Many of us have not been flying as much due to hybrid or remote contracts. Its been over 6 months for me and this week while looking at flights, I found myself scratching my head on how the website was showing flight costs that were not what I am used to seeing. The little red X marks had me concerned about changes in cancellation fees and upgrade eligibility. After some digging, I knew some of us would have stories of being tricked.

All major U.S. airlines have had a policy in regards to no change or cancellation fees for standard economy tickets since Covid. Delta was one of the first to make this permanent, eliminating fees for Main Cabin and premium fares on flights originating in the U.S. American and United followed with nearly identical policies, and today all three allow free changes on most tickets. Southwest, for those who love this airline, has never charged change fees for any fare class.

But the real story sits beneath the surface. While Main Cabin flexibility has become the norm, Basic Economy remains a highly restricted product across all major airlines. Delta, American, and United all block changes and cancellations for these fares, and low‑cost carriers like Frontier and Spirit still charge fees that the big airlines have abandoned. This creates a two‑tiered experience: a flexible “consumer‑friendly” Main Cabin and a rigid, no‑changes‑allowed Basic Economy designed to look cheap but feel costly once the restrictions become clear.

That’s why airline websites almost always display Basic Economy as the default lowest fare. It’s not a glitch…it’s a revenue strategy. By leading with the cheapest number, airlines anchor the customer on price, then reveal the limitations only after you click on the lowest fare. Consumer advocates have criticized this as confusing or even “bait‑and‑switch,” especially in cases like American Airlines, which has been called out for making fare transparency harder to navigate. And while each airline handles the presentation differently, the pattern is consistent: Basic Economy is intentionally positioned to drive upsells to Main Cabin, where the no‑change‑fee promise actually applies.

In other words, the industry has embraced flexibility, but only for the fares they want you to buy. The headline policies sound generous, and in many ways they are, but the digital storefronts still steer travelers toward the most restrictive product first. Understanding that dynamic is the key to understanding modern airline pricing: the flexibility revolution is real, but the marketing strategy hasn’t changed at all

Most of you know I am a Delta loyalist, so I did some reading just to spell this out, and not favor Delta over other airlines…well, as best as I could.  The bottom line that we all need to be aware of is it is deceptive across all airlines.

The pattern is industry wide, though some airlines are more aggressive than others.

• Delta, American, and United all prominently display Basic Economy as the lowest fare, even though it does not allow changes or cancellations.
• The restrictions are often only visible after clicking into the fare details.
• Analysts and consumer advocates have repeatedly criticized this practice as confusing, opaque, and intentionally designed to push upsells.
• Southwest is the only major U.S. airline that avoids this issue entirely because it does not offer Basic Economy.

Has anyone find themselves fooled and stuck with a ticket they can’t cancel or get upgraded? Share in the comments below.

In a meeting I had just a couple of weeks ago with a Chief Innovation Officer of a healthcare system, I learned of their internal development of a new AI solution. It made me wonder who else might be doing this, and after just a few articles, I found there was a big trend in AI and overall technology development happening internally, vs hospitals going out to buy the solution needed. I wanted to share just a few examples here and my thoughts on potential impact to consultants.

Organizations including Mass General Brigham, Mayo Clinic, Cleveland Clinic, and Stanford Medicine are all building platforms inside their clinical environments, validating them on real patient data, and then exploring commercialization pathways, whether through spinouts, licensing, or joint ventures. These new tools are proving valuable enough that they can scale beyond their home hospital. The common theme I found appears to be that newly internally developed technology is being treated as strategic intellectual property, not just an internal tool.

These systems also share a similar pattern where they build a solution that solves deeply operational problems. In reading multiple articles, the focus appears to be on workflow automation, unstructured‑note extraction, population health risk stratification, and care‑pathway optimization. Before any commercialization step, the tools are deployed internally at scale, stress‑tested across multiple specialties, and integrated into clinical workflows before turning it into a company with a product.

For those of us in Healthcare IT consulting, this shift is going to reshape the landscape in a pretty fundamental way. As more health systems start building and commercializing their own products, we won’t just be advising on technology adoption; we’ll be helping organizations evaluate, integrate, and even compete with tools that originate inside other hospitals. It changes the mentality of just supporting Epic or Oracle because the clients we support may now be both buyers and creators in the AI/technical marketplace.

