EPtalk by Dr. Jayne 3/27/25

It looks like I’m one of the users who have been selected to test the beta version of the new Amazon Health AI digital assistant.

According to news articles, the tool is designed to field health and wellness questions, and of course to suggest products. Some responses have a “clinically verified” indicator that shows that the information has been “reviewed and confirmed as accurate by medical experts.” I couldn’t find any indication of their definition of “experts,” which can vary widely. It also didn’t indicate how often such information is reviewed or how long ago this particular excerpt was reviewed.

I tried a number of scenarios, including questions about an ongoing cough and a query about what a measles rash looks like. For the cough question, it suggested that I might be interested in purchasing Lipton tea or an over-the-counter inhaler.

For the measles question, I was shocked that it answered the question by providing a correct answer, but for a different question than the one that I actually asked. If I’m asking what a measles rash looks like, I would expect to see a photo of a measles rash (there are dozens out there that are easily accessible from search engines) rather than a description of a vaccine-associated rash.

Initially, when I read the answer, I missed the word “vaccine” because I skipped over the regurgitated question directly to the bullets. I would want to read more carefully next time. I also thought it was odd to add a disclaimer about “while I cannot provide an exact cause for your symptoms” when I didn’t indicate that I was asking about symptoms. I was just asking a health educational question, so the system isn’t sophisticated enough to understand that and probably assumes everyone has a symptom. Users have the ability to provide feedback on the responses, so you can bet I gave that one a thumbs down.

Next, I specifically asked whether the tool had a picture of a measles rash. It apologized for not having an image, but then went on to again discuss a rash that is related to a measles vaccine. It then offered me the opportunity to join Amazon One Medical, which I guess is not surprising.

I also asked how to care for a sprained ankle. The output was missing key information in the form of sentences that didn’t populate correctly: “Over-the-counter like or can also help manage pain and inflammation.” I guess the model forgot to throw in medication names like “acetaminophen” or “ibuprofen.” This search generated a suggestion that I may be interested in buying an elastic bandage as well as visiting Amazon One Medical. I repeated these questions in another search engine and frankly got better answers, so overall I’m going to give Amazon’s new tool a D-minus. Try again, folks.

From Primary Care: “Re: this article Did you see this article in JAMA Network Open? It talked about the fact that states with less regulation of health insurance offerings have higher rates of diagnosis for late-stage cancers. I don’t understand how people can see this data and not think we need payment reform or overall healthcare reform.” I can’t say that I’m surprised. Here’s the full scoop: the study looked at 1.3 million patients in states that had either no regulations or limited regulations on short-term, limited-duration (STLD) insurance plans. These are sometimes purchased by patients who are between jobs or who lose coverage for other reasons. They’re usually pretty poor plans and have waiting periods and other elements within the policies that essentially discourage the patient from receiving care. They typically have high deductibles and high out-of-pocket costs for patients. They are not compliant with the Affordable Care Act (ACA) requirements, which results in higher patient responsibility for tests that would have been fully covered by an ACA-compliant plan.

The study was led by the American Cancer Society and looked at adults aged 18-64 years who had a cancer diagnosis between January 2016 and February 2020. It covered 47 states plus the District of Columbia and used information from the National Cancer Database. States were classified as to whether they prohibited these plans before and after 2018, stopped them after 2018, allowed them with restrictions, or had no additional regulation of the plans. The study adjusted for social and demographic factors, year of diagnosis, and state random effect.

The authors found that in states with no additional regulations of STLD plans, there was a net increase of 0.76 percentage points in late-stage cancer diagnoses compared to those states that continuously prohibited such plans. States with some regulations had a net increase of 0.84 percentage points compared to those with continuous prohibition.

The authors concluded that “the 2018 federal policy loosening restrictions on STLD plans was associated with an increase in late-stage cancer diagnoses in states without or with inadequate additional STLD plan regulatory protections. Findings were consistent among cancer types with recommended screening tests (i.e., female breast and colorectal cancers) and extended prior research conducted in a limited number of states, underscoring the importance of state policies and federal efforts to limit STLD plans.”

