care teams—all hands-free. Hospitals have found that voice assistants are intuitive for patients regardless of age or technical experience and are a “game-changer” for engagement and workflow.nurse+2

  • BayCare Health System (Florida): As of 2025, Alexa is installed in all 16 hospitals in the system, offering patients control over room amenities and streamlining entertainment and communication with staff. Some patients even expect Alexa devices in their rooms, highlighting growing adoption and familiarity.mobihealthnews

  • Patient Experience: Hospitals report improved patient satisfaction and more efficient workflows due to voice assistant integration.healthcareweekly

Use of other AI assistants (including voice AI and virtual medical assistants) has also increased—dramatically.

  • Widespread Adoption: As of 2025, over 80% of U.S. hospitals use some form of AI assistant to improve patient care and operational efficiency, whether through voice, chat, or workflow automation.litslink+1

  • Market Growth: The virtual medical assistants market was valued at $1.41B in 2025, with annual growth rates around 30% and further rapid expansion expected. Nearly half of healthcare organizations use or plan to implement AI-powered virtual assistants, with common applications including appointment scheduling, routine patient queries, triage, prescription refills, and patient education.golean+1

  • Voice AI in Call Centers and Patient Communication: Hospitals like Houston Methodist have used AI voice assistants to handle massive patient call volumes—especially during health events like vaccine rollouts—automating up to 91% of inquiries and dramatically reducing costs by minimizing human staffing needs.simbo

  • Automated Intake, Triage, Decision Support: Beyond patient rooms, AI assistants power administrative workflows (e.g., admissions, billing), handle documentation, and support clinicians using large language models for diagnosis and protocol recommendations.ishir+2

Summary: Alexa vs Other AI Assistants in Hospitals (2025)

alexa adoption rate hospitals

alexa adoption rate hospitals

Insights

  • Alexa use is clearly rising in U.S. hospitals—driven by patient and staff demand for intuitive, hands-free interactions.

  • AI assistant adoption as a whole has surged, with nearly every hospital deploying either voice or virtual agents for both clinical and administrative tasks.

  • Voice AI agents are expected to become universal, with benefits for patient satisfaction, cost efficiency, and operational scalability.hyro+1

In summary, both Alexa and other AI assistants are being used much more widely in hospitals in 2025 compared to prior years, with the trend strongly upward for both categories.

Craig Allen Keefner

Epic and MyChart Make More Appointments

Patient Portal Use Associated with 21 Million Fewer Visit No-Shows in 2024

Research by Epic Research. Patients who use MyChart are making it to their appointments more often than those who don’t.  Slowly but surely patients are becoming more and more accustomed to check-in in every possible way.

patient kiosk

Typical 2025 patient kiosk — Olea Kiosks

A new study from Epic Research found that patient portal use was associated with 21 million fewer no-show appointments in 2024. Patients who used MyChart were more likely to attend scheduled visits across specialties, age groups, and appointment types.

Fewer no-shows mean more timely care, better outcomes, and greater efficiency for health systems.

Key Findings

  • Patients with an active patient portal account at the time of scheduling their appointment were 21.5% less likely to no-show than those without an account, with a no-show rate of 6.2% for those with a patient portal account compared to 7.9% for those without. 
  • The greatest difference was seen among patients aged 50–64, with users having a 6.2% no-show rate compared to 8.7% of non-users. 
Missed outpatient appointments, or no-shows, disrupt care continuity, reduce clinic efficiency, and impact availability for other patients. Digital tools, such as patient portals, might improve appointment adherence by enhancing communication and engagement.1 MyChart, Epic’s patient portal, allows patients to schedule and manage appointments, receive reminders, and access care-related information and is the patient portal assessed for this study.We studied more than 1.6 billion face-to-face outpatient visits in 2024, comparing no-show rates for patients with and without an established patient portal account at the time the appointment was scheduled.Overall, patients with an active patient portal had a no-show rate of 6.2%, compared to 7.9% for those without, as seen in Figure 1. Patients aged 50–64 saw the greatest percentage point difference (6.2% vs. 8.7%) followed by those aged 35–49 (7.8% vs. 9.9%). Younger patients had smaller gaps, with the smallest difference seen among 18–34-year-olds (9.3% vs. 10.9%).