Hospitals spinning out tech companies will expect consultants who understand not just EHR integration, but IP strategy, go‑to‑market planning, interoperability standards, and the operational realities of scaling technology safely. In other words, the consulting value proposition shifts from implementing tools to helping health systems become technology-driven organizations, or in this case, even an AI/technology vendor.

Regardless of your area of focus as a consultant, we’ll all need to adjust to a broader capability of support.  All these changes imply that hospitals are becoming product creators, not just adopters. I just wrote about continued learning as my new year’s resolution, so hearing about all these hospitals taking on development of their own technologies only reinforces the need to keep up on all these great new tools being developed. 2026 is going to be an interesting year in Healthcare IT!  

Anyone working with a client that this is a priority? Please feel free to share in the comments area below.

Here is the Mass General Brigham Press Release – Mass General Brigham Announces New AI Company to Accelerate Clinical Trial Screening and Patient Recruitment | Mass General Brigham

The press release from the US Department of Health and Human Services is big news for IT consultants. The newly announced $50 billion Rural Health Transformation Program represents one of the largest federal investments ever made in rural healthcare, with every state receiving substantial funding beginning in 2026. The initiative aims to expand access to care, strengthen the rural workforce, and modernize facilities across all 50 states. For rural hospitals, this signals a major shift toward more technology for care delivery, particularly in preventive services, behavioral health, emergency care coordination, and chronic disease management. All of which will require stronger digital infrastructure and more sophisticated technical support than many rural facilities currently have. Funding like this helped so many of us get contracts and work during Meaningful Use, so I can’t help but wonder if this also could open more doors for future opportunities.

A significant portion of the funding is dedicated to modernizing rural health infrastructure, including upgrades to equipment, cybersecurity, interoperability, telehealth, remote patient monitoring, and digital workflow tools such as AI scribing, which we are all used to via Nuance or Epic. These investments will dramatically increase the volume and complexity of IT systems rural hospitals must deploy, maintain, and secure. States will need to roll out new models, regional data sharing platforms, and clinically integrated networks. Additionally, rural hospitals will need more robust networking, 24/7 system monitoring, and specialized support for interoperability across disparate EHRs and care settings.

The program also encourages innovative care models and value‑based payment structures, which depend heavily on accurate data capture, analytics, and reporting. This will push rural hospitals, many of which currently operate with minimal IT staffing, to adopt more advanced data systems and require ongoing technical assistance, training, and cybersecurity oversight. This could be great news for so many of us in the consulting world!

In short, the federal investment will expand care access and modernize rural health delivery, but it will also create a surge in demand for IT support, managed services, cybersecurity expertise, and long‑term digital transformation planning across rural healthcare organizations. Feel free to leave comments. Curious what folks think about this news.

See the full Press Release here – US Department of Health and Human Services

Our entire industry of Healthcare IT is racing to sprinkle “AI” on everything in sight. Much like hard to fill consulting staffing needs, this is the tech world’s version of finding a unicorn. But in reality, a lot of what’s being marketed as artificial intelligence, in the various EHR systems today, might just be closer to automation vs sentient software.

Epic has embraced the AI label across its platform, from clinician assistants to patient-facing tools. At their 2025 Users Group Meeting, the company highlighted hundreds of new AI features, and at HIMSS demos, some 60+ new products, including Emmie, ART, and Penny, that were all aimed at helping clinicians with charting, documentation, and administrative tasks.

The reality? Most of these capabilities resemble what many refer to context aware automation, including:

• drafting prior authorization responses based on structured data
• suggesting codes after a visit
• summarizing chart sections for easier workflows.

These are truly just workflow automation, not the much hyped AI future of technology releases that we read about every day. These are all still ultimately guided by human decisions and rely on existing clinical processes, not independent clinical judgment.

Check out this great Epic article on CNBC.

Since Oracle acquired Cerner, the messaging has leaned heavily into new AI driven capabilities. The new Oracle Health EHR platform is described as “AI-driven intelligence” built into workflows, able to surface insights, handle voice-activated commands, and trim documentation burden.

