#data entry softwares

[acmemindspvt]

Role of Data Engineering Solutions in Modern Business

AcmeMinds, a leading data engineering company, provides comprehensive data engineering services to help businesses transform raw data into actionable insights. Their tailored data engineering solutions include building scalable data pipelines, data cleaning and transformation, real-time analytics, and support for AI and machine learning. AcmeMinds empowers businesses to optimize decision-making, enhance operational efficiency, and drive sustainable growth.

[theinnovatorsinsights]

With Innrly | Streamline Your Hospitality Operations

Manage all your hotels from anywhere | Transformation without transition

Managing a hotel or a multi-brand portfolio can be overwhelming, especially when juggling multiple systems, reports, and data sources. INNRLY, a cutting-edge hotel management software, revolutionizes the way hospitality businesses operate by delivering intelligent insights and simplifying workflows—all without the need for system changes or upgrades. Designed for seamless integration and powerful automation, INNRLY empowers hotel owners and managers to make data-driven decisions and enhance operational efficiency.

Revolutionizing Hotel Management

In the fast-paced world of hospitality, efficiency is the cornerstone of success. INNRLY’s cloud-based platform offers a brand-neutral, user-friendly interface that consolidates critical business data across all your properties. Whether you manage a single boutique hotel or a portfolio of properties spanning different regions, INNRLY provides an all-in-one solution for optimizing performance and boosting productivity.

One Dashboard for All Your Properties:

Say goodbye to fragmented data and manual processes. INNRLY enables you to monitor your entire portfolio from a single dashboard, providing instant access to key metrics like revenue, occupancy, labor costs, and guest satisfaction. With this unified view, hotel managers can make informed decisions in real time.

Customizable and Scalable Solutions:

No two hospitality businesses are alike, and INNRLY understands that. Its customizable features adapt to your unique needs, whether you're running a small chain or managing an extensive enterprise. INNRLY grows with your business, ensuring that your operations remain efficient and effective.

Seamless Integration for Effortless Operations:

One of INNRLY’s standout features is its ability to integrate seamlessly with your existing systems. Whether it's your property management system (PMS), accounting software, payroll/labor management tools, or even guest feedback platforms, INNRLY pulls data together effortlessly, eliminating the need for system overhauls.

Automated Night Audits:

Tired of labor-intensive night audits? INNRLY’s Night Audit+ automates this crucial process, providing detailed reports that are automatically synced with your accounting software. It identifies issues such as declined credit cards or high balances, ensuring no problem goes unnoticed.

A/R and A/P Optimization:

Streamline your accounts receivable (A/R) and accounts payable (A/P) processes to improve cash flow and avoid costly mistakes. INNRLY’s automation reduces manual entry, speeding up credit cycles and ensuring accurate payments.

Labor and Cost Management:

With INNRLY, you can pinpoint inefficiencies, monitor labor hours, and reduce costs. Detailed insights into overtime risks, housekeeping minutes per room (MPR), and other labor metrics help you manage staff productivity effectively.

Empowering Data-Driven Decisions:

INNRLY simplifies decision-making by surfacing actionable insights through its robust reporting and analytics tools.

Comprehensive Reporting:

Access reports on your schedule, from detailed night audit summaries to trial balances and franchise billing reconciliations. Consolidated data across multiple properties allows for easy performance comparisons and trend analysis.

Benchmarking for Success:

Compare your properties' performance against industry standards or other hotels in your portfolio. Metrics such as ADR (Average Daily Rate), RevPAR (Revenue Per Available Room), and occupancy rates are presented in an easy-to-understand format, empowering you to identify strengths and areas for improvement.

Guest Satisfaction Insights:

INNRLY compiles guest feedback and satisfaction scores, enabling you to take prompt action to enhance the guest experience. Happy guests lead to better reviews and increased bookings, driving long-term success.

Key Benefits of INNRLY

Single Login, Full Control: Manage all properties with one login, saving time and reducing complexity.

Error-Free Automation: Eliminate manual data entry, reducing errors and increasing productivity.

Cost Savings: Pinpoint problem areas to reduce labor costs and optimize spending.

Enhanced Accountability: Hold each property accountable for issues flagged by INNRLY’s tools, supported by an optional Cash Flow Protection Team at the enterprise level.

Data Security: Protect your credentials and data while maintaining your existing systems.