This illustrates the difference between allowing healthcare and healthcare finance to be regulated at a state level versus at the federal level. The latter would promote more consistent care delivery across our population. Looking at my own state, the level of education of many of our legislators varies greatly and very few have any firsthand experience with healthcare policy. The year is 2025 and I can’t believe we haven’t gotten on board with the idea that everyone in the US deserves high quality healthcare and that a state patchwork of rules isn’t going to do that for us.

Doctors’ Day is March 30 in the US, celebrated on the day when ether was first used for general anesthesia back in the 1840s. It’s on a weekend this year, so hopefully hospitals and healthcare institutions are planning to do something either before or after. It’s been a while since I worked anywhere that had any kind of formal recognition of the day, so if you have doctors in your life, please consider doing something nice for them or at least just wish them a Happy Doctors’ Day.

How does your organization celebrate Doctors’ Day? Is there a pizza party or a challenge coin involved? Leave a comment or email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 3/24/25

Mr. H was correct in his assumptions around what I would think about Function Health, the celebrity-backed company that offers subscriptions to lab tests.

I checked out their website and the first thing that annoyed me was the use of “insights,” which has become quite the buzzword over the last few years. What exactly does “insights from top doctors” mean? Are they sharing high-quality, peer-reviewed research findings, or are these just their opinions? How do they even define “top doctors?”

Just looking at their “all-in-one for everyone” laboratory test menu makes me cringe. The vast majority of these tests haven’t been proven to be useful for screening average-risk people. Selenium testing, anyone? Selenium deficiency is extremely rare in the US and Canada, except among patients who are undergoing dialysis and occasionally in patients with HIV. But sure, let’s test everyone and hope for the best, and let the beleaguered primary care physicians sort it out when a patient’s results flag high or low in a clinically insignificant way.

News flash: although it looks like it’s included on their home page, it’s actually an add-on test that costs extra, which to me adds an element of bait-and-switch for the customers who aren’t going to do the six additional clicks needed to see the lists of tests.

Most patients don’t understand that “normal” lab values are defined statistically. For that reason, people will be outside the accepted range even though their levels are probably just fine for them as a human. In fact, we don’t really use the word “normal” for most blood tests – we use “in range” and “out of range” unless it’s a critical high or low. Back when I was in med school, the students at my university were used in a project to revalidate the reference ranges for cholesterol tests. I can guarantee that based on our eating habits, we probably weren’t the best population to use for that effort.

We often see confusion when patients look at the results of chemistry panels and their values are a decimal point above or below the cutoffs. Usually those calls result in a phone conversation that is at least 10 minutes long, which takes away time from patients with actual issues who need care.

Other labs included in their testing panels are ones that are tricky to interpret in the face of patients with symptoms, let alone when ordered on a patient with no symptoms. Immune-related labs are the most common of these and can be vexing to patients to the point where we in the primary care trenches only order them when we’re trying to rule a disease or condition in or out of our diagnostic process. They will be “out of range” or mildly abnormal in quite a few patients, which is why you want to avoid ordering them unless the results will change your diagnostic or management plan.

I’m sure that some patient engagement advocates have thoughts around this, but I’ve been in this exact patient scenario and encouraged my own physician to only order the tests that were specifically indicated. I didn’t want to go down any other diagnostic rabbit holes chasing spurious abnormalities that weren’t going to drive the management of my particular situation in a productive direction.

Also in this scenario, the patient has no idea of the education, training, or reputation of the physicians or midlevel providers who may be reviewing their results. I personally like to know who my providers are and where they trained to ensure they’re not low quality. There are plenty of random physicians who will literally do this kind of work for $8-$10 per chart regardless of their qualifications, so buyer beware.

The company also offers the Galleri multi-cancer detection test as another extra-fee add-on. This can be useful, but is best performed after a patient receives appropriate counseling to understand the implications of having been tested for certain conditions or of receiving non-negative results. There are supposed to be laws protecting us from genetic discrimination, but in reality there are plenty of ways in which they can impact a person negatively.

