Curbside Consult with Dr. Jayne 2/3/25

In response to Oracle Health’s comments about its new and improved EHR, a reader recently asked Mr. H whether users are really asking EHR companies for a voice-driven solution. His response was that it “might draw interest if it doesn’t slow clinicians down.”

I heartily agree. The handful of demos that I’ve seen related to this kind of technology are always slower than looking at the summary screens that already exist in most EHRs. For new users or those who have yet to embrace all the whistles in their current systems, I agree that it could be a valuable tool. However, I think the level of potential impact is variable and somewhat depends on a user’s history and their experience with other types of documentation.

Some of us came of age in our medical careers during the era of paper charts. We had to learn to quickly find information and organize it in our heads. We often created summaries in the chart to help us better keep track of our patients. Those paper charts were often horrific messes, and you never knew whether they were fully current with labs printed out. You also couldn’t read some of the handwriting.

As EHRs became standard tools in hospitals, many implementations simply automated that paper process. Because of that, we became good at finding information in digital nooks and crannies just as we had previously. When EHRs came out with summary screens and the ability to graph and trend things, we felt we were in heaven because we no longer had to create those maps in our minds.

The next problem was how to educate users on the new features that are available and to get them to take advantage of those features. The last time I did an optimization project in an ambulatory setting, less than 20% of the physicians were taking advantage of extremely helpful parts of the EHR. For example, one system had the ability to superimpose blood pressure readings over a timeline that reflected medication adjustments. That’s powerful, but the vast majority of physicians had no idea it was in the system, let alone how to use it. They were literally deprived of the benefit of having the EHR synthesize information as well as the quality aspects of reducing the risk that you would miss information if you were digging through the chart on your own.

Then there’s the issue of the digital natives who are now practicing medicine, those who have spent the majority of their professional lives with a smartphone in their hands and the expectation that everything should be right in front of them with pretty visuals that fit on a six-inch screen and require no cognitive analysis. These are the folks who absorbed their medical school lectures via recordings played back at 2x speed. They’re also of an era where medical education has shifted away from “learning for learning’s sake” and more towards being able to pass national licensing exams with high enough scores to secure their spots in competitive residency training programs. Upon reaching independent practice, their needs often differ from those of their more clinically seasoned colleagues.

When you’re considering the addition of a voice assistant to the patient care environment, however, the physician’s needs are only one part of the equation. The always astute Bill Spooner commented, “I can imagine the patient visit during which the doc is talking to the computer, but I’m not sure whether the comment is directed to the computer or me. “Hey, doc, quit talking to the damn computer and tell me what’s going on. Who the hell is Hey Oracle?”

If the computer is returning audible information with the patient in the room, it had better be accurate and free of inappropriate interpretation or hallucination. As primary care physicians who have endeavored to build trust with our patients, we already have enough difficult discussions when we have to address potentially stigmatizing medical conditions like obesity. If our patients don’t want us to use that word, they definitely don’t want to hear it from a computer in the exam room.

Not to mention that at normal speeds of speech, this exchange of information may take longer than a typed and visualized interaction, especially if the clinician is a fast typist and a quick reader. You can ask nearly any ambulatory physician in the US – our visits certainly aren’t going to be allowed to be of longer duration unless we want to work 10- or 12-hour days to fit them in. It feels like every administrator is trying to figure out how to cram all of our visits into six-minute boxes, which is simply absurd.

I would love to see actual data on visits performed with these tools, using standardized patients with standardized scenarios just like we go through in medical school. I’d love to see transcripts of those visits and also a scoring rubric from the standardized patients about how the visits made them feel.

Like many of my clinical informatics colleagues, I’m a “Star Trek” junkie. Although I’ve never been to a convention or dressed up as a character, (although I did portray a nonspecific officer in a medical school class show), I can quote more episodes than is likely acceptable in the company of my non-clinician, non-informatics friends. If you want to talk about Darmok and Jalad at Tanagra or discuss the variety of desserts that are available from a standard Federation replicator, I’m your girl.

I’ve dreamed of being able to ask the “Computer” to do a variety of things to make my life easier. I would love to have Majel Barrett’s voice power my current digital assistants. However, I can think of specific patients who would be confused by having a third voice in the visit and who might be distracted by a verbal interaction during the visit.

Oracle Health isn’t the only company doing this. If you’re with one of the other EHR vendors using virtual assistants to provide information to clinicians in real time as they treat patients, I’d love to showcase what you’re doing. If you have data about your testing, that’s even better. If you’re a clinician who has used this technology in your practice, I’d love to hear your impressions of the initial weeks of use, any subsequent ramp up time , and where you’ve been able to take the technology.

Is ”Tea, Earl Grey, Hot” your kind of beverage? Leave a comment or email me.

Email Dr. Jayne.