Transforming Hospitality Without Transition

INNRLY’s philosophy is simple: transformation without transition. You don’t need to replace or upgrade your existing systems to benefit from INNRLY. The software integrates effortlessly into your current setup, allowing you to focus on what matters most—delivering exceptional guest experiences and achieving your business goals.

Who Can Benefit from INNRLY?

Hotel Owners:

For owners managing multiple properties, INNRLY offers a centralized platform to monitor performance, identify inefficiencies, and maximize profitability.

General Managers:

Simplify day-to-day operations with automated processes and real-time insights, freeing up time to focus on strategic initiatives.

Accounting Teams:

INNRLY ensures accurate financial reporting by syncing data across systems, reducing errors, and streamlining reconciliation processes.

Multi-Brand Portfolios:

For operators managing properties across different brands, INNRLY’s brand-neutral platform consolidates data, making it easy to compare and optimize performance.

Contact INNRLY Today

Ready to revolutionize your hotel management? Join the growing number of hospitality businesses transforming their operations with INNRLY.

Website: www.innrly.com

Email: contact@innrly.com

Phone: 833-311-0777

[date-assistance08]

Data Entry & Lead Generation Expert Service

[bridgehiring]

Bridge Hiring simplifies your journey when you decide to outsource software development. With a global talent network and a streamlined hiring process, we connect businesses with highly skilled developers who understand your vision. Our focus is on building long-term, scalable solutions with efficiency, speed, and reliability. By outsourcing your software development to Bridge Hiring, you reduce operational costs, accelerate time-to-market, and gain access to cutting-edge technologies.

Bridge Hiring 41 N Main, Parowan, UT 84761 (435) 523–5350

My Official Website: https://bridgehiring.com/ Google Plus Listing: https://maps.google.com/?cid=13677544134065067964

Service We Offer:

Web Development Data Entry Remote Engineers Virtual Assistant Bookkeeping Services

Follow Us On:

Linkedin: https://www.linkedin.com/company/bridge-hiring/ Twitter: https://x.com/BridgeHiri97164 Pinterest: https://www.pinterest.com/BridgeHiring/ Instagram: https://www.instagram.com/bridgehiring/ Facebook: https://www.facebook.com/people/Bridge-Hiring/61577163442833/

[cloudzone12]

CX One Software Download – Data Entry Made Easy for NetSuite Integration

Simplify your data entry process with seamless NetSuite integration. Whether you’re managing customer data, transactions, or financial records, CX One enhances accuracy and efficiency by automating repetitive tasks. This powerful software ensures smooth data flow, reducing manual errors and boosting overall productivity. With easy-to-use features, you can integrate directly with NetSuite to manage data effortlessly. Download CX One Software today and experience how it transforms your business operations, saving you time and improving your data management workflows.

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MI demography form filling auto typing software

Utilizing MI demography form filling auto typing software is the key to automate medical insurance form filling, offering a powerful software for MI data entry auto typing that answers the question of how to fill MI demography form automatically and functions as a dedicated form filling auto typer and Medical insurance auto filler, ultimately serving as an efficient MI data entry automation tool…

[pepminn]

Boost Productivity with the Right Data Entry Software

In today’s fast-paced business world, managing large amounts of information efficiently is essential. Whether you're a small business owner, an accountant, or a data analyst, handling data manually can be time-consuming and prone to errors. This is where data entry software comes in, providing an efficient way to streamline data management and improve accuracy.

Why You Need Data Entry Software

Manual data entry can lead to mistakes, wasted time, and unnecessary costs. Here are some common challenges businesses face without automation:

Human errors – Mistakes in data entry can lead to financial losses and incorrect decision-making.

Time-consuming processes – Entering data manually slows down operations and reduces productivity.

Data security concerns – Sensitive information may be at risk if not handled properly.

With data entry software, businesses can eliminate these issues and focus on growth.

Key Benefits of Using Data Entry Software

Increased Accuracy Automation reduces human errors by ensuring data is recorded correctly the first time. Many tools have built-in validation features to detect mistakes before they become problems.

Time Efficiency Instead of spending hours entering data manually, software can process thousands of entries in seconds, allowing teams to focus on more critical tasks.

Better Data Organization Most data entry software includes sorting, filtering, and search functions, making it easy to manage large databases and retrieve information quickly.

Improved Security Protecting sensitive data is crucial. Many solutions come with encryption, access control, and backup features to ensure data is safe from cyber threats.