This fall the press releases and news articles were endless, including this fun read Oracle Ushers in New Era of AI-Driven Electronic Health Records

But a closer look shows most of this is still just automation, including:

• converting speech to text and structuring notes,
• pulling up relevant chart data on keyword requests,
• auto-suggesting orders or navigation clicks.

These are valuable productivity enhancements, which everyone can benefit from, but they don’t think or diagnose on their own. They automate repetitive tasks that clinicians used to do manually.

There are genuinely some AI-centric tools that I’ve seen, including systems that analyze medical images, flag deterioration risk patterns, or predict clinical outcomes based on massive datasets. Check out Nuance/Microsoft, which partners with both Epic and Oracle. But let’s all be clear and recognize that most EHR-embedded features today are task automation with AI branding that tout age old promises of reducing clicks (ever hear that one before?), creates draft texts (been around for years), and directly improves workflows.

Thoughts on how “AI” is driving your optimization project support efforts? Share your comments here.

There was a recent post on LinkedIn that received hundreds of hits and dozens of responses regarding double dipping. It got me thinking about the scenarios where it could be normal to be working for more than one client…but also, I’ve known many that may have been pushing the line. So let’s dive into this subject, and please feel free to share your thoughts on this.

In the world of EHR consulting, the term “double dipping” carries ethical, contractual, and professional implications. At its core, double dipping refers to a consultant working two or more paid engagements at the same time, without disclosure to the client(s), while presenting themselves as fully committed to each role. While working multiple jobs isn’t automatically illegal, double dipping crosses into unethical territory when deception, overlapping hours, or conflicts of interest are involved. The original post on LinkedIn focuses on the idea that consultants who are double dipping are stealing, lying, and cheating their clients. Ok, let’s dissect this some more.

Double dipping typically occurs when a consultant accepts multiple high-commitment projects simultaneously and bills each client as if they were working exclusively for them. This can include billing the same hours to two clients, logging into multiple Epic instances or other environments during overlapping work periods, or hiding one engagement from another. These behaviors raise red flags for consulting firms and health systems alike and can expose consultants to allegations of fraud, breach of contract, or termination.

Here are some rather common forms of double dipping:

• Simultaneous Epic Projects: Taking on two full-time, or near–full-time, Epic contracts at once during demanding phases like implementations, optimizations, or go-lives.
• Conflict of Interest: Supporting competing health systems or vendors, which can risk exposure of sensitive workflows, build strategies, or proprietary information.
• Fraudulent Billing: Charging two clients for the same block of time could escalate into billing fraud.
• Deception and Non-Disclosure: Intentionally hiding another role from an employer or client, violating trust and contractual obligations.
• Epic System Monitoring: Epic environments can detect concurrent logins across different client systems, which may trigger internal audits or investigations. See many of my past articles on being black listed.

Double dipping is not really applicable when supporting efforts through managed services and/or call center roles. For example, a consultant may be assigned scheduled support hours for one organization while simultaneously providing managed services coverage for another. Because these roles often involve “availability-based” billing rather than strict project milestones, clients expect their agents to be only partially assigned to them. There are situations where the client wants call agents to be 100% assigned to their organization, and in those examples, double dipping would not be appropriate.

Not all secondary work is unethical. Moonlighting can be acceptable when roles are low commitment, schedules do not overlap, and all parties are informed and consenting. For example, a consultant might take on limited advisory work or short-term troubleshooting outside of core hours. We can’t assume malicious behavior when all clients are aware, and the consultant is 100% transparent.

Consulting relies heavily on trust, transparency, and professionalism. While the flexibility of consulting can create opportunities for additional work, crossing the line into double dipping introduces significant ethical and legal risks. Whether in project-based consulting, managed services, or call center support, disclosure and honesty are essential. When in doubt, clear communication and written approval are the only safe paths forward. I believe that there is a competitive nature that also warranted many of the comments on the LinkedIn post. I would love to hear your thoughts. Share your insights on the subject in the comment section.

After an extended pause, I’m excited to relaunch the consultant tips blog, a site I created back in 2011 to share practical insights from the world of consulting. With over 25 years of experience in Healthcare IT and 20 of those spent on the road as a traveling consultant, I’ve seen and learned so much from many fantastic organizations. In recent years, I transitioned into various executive roles, but the stories, lessons, and rhythms of consultant life continue to be my core focus.