One sneaky trick is not asking patients for the results of their genetic testing, but asking if they’ve ever been tested for a particular condition and then using that information to negatively impact the insurance underwriting process. I’m not an attorney and don’t know if it’s legal, but I’ve seen it. And if you’re in the military and seeking certain job roles, the presence of testing can disqualify you even with negative results. I had to write an appeal letter for one of my patients in that situation, and unfortunately it was not successful. Alzheimer’s risk testing is another one that falls into this bucket.

Other add-on tests are those related to food allergies. Let me tell you about the case that happened in my home town, where a patient died as the result of inappropriately ordered food allergy testing. It’s been written up in the literature and I wasn’t a treating physician, so not a HIPAA violation for those who might be concerned.

The pediatric patient ate peanut butter daily with no issue. However, their physician ordered an overly broad food allergy testing panel that said they were allergic to peanut butter. The parents immediately banned peanuts from the house. Months later, the patient was exposed to peanuts elsewhere and had an anaphylactic reaction and died. How does that happen? The patient had been orally desensitized to the allergen through daily consumption, which protected them. (We actually do this now intentionally with kids with severe peanut allergies, starting with microdoses and working our way up.) When they stopped that daily protection, a life-threatening allergy was now in play. To summarize, a poorly considered lab test that never should have been ordered killed this child.

Although this offering is a subscription service that offers all this testing for one low price, guess who pays for all the follow up of the abnormal tests? You and I do, in the form of increased insurance premiums, since it’s almost certain that people who need additional testing and medical visits to explain it all will do so on their commercial or publicly funded coverage. We also pay for it through an increase in unnecessary visits to follow up these findings, which reduce access to those who actually need care.

I experienced this personally when I was in traditional primary care practice and Quest Diagnostics launched their direct-to-consumer testing site. The site mentions that “clinicians call you promptly if any urgent results arise,” but I’m betting those clinicians who are making the phone calls are medical assistants, patient care technicians, or medical secretaries and not actual licensed clinicians. I doubt there will be a physician on the other end of the line to answer your questions.

There are also some interesting findings in the FAQs, including that Function is considered “beta” and is “not yet fully developed” and “there will be rapid changes with occasional bugs.” This would not be allowed in mainstream electronic health record or laboratory management software in this day and age. They try to absolve themselves through a disclaimer that they are a healthcare tech company and not a medical or laboratory provider, and that all the real work is done by independent third parties.

The FAQs also note that the company is jumping on the AI bandwagon and “aims to apply machine learning algorithms to your lab test results over time, in order to uncover things that humans are likely to miss.” Regarding privacy, the site notes that patients can delete their data and no personally identifiable information will be shared, but it doesn’t address any concerns about them selling de-identified or otherwise aggregated data, which I would bet they are.

Like the commenters on Mr. H’s post, I’d also like to see a copy of the clinical summary and how they interpret unnecessary tests. Maybe we should start a HIStalk fund drive to sponsor a reader to sign up in exchange for sharing their experiences throughout the course of the year-long subscription.

What do you think about Function? Is Matt Damon’s endorsement enough to lure you in? Leave a comment or email me.

Email Dr. Jayne.

EPtalk by Dr. Jayne 3/20/25

Google Chief Health Officer, Karen DeSalvo, MD, MSc blogged about six health AI updates that were recently covered at the company’s annual The Check Up event. Top on the list was “helpful health results in Search.” She notes that since the debut of AI Overviews, users are “asking longer, more complex questions” and states a goal that health-related overviews will “continue to meet a high bar for clinical factuality.”

It still surprises me when I hear my physician colleagues using Google to look up medical information compared to using a more validated healthcare-specific resource. I certainly wouldn’t want to be on a witness stand explaining where I got my information, as opposed to a peer-reviewed journal article or a national consensus guideline.

She also notes the release of medical records APIs in Health Connect, allowing systems to leverage core medical elements such as allergies, medications, immunizations, and lab results via FHIR. Another item highlighted is the company’s FDA clearance for the Loss of Pulse Detection features on the Pixel Watch 3. It can generate a call to emergency medical services if the wearer is unresponsive. It’s apparently been available in the EU and will roll to the US later this month.

