Curbside Consult with Dr. Jayne 3/3/25

One of my areas of focus this year is trying to be more mindful of the time that I spend online. It has been a challenging goal, because as a healthcare IT consultant, staying up to date on the industry is a major part of my job.

With that in mind, it’s more about using resources effectively and not being sucked into clickbait headlines or stories that aren’t going to somehow contribute to projects that I’m working on or knowledge I need to obtain. I spend a great deal of time following developments in AI since that’s a key topic for my clients. Still, it’s hard to keep up on everything even with search alerts and my own AI tools in support of those efforts.

I’ll admit I missed the introduction of HR 238, the Healthy Technology Act of 2025 that was introduced at the beginning of January. The bill was referred to the House Committee on Energy and Commerce, and if passed, it would amend the Food, Drug and Cosmetic Act to pave the way for artificial intelligence solutions to serve as practitioners, prescribing medications as long as states authorize the practice and it is approved by the US Food and Drug Administration.

Although there are AI solutions out there that are looking at delivering diagnosis information based on a clinical picture, and those that can suggest appropriate prescriptions based on drug data, I haven’t seen anything that pulls it all together in a cohesive fashion even at a base level. I definitely haven’t seen anything that also pulls in data on drug pricing, patient values, habits, and preferences, or any of the other dozen or so things that physicians regularly consider when we’re deciding which potential treatments to discuss with our patients.

Even if we had great AI tools that could cut through all of the data and noise that are out there, there’s also the human element of creating a therapeutic alliance with a patient and understanding how various comorbid conditions might impact a treatment that we’re suggesting.

Let’s take a simple example, like recommending that a woman over a certain age gets a certain amount of calcium every day. That’s a very simple recommendation that most EHRs can prompt us to do based on simple rules. First we need to assess the patient and determine if they’re already at goal, which may require teaching them about calcium in their diet and how to track it, plus motivating them to do so. If you have a motivated patient, they might track it for a week or two, but most tend to taper off.

Now let’s think about a patient who isn’t motivated to be concerned about their calcium intake. Maybe it’s a patient who is grappling with depression, anxiety, or worries that they’re going to lose their job. They might also have other health issues that are higher priority, such as the need to follow up on an abnormal cervical cancer screening test or to address high blood pressure that puts them at risk for heart disease. Add in the fact that they have a high-deductible insurance plan with crummy coverage that makes it difficult for them to afford the care they need and you have a recipe for a low likelihood to actually drive a change with that patient.

These are the situations that AI really isn’t equipped to address and that make up a good part of what many of us consider the “art” part of practicing medicine. Another important element of clinical care is managing the next steps after a recommendation fails.

Let’s take our calcium recommendation as our example again. Assuming we have a motivated patient who has tracked her diet, figured out she needs a supplement, and buys one after asking friends for recommendations. After a week of trying it, she’s having daily nausea and wants to talk to someone about strategies to either make it more tolerable for her to take the supplement or about recommendations for a different supplement. Is AI going to be ready to field those follow up questions, or will it be one more thing for a busy primary care physician to follow up on, but this time without the benefit of context and conversation at the time the medication was initially prescribed, like we have now?

Of course, this is just a very simple example, involving an over-the-counter dietary supplement and not even a prescription medication, but if we don’t have solutions that can handle straightforward clinical scenarios, we’re certainly not ready to be discussing actual prescriptive authority.

If we think that there is a shortage of people who can prescribe, there are other options out there that have good data behind them, such as expanded prescriptive authority for pharmacists who are managing specific conditions that range from smoking cessation to anticoagulation management. It’s tempting to just throw AI solutions at problems when we forget that there are already options that we haven’t taken advantage of, which helps remind us that we’re all likely suffering a bit from so-called “shiny object syndrome.” Not to mention that when one has a hammer, everything tends to look like a nail. Similarly, when people are dumping millions into AI solutions, it’s tempting to try to deploy them in places they don’t belong.

As for this particular bill, I don’t personally see it going anywhere anytime soon, based on some of the other priorities in government at the moment.

Speaking of priorities, I’m making my last-minute plans for HIMSS and trying to decide what makes the cut for my packing list, since temperatures are looking a little cooler than I had hoped. Still, it will be better than the freezing weather we’ve had in the Midwest for the last several weeks, so I’ll take the mid-40s to mid-60s any day. I’m looking forward to getting some much-needed sunshine (albeit through the screen of my usual SPF 50) as well as being out and about during the day rather than having to stay close to my desk for meetings and calls. I can’t wait to see my favorite HIMSS booth crawl buddies and to see what the wild and wacky world of healthcare IT has to offer us this year.

What are you looking forward to at HIMSS? Or are you happy to be at home while others brave the smoky casinos and hustlers handing out stripper cards? Leave a comment or email me.

Email Dr. Jayne.