Figure 1

 

Converting this finding to a rate, approximately 1,700 fewer no-shows occurred for patients with portal accounts per every 100,000 scheduled visits. This equates to more than 21 million fewer no-shows in one year across the 1.26 billion scheduled visits among patient-portal users in 2024.A sensitivity analysis accounting for other factors such as patient demographics, social vulnerability, appointment lead time, rate of no-shows in 2023, social drivers of health, insurance type, and number of recent visits showed similar patterns.


These data come from summarized metrics of organizations that use the Epic EHR to provide direct patient care. This study was completed by two teams that worked independently, each composed of a clinician and research scientists. The two teams came to similar conclusions. Graphics by Brian Olson.  

References

  1. Carini E, Villani L, Pezzullo AM, et al. The Impact of Digital Patient Portals on Health Outcomes, System Efficiency, and Patient Attitudes: Updated Systematic Literature Review. J Med Internet Res. 2021;23(9):e26189. Published 2021 Sep 8. doi:10.2196/26189

 

More Epic Welcome Kiosk Resources

Craig Allen Keefner

Epic Systems Response to CMS/ONC RFI

Epic Systems CMS Response – Epic Welcome

Epic Systems submitted detailed recommendations to the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health IT (ONC) regarding the future of the U.S. health technology ecosystem. The response focuses on improving interoperability, patient access, data quality, digital identity, and regulatory clarity to strengthen the national digital healthcare infrastructure1

Key Points and Recommendations

1. National Healthcare Directory

  • Epic supports CMS’s plan to build a unified, national healthcare directory as a foundational step for interoperability.

    • The directory should use federated inputs: CMS would manage provider identity (via NPPES), while other organizations (payers, hospitals, licensing bodies) update contextual data (e.g., practice locations, specialties, network status).

    • Strong governance is needed to ensure data quality, with automated validation, routine audits, and a dedicated quality officer.

    • Automated, API-based updates are recommended to keep data current and reduce manual errors, prioritizing machine-to-machine communication over static portals1.

2. Digital Credentials and Patient Identity

  • Epic advocates for a common digital identity infrastructure (e.g., using Credential Service Providers like CLEAR or Login.gov) to streamline access, reduce administrative burden, and empower patients.

    • Identity proofing and patient matching remain critical: digital credentials should be linked to the correct medical record, with fallback options (like MFA or passwords) for those unable or unwilling to use digital IDs.

    • Consent and authorization must remain with the covered entity (provider), ensuring patients control data sharing.

    • Epic stresses the need for interoperable digital identity solutions (not proprietary), support for alternatives (mobile driver’s licenses, passkeys), and robust patient controls (revocation, audit trails).

    • Liability for inappropriate disclosures should be shared between providers and CSPs, with HIPAA updated accordingly1.

3. TEFCA (Trusted Exchange Framework and Common Agreement)

  • Epic views TEFCA as the core infrastructure for nationwide interoperability and urges further expansion:

    • Broaden use cases to include payment, operations, public health, and government benefits determination (e.g., Social Security disability).

    • Align TEFCA with the national directory to avoid duplicative systems and streamline data exchange.

    • Governance should prevent data exploitation, ensure compliance, and hold all participants accountable for privacy and security1.

4. Health IT Certification and Standards

  • Epic recommends streamlining ONC’s Health IT Certification Program to focus on interoperability and standards-based data exchange (e.g., USCDI, FHIR APIs).

    • Non-interoperability requirements (like “Insights Condition” and “Real-World Testing”) should be removed to reduce burden and encourage innovation.

    • Broader adoption of standards is needed, especially among labs, imaging centers, pharmacies, and long-term care facilities not currently using certified health IT1.

5. Large Language Models (LLMs) in Healthcare

  • LLMs are valuable for extracting insights from unstructured clinical data but should supplement—not replace—standards-based data exchange.

    • Structured data exchange via FHIR APIs is more reliable and cost-effective for many use cases1.

6. Quality Measures and Reporting

  • Epic supports the transition to digital quality reporting but urges CMS to provide flexibility for small practices lacking technical capabilities.

    • In the long term, Bulk FHIR Submit is recommended for standardized, efficient quality data submission1.

7. Information Blocking

  • Epic calls for clearer guidance and safe harbors to help regulated actors understand what is not considered information blocking.

    • Overly complex and vague regulations create compliance burdens and may discourage innovation.