Integration with Other Tools Many businesses use CRM, accounting software, and cloud storage. Good data entry software integrates with these platforms, ensuring seamless workflows.

How to Choose the Best Data Entry Software

Not all software is created equal. When selecting a solution, consider the following factors:

Ease of use – The software should be user-friendly and require minimal training.

Automation features – Look for AI-powered tools that can auto-fill, correct, and validate data.

Compatibility – Ensure the software works well with your existing business applications.

Scalability – Choose a solution that can grow with your business.

Popular data entry tools like Microsoft Excel, Google Forms, and dedicated solutions like UiPath or Kofax offer various automation features to enhance efficiency.

Final Thoughts

Investing in data entry software can transform your business by reducing errors, saving time, and improving productivity. If you're still relying on manual data entry, now is the time to upgrade your system. Explore different solutions and choose the one that fits your needs best.

[notepadplusautotypersoftware]

Notepad Plus .WRT Auto Typer Software and How To Download And Install Au...

[logistiservices]

Elevating Excellence: Why the Transportation and Logistics Industry Should Prioritize Enhanced Customer Service

In the fast-paced and competitive realm of transportation and logistics, the emphasis on enhanced customer service is becoming increasingly vital. This blog post delves into the reasons why the transportation and logistics industry should prioritize customer service, exploring how it can lead to increased customer satisfaction, improved operational efficiency, and a strengthened market position.

Transportation Customer Service:

Transportation customer service underscores the unique challenges and opportunities within the transportation sector. Acknowledging the specific needs of customers in the logistics chain is crucial for building lasting relationships and ensuring a positive overall experience.

Customer Support Management:

The customer support management highlights the strategic approach required to deliver exceptional customer service. Effective management of customer support processes, from order inquiries to issue resolution, is instrumental in meeting and exceeding customer expectations.

Multilingual Customer Support:

In an increasingly globalized world, the term Multilingual customer support becomes pivotal. Offering customer support in multiple languages is not just a convenience; it is a necessity in a diverse and interconnected marketplace. Multilingual customer support enhances accessibility, fosters international collaboration, and demonstrates a commitment to meeting the unique needs of a global customer base.

Reasons to Prioritize Enhanced Customer Service:

Customer Satisfaction: A focus on enhanced customer service directly correlates with increased customer satisfaction. By providing prompt and accurate information, addressing concerns proactively, and ensuring a seamless experience, businesses build trust and loyalty among their clientele.

Operational Efficiency: Streamlining customer support management contributes to operational efficiency. Resolving issues promptly, minimizing order discrepancies, and optimizing communication channels lead to smoother logistics operations and reduced disruptions.

Competitive Edge: In an industry where competition is fierce, superior customer service becomes a key differentiator. Companies that prioritize customer satisfaction gain a competitive edge, attracting and retaining clients in a market where service quality often defines success.

Brand Reputation: Customer service plays a crucial role in shaping a brand's reputation. Positive interactions with customers contribute to a positive brand image, while subpar customer service can lead to reputational damage. A strong brand reputation, built on excellent customer service, enhances market credibility and trust.

Conclusion: In conclusion, prioritizing enhanced customer service in the transportation and logistics industry is not just a matter of meeting expectations; it is a strategic imperative. From transportation customer service tailored to the unique needs of the industry to effective customer support management and multilingual support for a global clientele, the benefits are manifold. By placing customer satisfaction at the forefront, businesses in the transportation and logistics sector can navigate challenges, foster growth, and secure a prominent position in an ever-evolving and competitive marketplace. In a world where customer-centricity is paramount, elevating customer service becomes a pathway to sustained success and industry leadership.

[instantdataservices]

Hii Everyone! I Hope all are doing well

Medical Insurance Auto-Fill Software is a specialized tool designed to streamline and automate the process of filling out medical insurance claim forms and related documentation. The software is developed to enhance efficiency, reduce errors, and save time.

Implementing Medical Insurance Auto-Fill Software can contribute to a more streamlined and accurate claims submission process, reducing the administrative burden on data entry works

Thank you for watching, hope our video may helps you, for more helpful videos and relatable video please subscribe our channel, do share , follow and like the video.

[acmemindspvt]

Enterprise Application Development Services

AcmeMinds offers comprehensive Enterprise Application Development Services tailored to meet the unique needs of large organizations. Our solutions enhance operational efficiency, streamline workflows, and integrate seamlessly with existing systems. With a focus on scalability and security, AcmeMinds empowers businesses to thrive in a competitive landscape through innovative technology solutions. Read more ...