Fourth on the list is an “AI co-scientist” that is intended to “help biomedical researchers create novel hypotheses and research plans” after combing through the scientific literature. Development partners include Imperial College London, Houston Methodist, and Stanford University. Not included in the writeup is the Oxford comma, which I have compulsively added to the list.

Fifth is TxGemma, which aims to speed AI-enabled drug discovery. The solution can manage text as well as molecular structures. I have zero experience with that technology, but it brought back not-so-fond memories of building hydrocarbons during organic chemistry, which represents eight college credit hours of my life that I will never get back.

Last on the list is a tool called Capricorn, which is designed to support the rapid identification of personalized cancer treatments through the integration of public medical data and de-identified patient data. It is supposed to synthesize the literature along with potential treatment options. It is being developed in partnership with the Princess Maxima Center for pediatric oncology in the Netherlands. It will be interesting to revisit these solutions in six, nine, or 12 months to see which of them show real promise and whether any of them have fizzled.

Another Google feature that wasn’t covered in the story and about which I am less than enthusiastic is the “What People Suggest” search feature that will allow patients to “search through online commentary from patients with similar diagnoses.” Patient experience is certainly important, and patients can be powerful advocates and support systems for each other. However, just because another patient with a similar condition was treated in one way doesn’t mean it’s the right treatment for another patient.

It’s a rare patient care day that I don’t see information patients have researched on the internet or from patient forums, and a good chunk of it is irrelevant to the patient in front of me. It takes a great deal of time to have these discussions with patients and quickly becomes untenable for primary care physicians who are carrying panels of thousands of patients. Patients become frustrated when they learn that treatments advocated by others may not be standard of care or in fact might be harmful. I wish we could spend some public health dollars helping patients learn how to better analyze the information they see on social media and the internet, but we all know there aren’t enough public health dollars as it is.

A recent article in Science reviews an AI tool that can evaluate blood samples and determine the likelihood of infections, autoimmune diseases, or the response to a vaccine. It looks at the genes that code for B and T immune cell receptors and was able to identify patients with COVID-19, HIV, type 1 diabetes, lupus, those recently vaccinated, and those who met none of those criteria.

I found immunology to be one of the most interesting topics in my medical school curriculum, although I struggled with it due to a professor who really didn’t want to teach students and made it clear he preferred to be in the lab. Discoveries like this might just make me want to learn more about it again.

Good news from a payer (for once): Optum Rx, which is part of UnitedHealth Group, has announced its intention to update prior authorization requirements for 80 prescription drugs. Although several news articles about the announcement used the phrase “remove prior authorization requirements,” it’s not exactly what it sounds like. From what I understand, the modifications planned will impact “reauthorizations,” which is where a physician has to obtain approval to continue a drug that a patient is already taking. This is explained in the press release with examples.

A “necessary” reauthorization might occur for “drugs that have safety concerns, need ongoing monitoring for dose adjustments, require additional tests, or may have alternative therapy considerations.” Those that will be reduced are for drugs where “there is minimal additional value in reauthorizing an effective, lifelong treatment.” They expect a 25% reduction in reauthorizations. No list of drugs was provided, so I wonder if they haven’t fully identified the list yet or whether they’re keeping it to themselves in hopes that some requests will experience attrition during the process because physicians are simply exhausted.

I enjoyed reading a recent commentary by NYU Grossman School of Medicine ethicist Art Caplan, PhD. He was reacting to Elon Musk’s request that patients upload copies of their medical imaging studies to help train his Grok AI solution. I often read Caplan’s editorial pieces and respect his straightforward take on issues. He notes that AI hallucinations are real, and “If you go out and take random information submitted by a subpopulation of people, not representative of everybody, you’re going to get many false findings.”

He goes further to discuss the perils of not knowing the attributes of a particular image, such as whether it’s accurate, the demographic characteristics of the patient, and more as far as being able to have training data where bias is mitigated. He also notes that there are no assurances of privacy for any images that are sent.

My favorite quote from his comments is this: “The last big issue is, why should we be doing this for free? Elon Musk is a gazillionaire. If he wants information, why doesn’t he go out and pay a representative sample of people to undergo tests, establish what a normal baseline looks like, and then try to explore what disease baselines look like? That’s what we need to have good automated technology to help diagnosis — and note that I said help it, not replace it. If there’s no baseline and people are just randomly firing in medical tests, you’re not going to have an accurate AI diagnostician; you’re going to have a mess.” Thanks for telling it like it is, Dr. Caplan.

