EPtalk by Dr. Jayne 2/6/25

I’m spending the week in the mountains, trying to find my Zen in front of a roaring fire while I sort through a flurry of new consulting requests. The recent deluge of executive orders in the US has led several of my previous clients to reach out for assistance.

I’ve been offered work ranging from high-level strategic guidance to “get your hands dirty” EHR work as organizations try to quantify the potential patient impact, create appropriate communications, and manage complaints from physicians who are concerned about the risk of providing certain kinds of care. Although my schedule was fully committed going into the new year, I’ve been doing my best to introduce my former clients to other trustworthy informatics consultants. With all the changes thus far, it seems that the only people winning are the attorneys and the consultants.

I’ve never been a skier and have been tempted to consider learning, but then I see someone come down the mountain in a rescue basket and am reminded how much I value the function of my knees. For those patients who have encounters with the health system due to their adventurous pursuits, it’s certainly a different experience than it was even a decade ago. With interoperability gains and the ready exchange of information, it’s nice to see patients be able to message their primary care physicians and ask them to review records and potentially arrange referrals and follow up before they travel home. It’s a definite improvement from the time when you were handed a CD and a pile of papers to hand carry to your physician.

The mountain is a wonderful place to sit around the fire and tell stories, so I’ll respond to a reader request to hear more about the time I practiced medicine in an evening gown.

I used to be on staff at a hospital that had an elaborate medical staff ball every year, with the physicians and their escorts donning tuxedoes and full-length gowns. We were having our event that year in a converted warehouse/loft type venue in our city’s downtown. Although it was a neat facility, there were a lot of stairs involved. As you can imagine, they didn’t necessarily go well with floor-length gowns and people who were not used to wearing them.

One of the medical staff administrators slipped and found herself on the floor, surrounded by a urologist and two otolaryngologists who immediately turned to “that new doc that works in the ER” to manage the situation. I would say I rolled up my sleeves and went to work, but of course there were no sleeves on my gown. But I was glad about the full skirt since I spent the next quarter hour on the floor keeping her from moving until paramedics arrived, as required by the venue. I could have cleared her after my evaluation, but they were insistent, and her husband was grateful that someone other than him was making sure she followed the directions. As a physician, you never know when or where you might be called into action. And for the curious fashion afficionados, the gown was dark violet silk accompanied by a vintage beaded clutch and black crepe de chine shoes.

I have several friends who work for the Centers for Disease Control and Prevention and others who rely heavily on government datasets as part of their research efforts. One clued me in about the lawsuit that was filed earlier this week by Doctors for America. It asserts that lack of access to key clinical information, guidelines, and datasets has created risky gaps in scientific data, reduced the ability to manage disease outbreaks, and impaired the ability to manage patient care.

Mr. H has been asked whether he’ll cover “DC happenings” and he provided his response last week. When there’s an executive order that dramatically impairs a physician’s ability to do their jobs, or a negative impact to the practice of clinical informatics, you can bet I’ll be covering it. Patient safety should be a national priority, and I welcome a conversation with anyone in policy making who would like to convince me that restricting access to Vaccine Information Statements that are used every day by physicians across the US improves patient safety or clinical outcomes.

From Jimmy the Greek: “Re: more return-to-office shenanigans.” I always appreciate his newsy tidbits, and this one describes next-level monitoring of in-office employees. It describes peel-and-stick radar sensors that can help companies understand whether people are in a room, measuring not only movement but carbon dioxide, volatile organic compounds, air pressure, temperature, humidity, and particulates. It’s like a little indoor weather station. On one hand, it can help companies understand the true utilization of their real estate footprint, but on the other hand, it could force employees to take the concept of “coffee-badging” to the next level if they need to demonstrate a presence in a particular area of the office. The comments are pretty good if you’re an executive who wants to better understand why your employees don’t want to return to the office.

Cleveland Clinic has spoken out about RFK Jr.’s claim that they have developed an AI nurse. A hospital spokesperson confirmed in a recent statement that the claim was not correct. I’ve been deeply involved in the world of virtual care for years, looking at how organizations are virtualizing care in a thoughtful way to ensure that patient safety remains paramount. There are hundreds of clinical informaticists and related professionals working to create AI-driven clinical solutions every day. Each of us is savvy enough to know whether what we’re seeing in a demo is an AI nurse or not. One would hope that individuals who have the potential to run one of the most challenging healthcare administrative organizations in the world would surround oneself with people who understand what they were looking at and how it might be used (or not used) to care for patients. Plenty of us would free our schedules to ensure that our nation’s leaders aren’t being confused by what they see or at worst hoodwinked by unscrupulous technology vendors.

What’s your over/under on how many years it will be until we truly have AI nurses that are indistinguishable from human nurses interacting with patients? Leave a comment or email me.

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