This blog was built as a neutral, no-nonsense space where real experiences take center stage. Whether you’re a seasoned consultant, just getting started, or simply curious about the industry, you’ll find something here from tried-and-true consulting tips and professional advice to travel hacks, hotel and airline reviews, and stories from the road. It’s part insider guide, part travel log, and part community hub for anyone navigating the dynamic life of a consultant.

As the site grows, I’m welcoming guest voices, reader comments, and shared experiences. The goal is to keep things informative, relatable, and most importantly, fun. So grab a coffee (or a boarding pass), explore the content, and feel free to join the conversation.

Many of us started our consulting careers in Healthcare IT supporting an EHR implementation.  My first engagement was rolling out Epic from facility to facility for over 2 years.  In fact almost all my engagements were either a full install, a Community Connect project or a new facility roll out. Then I started to see more opportunities beginning to appear that were optimization and/or process improvement project type of work.  A ton of KPI driven project efforts and specific system enhancement projects were popping up everywhere.  It’s only been in the last year or so that I’ve seen a new type of opportunity coming over, straight forward application management support…a significant shift from project work, and a rather interesting change in staffing demand worth talking about.

Almost all employers, across most industries, are facing staffing issues.  Those issues span across shortage of qualified candidates, retention of staff, utilization/performance, and increasing costs. The shift in demand to provide day to day system support is starting to tackle some of these challenges our clients are facing.  By using consultants to cover day to day needs including ticket management, quick fixes, or even upgrades, clients can keep their staff busy on project work.  I have a colleague who always says, “Let your team do the sexy work and we’ll take on the rest.”  This type of model can help with retaining and developing staff, not to mention improve staff moral and team culture all the while making sure ticket backlog doesn’t become an issue and impact end users.

In interviewing several candidates over the last few weeks almost all the opportunities being presented to them are to provide backfill to team members so the client’s full time employees can support various initiatives and project work.  While ticket management certainly isn’t “sexy,” it can be very fulfilling work as a consultant. I always think we are directly supporting end users, improving end user satisfaction and helping the client directly see the benefits of their EHR investment. That’s why I became a consultant.   

Some will argue that application support has been an offering for some time via Managed Services.  I’ll agree, some clients have outsourced their system maintenance and application support to Managed services firms.  Many of you may have agreed to work in a call center setting, but I’ve found most of these efforts are supported by full time employees and the firm’s contract durations are for years, not months. As a consultant many of us are not ready to go full time, as we still enjoy the variations of client support needs.

Application Managed Services (AMS) seems to be what more and more clients are discussing today.  It’s a perfect merge of the traditional staff augmentation support with portions of Managed Services that are cost effective and can be customized in every way to the clients need.  The client can request specific tier level support, focus on all or some applications, request specific service lines agreements (SLAs), and maintain ownership of their governance and change management processes.  While Managed Services often includes telephony, ticket management systems (TMS), and other bells and whistles…not all clients are looking for that level of support, so AMS seems a better fit. 

As consultants we are faced with more and more choices as staffing challenges continue.  While I know I loved the excitement of a go-live and the longer duration projects associated with an install, I also know I enjoy helping end users be successful.  Application support is going to be another option for us more and more.  Are there still upcoming implementations?  For sure there are…as well as plenty of optimization project support efforts. It’s a great time to be a consultant, we have a ton of options and now AMS could be another engagement to consider for your next consulting adventure.

The Spring season is upon us and with that comes two of the largest healthcare conventions of the year, back to back.  Last year I wrote about these two conventions to explain the differences and how ViVE became to be as a result of Covid confusion and HIMSS mismanagement of the 2020 canceled convention.  I thought this year I would keep it lighter and just share who I think did a better job in terms of location and venue as well as a look at the shows offerings and benefits of participating.  I’ll share some opinions on things that didn’t work so well, but really highlight those that did.

VENUES

Nashville, TN was the host city this year for ViVE, held March 26^th through March 29^th at the Music City Center.  This was my first time attending a conference at the Music Center. It was also my first time staying in the convention area of downtown Nashville. 