[suvitfintechprivatelimited]

Financial accounting is the process of recording, summarizing, and reporting a company's financial transactions to external users. These users include investors, creditors, and other stakeholders who need to make informed decisions about the company. There are a number of basic financial accounting concepts that are essential for understanding how financial statements are prepared and interpreted. These concepts provide the foundation for financial reporting and help to ensure that financial statements are accurate and reliable.

[pebblegalaxy]

India's Rise as a Trusted Services Outsourcing Hub: Dominating in Advertising, Engineering, and Software Solutions

India’s Growing Dominance in Services Outsourcing: A Trustworthy Alternative to China Introduction: In an increasingly interconnected world, the role of services outsourcing has gained significant prominence. Companies from advanced economies often seek to leverage talent and cost advantages offered by emerging economies. Among these, India has emerged as a global leader in providing a wide…

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Cibil Management form filling auto typing software

The CIBIL Management Form Filling Auto Typing Software, also known as the MI Demography Form Filling Auto Typing Software, is a powerful tool that includes the MI Demography Auto Typer and CIBIL Management Auto Typer modules—making it the perfect solution for fast, accurate data entry using an advanced Data Entry Auto Typer system Cibil Management form filling auto typing software Demo…

[treasure-mimic]

So, let me try and put everything together here, because I really do think it needs to be talked about.

Today, Unity announced that it intends to apply a fee to use its software. Then it got worse.

For those not in the know, Unity is the most popular free to use video game development tool, offering a basic version for individuals who want to learn how to create games or create independently alongside paid versions for corporations or people who want more features. It's decent enough at this job, has issues but for the price point I can't complain, and is the idea entry point into creating in this medium, it's a very important piece of software.

But speaking of tools, the CEO is a massive one. When he was the COO of EA, he advocated for using, what out and out sounds like emotional manipulation to coerce players into microtransactions.

"A consumer gets engaged in a property, they might spend 10, 20, 30, 50 hours on the game and then when they're deep into the game they're well invested in it. We're not gouging, but we're charging and at that point in time the commitment can be pretty high."

He also called game developers who don't discuss monetization early in the planning stages of development, quote, "fucking idiots".

So that sets the stage for what might be one of the most bald-faced greediest moves I've seen from a corporation in a minute. Most at least have the sense of self-preservation to hide it.

A few hours ago, Unity posted this announcement on the official blog.

Effective January 1, 2024, we will introduce a new Unity Runtime Fee that’s based on game installs. We will also add cloud-based asset storage, Unity DevOps tools, and AI at runtime at no extra cost to Unity subscription plans this November. We are introducing a Unity Runtime Fee that is based upon each time a qualifying game is downloaded by an end user. We chose this because each time a game is downloaded, the Unity Runtime is also installed. Also we believe that an initial install-based fee allows creators to keep the ongoing financial gains from player engagement, unlike a revenue share.

Now there are a few red flags to note in this pitch immediately.

Unity is planning on charging a fee on all games which use its engine.

This is a flat fee per number of installs.

They are using an always online runtime function to determine whether a game is downloaded.

There is just so many things wrong with this that it's hard to know where to start, not helped by this FAQ which doubled down on a lot of the major issues people had.

I guess let's start with what people noticed first. Because it's using a system baked into the software itself, Unity would not be differentiating between a "purchase" and a "download". If someone uninstalls and reinstalls a game, that's two downloads. If someone gets a new computer or a new console and downloads a game already purchased from their account, that's two download. If someone pirates the game, the studio will be asked to pay for that download.

Q: How are you going to collect installs? A: We leverage our own proprietary data model. We believe it gives an accurate determination of the number of times the runtime is distributed for a given project. Q: Is software made in unity going to be calling home to unity whenever it's ran, even for enterprice licenses? A: We use a composite model for counting runtime installs that collects data from numerous sources. The Unity Runtime Fee will use data in compliance with GDPR and CCPA. The data being requested is aggregated and is being used for billing purposes. Q: If a user reinstalls/redownloads a game / changes their hardware, will that count as multiple installs? A: Yes. The creator will need to pay for all future installs. The reason is that Unity doesn’t receive end-player information, just aggregate data. Q: What's going to stop us being charged for pirated copies of our games? A: We do already have fraud detection practices in our Ads technology which is solving a similar problem, so we will leverage that know-how as a starting point. We recognize that users will have concerns about this and we will make available a process for them to submit their concerns to our fraud compliance team.