    • Participation in TEFCA should be recognized as a “safe harbor” for information sharing, and actors demonstrating a commitment to interoperability (e.g., public APIs, TEFCA membership) should be acknowledged1.

Conclusion
Epic’s letter advocates for a federated, standards-based, and patient-centric health technology ecosystem. The company emphasizes the need for strong governance, automation, regulatory clarity, and shared responsibility across all stakeholders to advance interoperability and improve patient outcomes in the U.S. healthcare system1.

Epic Systems Response To RFI

More Epic Systems CMS Response Resources

  • CMS Official Announcements:
    The Centers for Medicare & Medicaid Services (CMS) website and newsroom regularly post updates about the RFI process, listening sessions, and next steps for building the digital health infrastructure, including the national provider directory23.

  • Industry News and Analysis:
    Outlets such as Digital Health News and HealthManagement.com provide coverage and expert commentary on the RFI process, Epic’s role, and broader industry reactions45.

More

Summary Table: Epic’s Recommendations for a National Healthcare Directory

Recommendation Details
Federated Inputs CMS manages provider identity; other orgs update contextual data; each actor responsible
Strong Governance Eliminate redundant reporting; align with TEFCA; quality officer; audits and validation
Automated, API-Based Updates Use FHIR APIs for real-time, machine-to-machine updates; minimize manual entry
TEFCA Alignment Harmonize directory with TEFCA to avoid duplication and fragmentation

Summary Table: Epic’s Recommended Standards

Use Case Recommended Standard/Specification
Directory automation HL7 FHIR Directory APIs (e.g., Mobile Care Services Discovery, FAST NDH)
Clinical data exchange HL7 FHIR, HL7v2
Imaging data exchange DICOM, FHIR ImagingStudy, DICOMWeb WADO-RS
Pharmaceutical data exchange NCPDP
Security/authorization OAuth 2.0
Craig Allen Keefner

Mayo Clinic: Remote Flight Physicals

Flight Physicals Via Kiosks Telemedicine

As the field of AMEs continues to thin and demand for FAA medical certification rises, kiosk-based flight physicals could make a lot of sense.  From Flying Mag

Mayo Clinic’s Vision for Remote Flight Physicals: A Deep Dive

A System at the Breaking Point

The world of aviation medicine is at a crossroads, and the Mayo Clinic’s Aerospace Medicine division is stepping up with a bold, tech-forward solution: remote flight physicals. The timing couldn’t be more critical. The FAA’s medical certification division is overwhelmed, and the number of Aviation Medical Examiners (AMEs) has plummeted from over 9,600 to fewer than 2,200. This shortage, fueled by healthcare consolidation and the retirement of seasoned AMEs, is grounding qualified pilots simply because they can’t get a timely exam1.

A Legacy of Innovation

Mayo Clinic’s aeromedical pedigree stretches back to 1920, when its doctors helped establish the very first pilot medical exams for the Civil Aeronautics Board. Their innovations—high-altitude pressure chambers, World War II pilot simulators, and advanced oxygen masks—set the standard for aviation medicine. But the COVID-19 pandemic forced a rethink: if pilots can’t come to the clinic, can the clinic come to them1?

The Kiosk Concept: Bringing the Exam to the Pilot

Enter the remote flight physical kiosk. Picture this: a pilot schedules an appointment through an app, walks into a fully equipped, enclosed kiosk at a flight school or pilot domicile, and connects with a remote AME. The kiosk is packed with biometric sensors, electronic stethoscopes, and a visual acuity unit—everything needed to capture vital data and beam it to a doctor hundreds or thousands of miles away1.

Mayo Clinic has already run about 20 pilots through a proof-of-concept phase. The setup is basic but promising: pilots come in for a traditional FAA physical, then volunteer for a kiosk exam. The data isn’t official yet, but the aim is to publish initial results in mid-2025. The next step is a “non-inferiority” study, pitting remote exams against in-person ones, especially for patients with known medical issues like heart murmurs or movement disorders1.

The Technology Stack

The hardware and software market for remote diagnostics is advancing rapidly. FDA-approved biometric devices can measure vitals with a simple arm insertion. MedWand Solutions, for example, offers a device that captures temperature, blood oxygen, pulse, heart and lung sounds, and even real-time electrocardiograms. These tools, paired with secure video feeds, make remote, clinical-grade exams a reality1.