From a location and venue perspective Nashville is the real winner here.  A fun city with plenty of hotels within walking distance and tons of restaurants and entertainment to meet and network.  Hotel costs were great and the convention center itself impressive. The convention center opened in 2013 and offers 2.1 million square feet of meeting and showroom space. The meeting spaces used for CHIME both at the convention center and at the Embassy Suites across the street were easy to get to vs the miles of distance at other conventions.  It seemed to be very modern and open.  I especially enjoyed the decision to have live music in various areas of the convention space. 

HIMSS choose to once again visit the windy city of Chicago April 17^th – 20^th at the McCormick Convention Center.  The last time to convention was hosted here in 2019 the city had a blizzard, and to no surprise to me, it snowed as most of us arrived again this year.  A big change from the regular locations of either Orlando or Vegas for sure.

Unfortunately, Chicago’s convention center is in an isolated area of the city and provides challenges for a daily commute if you didn’t get a reservation at the two or three local hotels.  If you wanted to meet someone or just grab something to eat, there were very few venues within walking distance that were not already sold out for private parties, and the hotels were completely packed.  There was several take out type food establishments, much better than Orlando has, but lines were still crazy long and the quality of the food was worse than most airports. The costs with Chicago also are a big difference to attendees in comparison to usual locations in Orlando or Vegas.  Hotel rates were almost 3 times that paid last year.

BENEFITS

As a vendor attending a trade show we all know that the focus is on sales, marketing, and customer interaction.  I have to admit I also like to use these gatherings for education purposes.  It’s also nice to see old colleagues and friends.  Networking is a big driver for many.  I will say most of these shows are more vendors then not, but that’s not always a bad thing as many attendees are also looking for opportunities to identify partnerships and/or do competitive comparisons.  In either case, both shows offer all of the above.

CHIME is typically an isolated event from the rest of the show, either held in a different part of the convention center or held entirely in a separate location.  This year ViVE choice to provide a space in the general showroom for CHIME to give its keynote and other presentations.  While the convention center was really impressive in its size, we were all cramped without enough seats and so much foot traffic and competing presentation happening, it was hard to hear or stay focused.  It looked great in the morning though when no one was there yet.  CHIME should have had a ballroom space, away from the show floor…it just didn’t work.

ViVE did a great job with providing a ton of networking offerings, including an option to buy client meetings in a type of speed dating scenario.  I enjoyed the opportunity to meet with current and potential clients to hear about their upcoming projects and initiatives.  There was plenty of seating areas and coffee areas where you could meet with a client.  CHIME offered an area with tables and comfortable sofas to catch up with a friend or host a meeting.  Even the lobby area had live great places to grab a coffee and enjoy soft live music in the background (check out band in the background in the pic below).

Another thing that ViVe offers is breakfast, lunch and snacks.  There is literally an endless array for food and beverages from opening to closing. My favorite was on the last day they offered fresh biscuits and sausage gravy for breakfast, I was in heaven!  There is a debate regarding bottled water.  ViVE stated they spent almost a half a million dollars on water bottles.  I brought my own water, but I know its another benefit many enjoyed. 

ViVE offered a ton of educational sessions, over 60 over the three days.  In addition to that, CHIME offered their breakouts as well.  While most were offered on the main floor, it was nice that CHIME held sessions over at the Embassy Suites, right across the street.  While most of the general sessions were packed, those offered later in the day had plenty of seats and allowed for more interactions with the speakers.

I probably should have said this right from the start, a comparison of ViVE to HIMSS isn’t really apples to apples and might not be a fair comparison.  HIMSS expected just over 40,000 attendees (compared to the 7500 for ViVE) this year.  I’ve attended this event for years and it really is all about the vendors and the show floor.  I overheard someone the other day comparing it to a boat show.  I loved that analogy. Walking through the floor the day before opening was an impressive gathering of workers opening giant crates, laying down carpeting, and wiring each booth to be ready for Tuesday’s big opening.