This is potentially related to a new system that will require Unity Personal developers to go online at least once every three days.

Starting in November, Unity Personal users will get a new sign-in and online user experience. Users will need to be signed into the Hub with their Unity ID and connect to the internet to use Unity. If the internet connection is lost, users can continue using Unity for up to 3 days while offline. More details to come, when this change takes effect.

It's unclear whether this requirement will be attached to any and all Unity games, though it would explain how they're theoretically able to track "the number of installs", and why the methodology for tracking these installs is so shit, as we'll discuss later.

Unity claims that it will only leverage this fee to games which surpass a certain threshold of downloads and yearly revenue.

Only games that meet the following thresholds qualify for the Unity Runtime Fee: Unity Personal and Unity Plus: Those that have made $200,000 USD or more in the last 12 months AND have at least 200,000 lifetime game installs. Unity Pro and Unity Enterprise: Those that have made $1,000,000 USD or more in the last 12 months AND have at least 1,000,000 lifetime game installs.

They don't say how they're going to collect information on a game's revenue, likely this is just to say that they're only interested in squeezing larger products (games like Genshin Impact and Honkai: Star Rail, Fate Grand Order, Among Us, and Fall Guys) and not every 2 dollar puzzle platformer that drops on Steam. But also, these larger products have the easiest time porting off of Unity and the most incentives to, meaning realistically those heaviest impacted are going to be the ones who just barely meet this threshold, most of them indie developers.

Aggro Crab Games, one of the first to properly break this story, points out that systems like the Xbox Game Pass, which is already pretty predatory towards smaller developers, will quickly inflate their "lifetime game installs" meaning even skimming the threshold of that 200k revenue, will be asked to pay a fee per install, not a percentage on said revenue.

[IMAGE DESCRIPTION: Hey Gamers!

Today, Unity (the engine we use to make our games) announced that they'll soon be taking a fee from developers for every copy of the game installed over a certain threshold - regardless of how that copy was obtained.

Guess who has a somewhat highly anticipated game coming to Xbox Game Pass in 2024? That's right, it's us and a lot of other developers.

That means Another Crab's Treasure will be free to install for the 25 million Game Pass subscribers. If a fraction of those users download our game, Unity could take a fee that puts an enormous dent in our income and threatens the sustainability of our business.

And that's before we even think about sales on other platforms, or pirated installs of our game, or even multiple installs by the same user!!!

This decision puts us and countless other studios in a position where we might not be able to justify using Unity for our future titles. If these changes aren't rolled back, we'll be heavily considering abandoning our wealth of Unity expertise we've accumulated over the years and starting from scratch in a new engine. Which is really something we'd rather not do.

On behalf of the dev community, we're calling on Unity to reverse the latest in a string of shortsighted decisions that seem to prioritize shareholders over their product's actual users.

I fucking hate it here.

-Aggro Crab - END DESCRIPTION]

That fee, by the way, is a flat fee. Not a percentage, not a royalty. This means that any games made in Unity expecting any kind of success are heavily incentivized to cost as much as possible.

[IMAGE DESCRIPTION: A table listing the various fees by number of Installs over the Install Threshold vs. version of Unity used, ranging from $0.01 to $0.20 per install. END DESCRIPTION]

Basic elementary school math tells us that if a game comes out for $1.99, they will be paying, at maximum, 10% of their revenue to Unity, whereas jacking the price up to $59.99 lowers that percentage to something closer to 0.3%. Obviously any company, especially any company in financial desperation, which a sudden anchor on all your revenue is going to create, is going to choose the latter.

Furthermore, and following the trend of "fuck anyone who doesn't ask for money", Unity helpfully defines what an install is on their main site.

While I'm looking at this page as it exists now, it currently says

The installation and initialization of a game or app on an end user’s device as well as distribution via streaming is considered an “install.” Games or apps with substantially similar content may be counted as one project, with installs then aggregated to calculate the Unity Runtime Fee.

However, I saw a screenshot saying something different, and utilizing the Wayback Machine we can see that this phrasing was changed at some point in the few hours since this announcement went up. Instead, it reads:

The installation and initialization of a game or app on an end user’s device as well as distribution via streaming or web browser is considered an “install.” Games or apps with substantially similar content may be counted as one project, with installs then aggregated to calculate the Unity Runtime Fee.

