EPtalk by Dr. Jayne 2/13/25

California legislators are getting on the AI regulation train. A bill was introduced earlier this week that would prevent AI systems from calling themselves health professionals. Mia Bonta represents California’s 18th Assembly District, which includes the East Bay area, and chairs the Assembly Health Committee. She stated, “Generative AI systems are not licensed health professionals, and they shouldn’t be allowed to present themselves as such.”

The legislation, AB 489, is supported by SEIU California and the California Medical Association. It would help patients understand whether they’re interacting with a licensed professional or an AI-powered chatbot. Perhaps clear definitions around the idea of “AI nurses” would have helped avoid some of the confusion that the new Secretary of Health and Human Services encountered when he was recently at the Cleveland Clinic.

Another AI-related headline that caught my attention this week was around using the technology to “make our physicians superhuman.” A health system is using AI tools to help detect lung cancer by using radiology reports where nodules are mentioned, then reviewing and tracking those reports. One of the organization’s leaders stated that physicians are “receiving a CT report on the patient, then having to read the entire body of it and make multiple decision analyses of the individual nodules. Let’s automate that. Let’s make our physicians superhuman in their ability to manage the number of patients under their purview.”

I don’t have an issue with the concept of making physicians more efficient or allowing them to better manage the patients in their care. I do have an issue with the use of the word “superhuman,” though. As someone who saw patients in emergent settings through the worst parts of the COVID pandemic, I feel strongly that this idea of physicians needing to be superhuman is detrimental. It conditions us and our patients that physicians aren’t allowed to fail, have a bad day, or make mistakes. It can raise patient expectations beyond what one can reasonably deliver. I saw this acutely during the pandemic, when we were expected to see ridiculously high patient volumes without appropriate personal protective equipment, support staff, or supplies.

I’ve practiced in a small town as well as in the big city. I honestly feel like the time I spent in rural America and interacted with my patients regularly outside the office was better as far as helping set expectations about what physicians should and could do. When you see your patients at the grocery store picking up bread and milk just like everyone else, it gives both the clinician and the patient a different perspective. There’s nothing more human than sitting in the stylist’s chair at the local hair salon or “beauty parlor” with foils all over your head and chatting with your patient over a People magazine. I definitely miss those times when I’m working on projects that turn patients into numbers and physicians into productivity widgets.

I frequently work on EHR adoption and optimization projects, so I always like reading about others’ efforts in the literature. A recent article on team approaches to training and optimization caught my eye. The authors surveyed health organization informatics leaders and received 193 responses from 147 organizations. Some of the statistics were rather interesting: “Of these, 69% offer ongoing EHR training, and 52% offer some version of an ETOP (EHR Training and Optimization Program).”

That leads me to wonder what the other organizations are doing. One might assume that they are training once and then just hoping that clinicians wing it as they go. The authors suggest that ongoing optimization and training programs can lead to reduced healthcare worker burnout through improved EHR efficiency and satisfaction. They recommend that additional research be done “to identify the optimal features, methods, and outcomes of ETOPs, and to disseminate them across HCOs.”

Although I’ve seen cool presentations at various EHR user group meetings about how different organizations approach it, I know that in my own consulting practice, what I see varies widely.When I was a health system informaticist, I certainly didn’t want to reinvent the wheel when I could copy from someone who was successful. The article confirms the variety of different offerings, including tip sheets, videos, training software, one-on-one training, clinic rounding by trainers, and formal programs.

As keen as physicians are on the concept of evidence-based practice in caring for patients, I would think they would be more excited about developing best practices for implementing and maintaining EHRs. I think we’re going to see shifts in what is needed as the clinician workforce demographics change, and it will be interesting to see how the research keeps up with this evolution.

Worker retention is a huge issue in healthcare. Especially in cities with multiple health systems, there can be frequent movement among IT roles as people try to improve their compensation. It always amused me as a health system leader that I couldn’t pay my valued workers more, but if they quit and I had to replace them, I could get the role moved into a higher salary band. It seems like it would have been easier to just pay people commensurate with their skills and experience, but hey, I’m just the doctor.

A healthcare article states that the average worker with capped vacation days takes 14 days off annually, while those with unlimited PTO take an average of 16. This is in stark contrast to European countries, where more paid time off is typically the norm. Jefferson Health notes that “executives typically use for to six weeks of PTO annually,” but doesn’t mention how much other employee classifications typically use. I would be interested to hear from care delivery organizations that have unlimited PTO and what their statistics are like. I’m happy to maintain your anonymity.

I appreciate the shout out from Mr. H last week as he mentioned the expanding partnership between EHR vendor CampDoc and Scouting America (formerly known as Boy Scouts of America). I read the press release in detail and noted that CampDoc will also be used for the 2026 National Jamboree.

This means that CampDoc has replaced Cerner, which made a simplified version of its flagship software available for previous major scouting events ,including the 2019 World Scout Jamboree where I made friends with quite a few Cerner implementation specialists who were there to support us. I have to say that it was the easiest version of Cerner I’ve ever used since we only had to document the important parts of acute patient care. We didn’t have to worry about the other data elements that are required for long-term population health, preventive screenings, or billing.

I hope the folks from CampDoc get into the spirit — the Cerner team had patches to trade and were a lot of fun. If you work for CampDoc and you are looking for someone to advise you on how to be the coolest kids at camp, I might know someone.

Email Dr. Jayne.