EPtalk by Dr. Jayne 7/24/25

JAMA Network Open recently published an Original Investigation titled “Patient Care Technology Disruptions Associated With the CrowdStrike Outage.” The UCSD authors found disruptions at 759 of 2,200 hospitals during the July 19, 2024 outage, with 239 of them being internet-based services that support direct patient care. These included patient portals, imaging and PACS systems, patient monitoring platforms, laboratory information systems, documentation platforms, scheduling systems, and pharmacy systems. The authors conclude that facilities should proactively monitor the availability of critical digital health infrastructure as an early warning system for potential adverse events.

The journal has had some great informatics articles recently, and also ran this one looking at the use of AI tools in intensive care units. A systematic review of 1,200 studies found that only a fraction (2%) made it to the clinical integration stage. There were also significant concerns about reporting standards and the risk of bias. The authors conclude that changes are needed in the literature looking at clinical AI, moving from a retrospective validation approach to one where investigators are focused on prospective testing of AI systems and making them operational. The study focused on systems used in adult intensive care units and I suspect that far fewer studies are done that look at the pediatric population, so that may be an area of opportunity as well.

From Savannah Banana: “Re: stadium naming rights. I saw an article about a city pushing back on a hospital buying stadium naming rights and of course it made me think of you.” Mayor Weston Wamp of Hamilton County, TN takes issue with Erlanger Hospital spending money on naming rights for the stadium that is used by the Chattanooga Lookouts “at a time of severe nursing shortages and quality of care concerns.” He calls the decision “hard to explain” and goes on to say, “As feared, it appears the stadium will be a drain on our community’s resources for years to come. Before I was elected, the Lookouts convinced city leaders to give the team all revenue from naming rights on this publicly owned facility. Now, in a sad twist, our local safety net hospital will be footing the bill for the Lookouts $1 million annual lease payment.”

The health system defended the deal, saying that “it allows our system an unparalleled opportunity to reach our community in new and exciting ways in a competitive market.” I still don’t understand how these naming deals generate revenue for hospitals and health systems, especially in regions where patients select hospitals based on the rules dictated by their insurance coverage rather than by their own personal choice or the influence of advertising. If some of our readers have insight, feel free to educate me.

Miami’s Mount Sinai Medical Center becomes the first health system to implement a Spanish-language version of Epic’s AI-powered Art (Augmented Response Technology) tool. Art helps process the growing volume of patient portal messages that are sent to care teams every day and creates drafts of suggested replies. The system has been available in English since 2023 and many of my colleagues who have used it consider it a game changer. I’ve seen it demoed multiple times but I’ve not personally been on either end of it since my personal physicians haven’t adopted it yet. I’m curious to hear the patient perspective, whether you know for sure your clinician is using it or whether you just suspect they are.

People are talking about Doximity’s free GPT. I tried it once awhile back, but I can’t remember if I was impressed by it. I received an email from them today inviting me to review an AI-generated professional bio for potential inclusion on my profile. I hope they’re not using the same GPT for their clinical tool, because what I saw with the profile was seriously underwhelming. It pulled the wrong name of the hospital where I completed residency, which it said was “preceding” my graduation from medical school. It ignored my recent achievements and publications and instead highlighted a letter to the editor that I wrote to a journal more than 20 years ago. I clicked the “don’t add” button on the entire thing. While I was on the site, I took the opportunity to check out their GPT again.

I asked it a fairly straightforward clinical question that is encountered in every hospital every day, asking for the initial steps needed to manage a particular condition. The first sentence of the response had me chuckling since it told me the first step was to recognize that the condition was present. Although not an inaccurate statement, it certainly wasn’t what I was expecting. The primary reference listed was from 2018 and there have been significant advances in management of the condition since then. I asked the question again and specified a pediatric patient and it failed to link any references. Based on those factors, I can say that I’m officially underwhelmed.

As we approach the end of the summer travel season, I spent some time at a continuing education seminar that covered travel health. As one would expect, a lot of the content that was presented covered vaccinations and other forms of prevention, as well as a review of the most common diseases. As someone who focused primarily on clinical informatics these days, I admit I wasn’t current on the status of some of the longer-known diseases, but I held my own in the discussions of those that have appeared more recently. Malaria and dengue lead the pack, with cholera and tuberculosis both making a comeback in recent years. Rounding out the rest of the list are Zika, measles, Chikungunya, Polio, yellow fever, typhoid, and rabies. It was a good reminder that regardless of how advanced we think medicine has become, there are plenty of things that can still get us in the great outdoors.

Have you ever had a travel medicine consultation prior to a trip? Did you find it valuable? Leave a comment or email me.

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