Screenshot for posterity:

That would mean web browser games made in Unity would count towards this install threshold. You could legitimately drive the count up simply by continuously refreshing the page. The FAQ, again, doubles down.

Q: Does this affect WebGL and streamed games? A: Games on all platforms are eligible for the fee but will only incur costs if both the install and revenue thresholds are crossed. Installs - which involves initialization of the runtime on a client device - are counted on all platforms the same way (WebGL and streaming included).

And, what I personally consider to be the most suspect claim in this entire debacle, they claim that "lifetime installs" includes installs prior to this change going into effect.

Will this fee apply to games using Unity Runtime that are already on the market on January 1, 2024? Yes, the fee applies to eligible games currently in market that continue to distribute the runtime. We look at a game's lifetime installs to determine eligibility for the runtime fee. Then we bill the runtime fee based on all new installs that occur after January 1, 2024.

Again, again, doubled down in the FAQ.

Q: Are these fees going to apply to games which have been out for years already? If you met the threshold 2 years ago, you'll start owing for any installs monthly from January, no? (in theory). It says they'll use previous installs to determine threshold eligibility & then you'll start owing them for the new ones. A: Yes, assuming the game is eligible and distributing the Unity Runtime then runtime fees will apply. We look at a game's lifetime installs to determine eligibility for the runtime fee. Then we bill the runtime fee based on all new installs that occur after January 1, 2024.

That would involve billing companies for using their software before telling them of the existence of a bill. Holding their actions to a contract that they performed before the contract existed!

Okay. I think that's everything. So far.

There is one thing that I want to mention before ending this post, unfortunately it's a little conspiratorial, but it's so hard to believe that anyone genuinely thought this was a good idea that it's stuck in my brain as a significant possibility.

A few days ago it was reported that Unity's CEO sold 2,000 shares of his own company.

On September 6, 2023, John Riccitiello, President and CEO of Unity Software Inc (NYSE:U), sold 2,000 shares of the company. This move is part of a larger trend for the insider, who over the past year has sold a total of 50,610 shares and purchased none.

I would not be surprised if this decision gets reversed tomorrow, that it was literally only made for the CEO to short his own goddamn company, because I would sooner believe that this whole thing is some idiotic attempt at committing fraud than a real monetization strategy, even knowing how unfathomably greedy these people can be.

So, with all that said, what do we do now?

Well, in all likelihood you won't need to do anything. As I said, some of the biggest names in the industry would be directly affected by this change, and you can bet your bottom dollar that they're not just going to take it lying down. After all, the only way to stop a greedy CEO is with a greedier CEO, right?

(I fucking hate it here.)

And that's not mentioning the indie devs who are already talking about abandoning the engine.

[Links display tweets from the lead developer of Among Us saying it'd be less costly to hire people to move the game off of Unity and Cult of the Lamb's official twitter saying the game won't be available after January 1st in response to the news.]

That being said, I'm still shaken by all this. The fact that Unity is openly willing to go back and punish its developers for ever having used the engine in the past makes me question my relationship to it.

The news has given rise to the visibility of free, open source alternative Godot, which, if you're interested, is likely a better option than Unity at this point. Mostly, though, I just hope we can get out of this whole, fucking, environment where creatives are treated as an endless mill of free profits that's going to be continuously ratcheted up and up to drive unsustainable infinite corporate growth that our entire economy is based on for some fuckin reason.

Anyways, that's that, I find having these big posts that break everything down to be helpful.

[mostlysignssomeportents]

Epic Systems, a lethal health record monopolist

Epic Systems makes the dominant electronic health record (EHR) system in America; if you're a doctor, chances are you are required to use it, and for every hour a doctor spends with a patient, they have to spend two hours doing clinically useless bureaucratic data-entry on an Epic EHR.

How could a product so manifestly unfit for purpose be the absolute market leader? Simple: as Robert Kuttner describes in an excellent feature in The American Prospect, Epic may be a clinical disaster, but it's a profit-generating miracle:

https://prospect.org/health/2024-10-01-epic-dystopia/

At the core of Epic's value proposition is "upcoding," a form of billing fraud that is beloved of hospital administrators, including the "nonprofit" hospitals that generate vast fortunes that are somehow not characterized as profits. Here's a particularly egregious form of upcoding: back in 2020, the Poudre Valley Hospital in Ft Collins, CO locked all its doors except the ER entrance. Every patient entering the hospital, including those receiving absolutely routine care, was therefore processed as an "emergency."