The Uberization of Aviation Medicine

Dr. Clayton Cowl, a Senior AME at Mayo, envisions a future where pilots and AMEs connect much like riders and drivers on Uber. Retired or semi-retired doctors could clock in for a few hours a week, staying current with FAA regulations but skipping the overhead of a traditional office. This flexibility could help stem the tide of AME retirements and keep more pilots in the air1.

Yet, the economics are tough. Large healthcare systems, focused on high-margin specialties, have little incentive to keep low-fee FAA physicals on the menu. Many experienced AMEs have been absorbed into these systems or have retired, leaving pilots in rural areas especially stranded1.

Who Benefits—and Who Doesn’t

Remote flight physicals won’t be a one-size-fits-all solution. Dr. Cowl likens it to the 1040EZ tax form: great for straightforward cases, less so for complex ones. Healthy, younger pilots without a laundry list of medical conditions are the best fit. Older pilots or those with special medical needs will likely still require in-person exams, especially for FAA Special Issuance cases1.

A Looming Crisis

The FAA expects to process about 500,000 flight physicals by the end of 2026. With AME numbers dwindling, delays of six to twelve months for medical certificates are becoming the norm—especially for mental health or substance abuse cases. This not only disrupts pilots’ livelihoods but also drives up disability insurance costs and creates bottlenecks in commercial aviation1.

If the system doesn’t adapt, legislative workarounds like BasicMed—already a patchwork solution—will proliferate. But even BasicMed isn’t perfect, and some pilots who should be under traditional oversight are slipping through the cracks. As Dr. Cowl puts it, “the bottom line is that we have technology that can support the remote flight physical concept, and with an FAA that’s doing the best it can, the demand has outstripped the ability for it to keep up”1.

The Takeaway

Mayo Clinic’s remote flight physicals are not just a technological experiment—they’re a necessary evolution for an industry on the brink. The concept promises to make aviation medicine more accessible, efficient, and resilient, but it will require regulatory change, rigorous validation, and a willingness to rethink how pilots and doctors connect. For now, it’s a glimpse of the future, and for many pilots, it can’t come soon enough1.

More Resources

Craig Allen Keefner

ADA and Accessibility Data and Demographics

Closer Look at Accessibility (Web) and Disabled Demograghics

From KioskIndustry

A Web-Centric View of Accessibility With Demographic Data

We encourage accessibility.  Accessible self service is the ideal for us. If we had one wish, it would be that self-service accessibility for all be treated much like safety. Seat belts and airbags benefit everyone. They are not optional for auto manufacturers. Emissions control is another. I drive a 2006 Acura TL and it would not be allowed on the road in China.

The value of a single aspect detail checklist like below is that we need 20 or 30 other ones like this, covering the different aspects of self-service, and not just a web interface on a desktop computer screen.  Most of us use mobiles anyway.

We have our basic checklist, but we would like to expand those items into actions. In the kiosk and digital signage world we have to think about multiple factors

    • hardware  (includes Mobiles)
    • software
    • Pre-deployment usability using personas.
    • installation
    • site surveys
    • Connectivity (good luck getting decent internet in rural?)
    • Ongoing service
    • Post deployment surveys of customers for what we got right and what we got wrong
    • Application flow  (much like proper syntax in sentence structure.  e.g. — Accessibility self-service for important is people use can everyone when easy not if.) All the checkboxes checked but good luck making sense.
    • When clients do their own software kiosk manufacturers are at their mercy and never see the code fyi*

Insight — with the onset of “AI Fever” there are already examples of transactional processes being needlessly confused and diverted due to AI.

Note: current website project if interested — The City of Dallas (“the City”) invites information from established vendors or providers specializing in State and Local government technology services, specifically digital agencies/companies experienced with redesign, redevelopment, maintenance and management of external / public facing websites. The project scope includes user research to review the effectiveness of current websites (both the homepage and department specific pages), development of revised architecture, design and templates; content migration; and recommendations for new service-based functionality. The City is interested in responses from those with proven experience in the website design, redesign, migration, upgrade and ongoing maintenance sector.  01- Specifications- Website Redesign and Maintenance RFI Specs Final (002)

Examples of Good WCAG Testing

Features used to enhance accessibility:

  • Focus on using semantic HTML for better page performance, more enhanced SEO rankings, better mobile optimizations, built-in functionality, and screen reader compatibility.
  • Information, structure, and relationships are conveyed programmatically in the product.
  • Using ARIA where HTML elements do not provide enough detail or information.
  • Textual equivalents are provided for all non-textual elements.
  • Using a mechanism to bypass blocks of content that are repeated on multiple web pages.
  • All forms and form elements are designed for accessibility.
  • Labels or instructions are provided in the product when content requires user input.
  • Color recognition is not required to convey information.
  • The visual presentation of all text and images of text in the product have a contrast ratio that meets the minimum requirements.
  • Focusable components in the product receive focus in an order that preserves meaning and operability.
  • Data tables are clearly identified for logical use.
  • Style sheets are not required to view content.
  • No multimedia elements are used.
  • Animation is not utilized in applications.

Ongoing accessibility initiatives include:

  • Review and application of updated guidelines as they are released.
  • Continuing assessment of application software and development processes as they relate to future guidelines.
  • Ongoing review, documentation and remediation of all end user applications using internal audits, development and testing processes.
  • Evaluate the applications with NVDA, Deque Axe Accessibility Chrome extension, WebAIM WAVE Tool, WebAIM Color Contrast Checker, Windows accessibility settings, manual keyboard checks, third party (Deque, Level Access) automated and end user testing.
  • Engage clients, students and users if issues are reported. We ask them to describe and or document the issue(s) found, demonstrate with assistive technology and test the results of our remediation.
  • Work with third party providers to review, document, remediate issues and provide detailed VPAT documentation based on WCAG 2.1 AA (and continuing to evolve based on newer versions of WCAG).

About WCAG

The most recently released version of the Web Content Accessibility Guidelines (WCAG) is WCAG 2.2. It was officially published as a W3C Recommendation on October 5, 2023, with an update released on December 12, 2024267. WCAG 2.2 adds nine new success criteria to those in WCAG 2.1 and removes one obsolete criterion (4.1.1 Parsing), aiming to improve accessibility for users with cognitive disabilities, low vision, and limited fine motor skills678.

WCAG 2.2 is now the recommended standard for web accessibility, but it does not deprecate or supersede WCAG 2.1 or 2.0. All three versions remain valid, though the W3C encourages organizations to use the most recent version—WCAG 2.2—for the greatest future applicability127.

A future major version, WCAG 3.0, is still under development and has not been released. It is expected to become a W3C standard in several years458.

Breakdown of Age Generations in the U.S. (2023-2025)

Note: that we have excluded the Jones Generation (I am in that one).

Here is a summary of the primary generational cohorts in the United States, their typical birth years, current age ranges, and their estimated share of the U.S. population:

Generation Birth Years Age in 2025 % of U.S. Population (2023)
Silent Generation 1928–1945 80–97 Not specified
Baby Boomers 1946–1964 61–79 73 million
Generation X 1965–1980 45–60 65 million
Millennials 1981–1996 29–44 73 million
Generation Z 1997–2012 13–28 69 million
Generation Alpha ~2013–2024 1–12 38 million

What about Disability Ratios?

  • Baby Boomers — 24% (65–74), 46% (75+)
  • Gen X — 12% (35–64); up to 36% self-report
  • Millenials — 8% (<35); up to 33% self-report
  • Gen Z — 8% (<35); 42% mental health dx
  • 37 Million disabled or impaired total?
  • 340 Million total population in US
  • Retail shoppers =  135 million
  • Online = 274 million
  • How many consumers prefer using self-service? —  77% — 80% express interest.
  • Total self-service user base? 110 Million
  • percentage of those with some form of disability?  33%

Key Details:

  • Millennials (born 1981–1996, ages 29–44 in 2025) are the largest generation group, making up about 21.71% of the U.S. population in 202342.

  • Generation Z (born 1997–2012, ages 13–28 in 2025) accounts for around 20.69% of the population47.

  • Baby Boomers (born 1946–1964, ages 61–79 in 2025) are the second-largest group, though their numbers are shrinking as the population ages257.

  • Generation Alpha (born early 2010s–2024, ages 1–12 in 2025) is the newest named generation and is said to make up a significant share of the population, with some estimates suggesting around 42.75%, though this figure may include overlap with younger Gen Z27.

  • Generation X (born 1965–1980, ages 45–60 in 2025) is smaller than Boomers and Millennials but will surpass Boomers in population by 2028 as the latter cohort ages57.