With over 1,100 vendor booths, you can find most any kind of healthcare related business from infrastructure, to equipment, IT, and every kind of service offering you can imagine on the floor.  The big players, and largest booths, come from familiar names like Google, Amazon, Epic, and Oracle.  Most offered give-a-ways ranging from stuffed animals to popcorn.  All to lure you in to perhaps watch a demo or talk about your organization.  Its an impressive display of sales at its core.  Fund, but exhausting. I averaged 14,000 steps a day for 4 days. 

I am always impressed with Epic’s booth. OK, I know I am biased, but while the same theme and design is the same year over year, the opportunity to meet with their team and participate in demos is just awesome.  They go over the top with marketing signage, but I love the stats just the same.  I also was impressed with SalesForce this year.  They had an awesome forest themed booth and impressive team of subject matter experts providing demos all day long.

My company opted to have a meeting space instead of a booth this year. The space was basically the inside of a pods storage space.  It actually worked great.  Located right on the show floor, tucked in the back was dozens and dozens of pods all set up to welcome clients in a formal meeting setting. Our room was simple with table and demo set up and was booked everyday.  From a cost perspective, a booth at HIMSS start at $20,000 and companies like Oracle spend over a $1M.  Having an option like this was perfect, and I highly advise using something like this.

Another positive aspect of HIMSS is the ability to attend regional events and gatherings.  Most chapters host a vendor sponsored event towards the end of the day as a happy hour or an offsite dinner or party.  I was fortunate to attend an excellent function hosted by the Gulf Coast Chapters of MS, AL, and LA at Lou Malnati’s…the best deep dish in Chicago.  I also attended two other happy hour events that were a bit more educational focused, but nice as well.  The benefit here is to meet you customers and network while being wined and dined by your host. I find this to be a real differentiator between ViVE and HIMSS. 

I’ll wrap up with sharing a selfish part of why I enjoy these shows, seeing old friends and networking with clients and coworkers.  We are all busy at work and home that sometimes keeping in touch with friends and colleagues can be hard.  Events like these provide an opportunity to reconnect with folks that you don’t usually get to see often, have great food and conversation with clients, or even have drink or two with coworkers that you haven’t had time to get to know. 

What did you think of the shows? Leave your comments below.

In 2018 I shared a blog on the idea of remote contracting work (link), and the impact of rate, at a time that almost no one offered nor wanted such a situation.  Consultants wanted to travel, saw points and hotel/airline perks as an added benefit to their career.  Clients expected the team to be onsite, to be incorporated into the team, and directly impact productivity.  I interviewed dozens of consultants and they all said they had zero interest in remote.  In March 2020 I posted another very different idea on the same subject, all work efforts would convert to remote for considerable time due to Covid…and at that time, we had no idea of the changes to come.

Three years later there is no question that “remote,” is the new norm.  Consultants have accepted the fact that their airlines status has shifted from Diamond to Gold, or Titanium to Silver or…well, it doesn’t really matter anymore, does it?  Clients, or a large number of them, have simply shifted their models for their teams to almost be 100% remote and their consultants are expected to be the same.  The few that do go on site, with a limited travel arrangement, seem to average a trip once a month, or 20% travel schedule.

Another interesting change is hiring full time staff regardless of where the employees live.  This trend is happening all across the country.  I’ve spoken with several local hospitals here in Boston and they all have employees who live in Ohio, for example, or even further away.  They allow their own workers to travel and work from their Florida home in the winter months or summer cottage locations in the summer.  No doubt this has improved retention of talent for clients and may be an option for consultants to consider in a contract to hire scenario. 

Onsite requirements continue to change and no doubt clients are looking at variations of home work options. We have all read that some industries are buckling at the remote concept, including software companies.  There is no doubt in my mind we will continue to see changes over the next several years.  Don’t get me wrong, there are still plenty of clients who are asking for onsite consultants, but they are the minority right now.

So what’s next for us in the world of healthcare IT consulting? If I had to make a prediction on any shift to consultant travel expectations in the future, it would be simple, expect more of a hybrid model.  It’s a standard contract question now…”what level of travel do you expect for this role.”  These agreements, 80% remote 20% onsite for example, are now a part of any work order.  Recruiters have to ask travel related questions to every candidate now, and as a consultant…you have more options than ever before when it comes to remote vs onsite opportunities.

What are you doing today…remote or onsite?  Share your thoughts below in the comments section.