In April 2020, Caitlin Wells Salerno – a pregnant biologist – drove to Poudre Valley with normal labor pains. She walked herself up to obstetrics, declining the offer of a wheelchair, stopping only to snap a cheeky selfie. Nevertheless, the hospital recorded her normal, uncomplicated birth as a Level 5 emergency – comparable to a major heart-attack – and whacked her with a $2755 bill for emergency care:

https://pluralistic.net/2021/10/27/crossing-a-line/#zero-fucks-given

Upcoding has its origins in the Reagan revolution, when the market-worshipping cultists he'd put in charge of health care created the "Prospective Payment System," which paid a lump sum for care. The idea was to incentivize hospitals to provide efficient care, since they could keep the difference between whatever they spent getting you better and the set PPS amount that Medicare would reimburse them. Hospitals responded by inventing upcoding: a patient with controlled, long-term coronary disease who showed up with a broken leg would get coded for the coronary condition and the cast, and the hospital would pocket both lump sums:

https://pluralistic.net/2024/06/13/a-punch-in-the-guts/#hayek-pilled

The reason hospital administrators love Epic, and pay gigantic sums for systemwide software licenses, is directly connected to the two hours that doctors spent filling in Epic forms for every hour they spend treating patients. Epic collects all that extra information in order to identify potential sources of plausible upcodes, which allows hospitals to bill patients, insurers, and Medicare through the nose for routine care. Epic can automatically recode "diabetes with no complications" from a Hierarchical Condition Category code 19 (worth $894.40) as "diabetes with kidney failure," code 18 and 136, which gooses the reimbursement to $1273.60.

Epic snitches on doctors to their bosses, giving them a dashboard to track doctors' compliance with upcoding suggestions. One of Kuttner's doctor sources says her supervisor contacts her with questions like, "That appointment was a 2. Don’t you think it might be a 3?"

Robert Kuttner is the perfect journalist to unravel the Epic scam. As a journalist who wrote for The New England Journal of Medicine, he's got an insider's knowledge of the health industry, and plenty of sources among health professionals. As he tells it, Epic is a cultlike, insular company that employs 12.500 people in its hometown of Verona, WI.

The EHR industry's origins start with a GW Bush-era law called the HITECH Act, which was later folded into Obama's Recovery Act in 2009. Obama provided $27b to hospitals that installed EHR systems. These systems had to more than track patient outcomes – they also provided the data for pay-for-performance incentives. EHRs were already trying to do something very complicated – track health outcomes – but now they were also meant to underpin a cockamamie "incentives" program that was supposed to provide a carrot to the health industry so it would stop killing people and ripping off Medicare. EHRs devolved into obscenely complex spaghetti systems that doctors and nurses loathed on sight.

But there was one group that loved EHRs: hospital administrators and the private companies offering Medicare Advantage plans (which also benefited from upcoding patients in order to soak Uncle Sucker):

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8649706/

The spread of EHRs neatly tracks with a spike in upcharging: "from 2014 through 2019, the number of hospital stays billed at the highest severity level increased almost 20 percent…the number of stays billed at each of the other severity levels decreased":

https://oig.hhs.gov/oei/reports/OEI-02-18-00380.pdf

The purpose of a system is what it does. Epic's industry-dominating EHR is great at price-gouging, but it sucks as a clinical tool – it takes 18 keystrokes just to enter a prescription:

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2729481

Doctors need to see patients, but their bosses demand that they satisfy Epic's endless red tape. Doctors now routinely stay late after work and show up hours early, just to do paperwork. It's not enough. According to another one of Kuttner's sources, doctors routinely copy-and-paste earlier entries into the current one, a practice that generates rampant errors. Some just make up random numbers to fulfill Epic's nonsensical requirements: the same source told Kuttner that when prompted to enter a pain score for his TB patients, he just enters "zero."

Don't worry, Epic has a solution: AI. They've rolled out an "ambient listening" tool that attempts to transcribe everything the doctor and patient say during an exam and then bash it into a visit report. Not only is this prone to the customary mistakes that make AI unsuited to high-stakes, error-sensitive applications, it also represents a profound misunderstanding of the purpose of clinical notes.