Note: The exact percentage for some generations (Silent, Gen X) is not specified in the latest available data, but Millennials and Gen Z together make up over 42% of the population as of 20234.

Major Disabilities and Impairments in the U.S. Population

More than 1 in 4 adults in the United States—over 70 million people—report having some type of disability, according to the latest CDC data from 2022214. The most common types of disabilities and their prevalence among U.S. adults are as follows:

Disability Type % of U.S. Adults Estimated Number of Adults (2022)
Any disability 28.7% 70+ million214
Cognitive disability 13.9% ~34 million145
Mobility disability 12.2% ~30 million145
Independent living 7.7% ~19 million15
Hearing disability 6.2% ~15 million135
Vision disability 5.5% ~13 million135
Self-care disability 3.6% ~9 million1

Definitions and Examples

  • Cognitive disability: Serious difficulty concentrating, remembering, or making decisions. Includes learning disabilities, intellectual disabilities, autism, ADHD, and memory loss145.

  • Mobility disability: Serious difficulty walking or climbing stairs. Includes conditions like arthritis, muscular dystrophy, multiple sclerosis, and spinal injuries15.

  • Independent living disability: Difficulty doing errands alone, such as visiting a doctor or shopping15.

  • Hearing disability: Deafness or serious difficulty hearing135.

  • Vision disability: Blindness or serious difficulty seeing even when wearing glasses135.

  • Self-care disability: Difficulty dressing or bathing independently1.

Additional Insights

  • Disability prevalence increases with age, affecting 16% of adults aged 18–44, 29% of those aged 45–64, and about 50% of individuals over 654.

  • Rates are higher among Black (31%) and Hispanic (30%) adults compared to white adults (24%)4.

  • Many adults experience more than one type of disability3.

  • Dealing with Epilepsy – Driving A Car

These figures underscore the significant impact of disability across U.S. society and highlight the importance of accessibility and support for individuals with a wide range of impairments.

How many buying cycles for a Baby Boomer compared to Millenial?

Yes, Baby Boomers have fewer years left to buy cars compared to Millennials.

  • Life Expectancy: Most Baby Boomers (born 1946–1964) are currently between 61 and 79 years old. The average life expectancy for Boomers is around 79–88 years, depending on gender and health1356. This means the oldest Boomers may have less than a decade, and the youngest up to 20–25 years, of car-buying years left.

  • Current Car-Buying Patterns: Despite their age, Boomers are still very active car buyers. In fact, the 55-to-64 age group (older Boomers) is currently the most likely to buy a new car, and even those over 75 buy cars at higher rates than some younger groups24.

  • Generational Shift: As Boomers age into their 80s, car buying will naturally decline due to reduced mobility, health issues, and eventually, the cessation of driving1356. Millennials, being younger, have many more years ahead for car purchases.

In summary: Boomers are still strong contributors to car sales, but their remaining years for buying cars are limited compared to Millennials, who have several decades of car-buying ahead of them1256.

In Practice:

  • Over a typical adult lifespan, both Baby Boomers and Millennials are likely to purchase between 6 and 8 vehicles (new and used), assuming average car replacement every 7–10 years over a 50–60 year driving lifetime (from age 18 to 75+).

  • Millennials may buy cars at a slightly slower rate early in adulthood, but this gap closes as they age and their life circumstances converge with those of Boomers38

World Data

World Population by Age Generations

The global population is distributed across various age generations, each defined by birth years and shaped by demographic trends. Here is a breakdown of the world’s population by these generational cohorts, using the most recent and reliable data available.

Generational Breakdown (2025–2035)
Generation Birth Years Current Population Share (2025) Projected Share (2035)
Silent Generation Before 1946 3% 0.4%
Baby Boomers 1946–1964 13% 8%
Generation X 1965–1979 17% 14%
Millennials 1980–1994 21% 19%
Generation Z 1995–2009 23% 20%
Generation Alpha 2010–2024 23% 23%
Generation Beta 2025–2039 16%
  • Generation Beta will begin to be born in 2025 and is projected to comprise 16% of the global population by 2035, with an estimated 2.1 billion people35.

  • Generation Alpha (born 2010–2024) currently makes up about 23% of the world population and is projected to remain at this share through 20353.