What do you think of the idea of crowdsourcing medical images for an AI training dataset? Leave a comment or email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 3/17/25

In this week’s Monday Morning Update,  Mr. H launched a poll that asks about reader strategies to reduce the time spent in meetings that are less than productive.

After a couple of decades in healthcare IT, with many of those spent working on large and lengthy projects, I feel like I’ve attended more than my share of unproductive meetings. I can’t wait to see the poll results, but here are my recommendations for productive meetings (most of which are directly related to having high performing teams, so I’ll include those too).

• Consider making meetings shorter than standard blocks. I’m a huge fan of having 50-minute meetings rather than hour-long ones, or 25-minute meetings rather than half-hour ones. This approach provides attendees time between meetings to prepare and arrive promptly for the next.
• Start meetings on time with no apologies. One of my favorite hobbies is to calculate the cost per minute when people start “just a few minutes late to allow others to arrive.” I’m regularly in meetings with high-level executives and multiple external consultants where the burn rate is in excess of $3K per hour. Every minute counts in those situations.
• Be mindful of small talk and whether it’s good for your team dynamics. If team members are stressed about other projects or a previous meeting, odds are they may not want to hear about what everyone did over the weekend.
• Have an agenda before the meeting is scheduled. No agenda, no meeting.
• Distribute any key materials that will be discussed with the meeting invitation and agenda. There’s nothing worse than trying to read and understand things that are brand new to you while someone is also talking about them and presenting slides that may or may not summarize the concepts.
• Use time-boxed agendas to keep people on track.
• Assign specific meeting roles. including timekeeper and scribe. The latter can be outsourced to AI tools, although a human scribe should still proofread it and make any necessary corrections.
• For standing meetings with a designated set of regular attendees, consider creating a Team Operating Agreement that defines how the team operates and how it handles team members that either don’t participate or that tend do monopolize the meeting. This can enable the team to self-police and discuss when people aren’t interacting with the group at the expected level. Many of us hated group projects when we were in school, and having a Team Operating Agreement is often a good antidote to bad behavior.
• As you’re creating your Team Operating Agreement, be mindful of how you want to manage video calls and people who are not on camera. I’ve been in plenty of meetings where people have been called out for not being on camera and not in a nice way. As a consultant who has worked in dozens of organizations over the years, this can be a minefield. Maybe someone wants to turn their camera off to blow their nose, eat their lunch, or just decompress for a few minutes because they’ve been on for four hours straight. These should all be OK. If you’re concerned about someone being excessively off camera, address the issue privately.
• If you’re working across multiple time zones, there’s a good chance that you’ll be scheduling during someone’s typical lunch time. Consider identifying these as camera-off meetings to allow people to eat lunch without having to apologize about it. Back in the days when I was in an office full time at a health system ,we routinely had brown bag lunch meetings and everyone ate in front of each other, so it still feels a little weird to me that people have to apologize for taking care of a basic physical need.
• For meetings that are hybrid with some attendees in person and some remote, make sure someone knows how to operate the cameras and screens effectively so that everyone feels like they have the same level of participation and engagement. The same thing goes for telephones and audio hookups.
• For meetings where people are expected to deliver status reports, require them to submit those reports in advance and distribute them to the group along with the agenda (you might see a theme here). Then you can do a speed round of “any questions” and reduce the likelihood of conducting a meeting that should have been an email.
• If decision makers or required participants are not in the room, reschedule. Don’t waste everyone’s time going through an agenda if it’s all going to have to be repeated in a meeting after the meeting.
• Learn how to use your calendar’s scheduling assistant. If you need to send an invite outside someone’s typical work hours or when they have a conflict, ask them if they can shift their workday before scheduling the meeting. Even if you can’t accommodate an individual, the fact that you at least asked / discussed the issue goes a long way towards building a good working relationship as opposed to just sending people appointments at 4am in their time zone without any recognition of the fact that it might be inconvenient.
• If you’re going to do a presentation during a meeting, make sure you know how to share your screen and how to either enter presenter mode or how to share your slides through your meeting app. There’s nothing more distracting than watching a side deck being delivered by clicking through the editable presentation.
• Allow for a recap at the end of the meeting where action items and their owners are reviewed. This helps prevent surprises.
• Make corrected minutes / notes available within one business day, while people still remember at least some of the meetings they attended.
• Consider having “no meeting” blocks where colleagues have dedicated time to actually get their work done and honor these blocks like they are sacred. I’ve seen plenty of organizations put these events on their calendars and then schedule right over them, so it does take a certain amount of cultural commitment to actually make it happen.