The very exercise of organizing your thoughts and reflections about an event – such as a medical exam – into a coherent report makes you apply rigor and perspective to events that otherwise arrive as a series of fleeting impressions and reactions. That's why blogging is such an effective practice:

https://pluralistic.net/2021/05/09/the-memex-method/

The answer to doctors not having time to reflect and organize good notes is to give them more time – not more AI. As another doctor told Kuttner: "Ambient listening is a solution to a self-created problem of requiring too much data entry by clinicians."

EHRs are one of those especially hellish public-private partnerships. Health care doctrine from Reagan to Obama insisted that the system just needed to be exposed to market forces and incentives. EHRs are designed to allow hospitals to win as many of these incentives as possible. Epic's clinical care modules do this by bombarding doctors with low-quality diagnostic suggestions with "little to do with a patient’s actual condition and risks," leading to "alert fatigue," so doctors miss the important alerts in the storm of nonsense elbow-jostling:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5058605/

Clinicians who actually want to improve the quality of care in their facilities end up recording data manually and keying it into spreadsheets, because they can't get Epic to give them the data they need. Meanwhile, an army of high-priced consultants stand ready to give clinicians advise on getting Epic to do what they need, but can't seem to deliver.

Ironically, one of the benefits that Epic touts is its interoperability: hospitals that buy Epic systems can interconnect those with other Epic systems, and there's a large ecosystem of aftermarket add-ons that work with Epic. But Epic is a product, not a protocol, so its much-touted interop exists entirely on its terms, and at its sufferance. If Epic chooses, a doctor using its products can send files to a doctor using a rival product. But Epic can also veto that activity – and its veto extends to deciding whether a hospital can export their patient records to a competing service and get off Epic altogether.

One major selling point for Epic is its capacity to export "anonymized" data for medical research. Very large patient data-sets like Epic's are reasonably believed to contain many potential medical insights, so medical researchers are very excited at the prospect of interrogating that data.

But Epic's approach – anonymizing files containing the most sensitive information imaginable, about millions of people, and then releasing them to third parties – is a nightmare. "De-identified" data-sets are notoriously vulnerable to "re-identification" and the threat of re-identification only increases every time there's another release or breach, which can used to reveal the identities of people in anonymized records. For example, if you have a database of all the prescribing at a given hospital – a numeric identifier representing the patient, and the time and date when they saw a doctor and got a scrip. At any time in the future, a big location-data breach – say, from Uber or a transit system – can show you which people went back and forth to the hospital at the times that line up with those doctor's appointments, unmasking the person who got abortion meds, cancer meds, psychiatric meds or other sensitive prescriptions.

The fact that anonymized data can – will! – be re-identified doesn't mean we have to give up on the prospect of gleaning insight from medical records. In the UK, the eminent doctor Ben Goldacre and colleagues built an incredible effective, privacy-preserving "trusted research environment" (TRE) to operate on millions of NHS records across a decentralized system of hospitals and trusts without ever moving the data off their own servers:

https://pluralistic.net/2024/03/08/the-fire-of-orodruin/#are-we-the-baddies

The TRE is an open source, transparent server that accepts complex research questions in the form of database queries. These queries are posted to a public server for peer-review and revision, and when they're ready, the TRE sends them to each of the databases where the records are held. Those databases transmit responses to the TRE, which then publishes them. This has been unimaginably successful: the prototype of the TRE launched during the lockdown generated sixty papers in Nature in a matter of months.

Monopolies are inefficient, and Epic's outmoded and dangerous approach to research, along with the roadblocks it puts in the way of clinical excellence, epitomizes the problems with monopoly. America's health care industry is a dumpster fire from top to bottom – from Medicare Advantage to hospital cartels – and allowing Epic to dominate the EHR market has somehow, incredibly, made that system even worse.

Naturally, Kuttner finishes out his article with some antitrust analysis, sketching out how the Sherman Act could be brought to bear on Epic. Something has to be done. Epic's software is one of the many reasons that MDs are leaving the medical profession in droves.

Epic epitomizes the long-standing class war between doctors who want to take care of their patients and hospital executives who want to make a buck off of those patients.

Tor Books as just published two new, free LITTLE BROTHER stories: VIGILANT, about creepy surveillance in distance education; and SPILL, about oil pipelines and indigenous landback.

If you'd like an essay-formatted version of this post to read or share, here's a link to it on pluralistic.net, my surveillance-free, ad-free, tracker-free blog:

https://pluralistic.net/2024/10/02/upcoded-to-death/#thanks-obama

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