Global Age Group Distribution (2020 Data)
Age Group Number of People % of Global Population
<20 years 2.6 billion 33.2%
20–39 years 2.3 billion 29.9%
40–59 years 1.8 billion 23.1%
60–79 years 918 million 11.8%
80–99 years 147 million 1.9%
100+ years 0.6 million 0.01%
  • As of 2020, about one-third of the global population was under 20 years old, but this proportion is expected to decline as the world ages2.

  • The elderly population (ages 60 and above) is growing rapidly, with those over 80 years old accounting for nearly 2% of the global population in 20202.

Demographic Trends
  • The median age of the world in 2025 is 30.9 years, reflecting a gradual aging of the global population1.

  • In 2018, the number of people over 64 years old surpassed the number of children under 5 for the first time in history, marking a significant demographic milestone4.

  • The share of older generations (Silent Generation, Boomers) is declining, while younger cohorts (Alpha, Beta) are growing in absolute numbers but will represent a smaller share of the total as population growth slows and life expectancy increases34.

Summary
  • The world population is becoming older, with a shrinking share of the youngest generations and a growing proportion of older adults.

  • By 2035, Generations Alpha and Beta will together represent nearly 40% of the global population, while Boomers and the Silent Generation will drop below 10% combined35.

  • These demographic shifts have significant implications for economies, healthcare systems, and social structures worldwide.

This overview provides a snapshot of how the world’s population is distributed across age generations and highlights the ongoing shift toward an older global demographic profile.

Visually Impaired (think Braille)

visually impaired population

visually impaired population

Nice graphic from LinkedIn

 

A map of Europe displays the median age of populations by country for 2024, color-coded by age range. A highlighted note asks, “How can Last Mile support this aging? +2 Million accessible self service OOH Points, 1.5 Million are Parcel Lockers.”.

Click for full size — A map of Europe displays the median age of populations by country for 2024, color-coded by age range. A highlighted note asks, “How can Last Mile support this aging? +2 Million accessible self service OOH Points, 1.5 Million are Parcel Lockers.”.

Author: Staff Writer   Craig Keefner — With over 40 years in the industry and technology, Craig is widely considered to be an expert in the field. Major early career kiosk projects include Verizon Bill Pay kiosk and hundreds of others. Craig helped start kioskmarketplace and formed the KMA. Note the point of view here is not necessarily the stance of the Kiosk Association or kma.global

Craig Allen Keefner

Blue Shield of California shared private health data

Data Privacy and Insurance Companies (and Tech Companies)

From Techspot

Blue Shield of California disclosed that it shared the private health data of up to 4.7 million members with Google’s analytics and advertising platforms over a three-year period, from April 2021 to January 2024. This occurred due to a misconfiguration in Google Analytics, which allowed sensitive health information—such as insurance details, addresses, and search queries—to be shared with Google Ads. The data may have been used for targeted advertising. However, Social Security numbers, driver’s license numbers, and financial information were not exposed. Blue Shield ended its relationship with Google Analytics and Ads in January 2024 and has since taken steps to address the issue. The company is notifying affected members and advising them to monitor their accounts for suspicious activity.

More Resources

 

Craig Allen Keefner

24/7 Medication Access Kiosks

Prescription Dispense Kiosks

From Becker — To improve care access, Tacoma, Wash.-based MultiCare Health System will unveil self-serve, automated prescription kiosks across its footprint March 31.  Picture we show is more complex model from Zhilai.

MultiCare Rolls Out Kiosks for 24/7 Medication Access discusses the innovative steps taken by MultiCare Health System to enhance patient access to medications. Here are the key highlights:

  • Automated Prescription KiosksMultiCare is introducing self-serve, automated prescription kiosks across its facilities. These kiosks are designed to provide 24/7 access to medications, improving convenience for patients.
  • Capacity: Each kiosk can hold up to 500 prepackaged items, allowing for a wide range of medications to be available at any time.
  • Patient Interaction: Patients can use these kiosks to request refills, view prescription instructions, and receive notifications about pick-up times through the MyChart patient portal.
  • Improved Access: This initiative aims to enhance care access, particularly for those who may have difficulty visiting a pharmacy during regular hours.
  • Location: The rollout of these kiosks is part of MultiCare‘s broader strategy to improve healthcare delivery in the TacomaWashington area.

More Links

Craig Allen Keefner
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