There you have it, folks. It’s like a free hour of management consulting from someone who has definitely been there and done that. In the meantime, visit the poll and let us know how you tackle the issue of unproductive meetings. If you have a great story to share, leave a comment or email me.

Email Dr. Jayne.

EPtalk by Dr. Jayne 3/13/25

It’s rare for me to see patients without having at least some discussion about the cost of care. Patients usually want to know if the medication I’ve prescribed is a generic, or if they’re in a high-deductible health plan, whether it’s going to be cheaper if they use GoodRx or another discount program.

I trained in a place where generic prescribing was not only encouraged but expected, so many of these conversations are fairly straightforward unless I’m having to recommend a second- or third-line medication after others haven’t worked, or if I’m stuck prescribing one that I know tends to have coverage issues. Patients are becoming more financially savvy when it comes to healthcare costs, which is good considering that patients in the US borrowed $74 billion to cover healthcare costs last year. The US leads the world in medical bankruptcies, and according to recent data, nearly a third of patients are “very concerned” about the possibility of medical debt.

EHRs have become better at embedding data about drug pricing, sometimes putting it at the point of prescribing. This can be cool when implemented well, but when implemented poorly, it’s annoying. For example, if most of the medications that I prescribe cost less than $15 because they’re generic, I really don’t want to see warnings telling me that the drug is going to cost $6 or $8 or whatever it is. EHR-embedded data is also less than helpful when it doesn’t take into account things like deductibles or coinsurances or patients who have both primary and secondary insurance coverage. Maybe we can put some AI resources to work making that information more actionable and also more accessible.

The University of Michigan is planning to reach rural patients through the use of AI-powered mobile clinics. The aspirational goal is one where “general practitioners with AI help could make diagnoses, run and interpret tests, and perform procedures like specialists.” The project is in partnership with the Advanced Research Projects Agency for Health (ARPA-H) and would use vehicles “equipped somewhere between a doctor’s office and hospital.” Even without consideration of the AI element, the devil is in the details for something like this. What kind of lab services will be performed? Is it considered a moderate complexity lab? What is the location of service? How will regulators think about a facility that is constantly on the move?

Those interviewed in the article note that AI agents would “coach” physician assistants and nurses to performed more advanced procedures. I’d like to offer a wild solution to help increase the numbers of advanced procedures that are done across the US. How about we allow family physicians (MDs and DOs) to perform the procedures for which they were trained?

I trained in a high-acuity residency program and developed the skills to perform a variety of outpatient surgical procedures, endoscopies, and even C-sections. But there’s not a hospital in a 100-mile radius that would allow me to have privileges to perform any of those unless I’m a member of a residency program’s faculty. It seems that if we could leverage the skills that highly trained physicians are actually mastering during their training, we could help more patients without the expense of developing and implementing AI. Just a thought. But of course, AI is a lot sexier than allowing family physicians to operate at the top of their licensure, so there you have it.

I was excited to learn that progress has been made in having state licensing boards and hospital credentialing offices remove certain questions from their applications that raise the risk that professionals won’t seek mental health services when they are needed. The Dr. Lorna Breen Heroes’ Foundation has been instrumental in promoting this effort to reduce the stigma of mental health issues among licensed clinicians. The foundation honors the memory of Dr. Lorna Breen, a long time emergency physician who died by suicide during the spring of 2020 while serving on the front lines of COVID. Many of us were in very dark places during that time as well as during other points in our careers. Thank you to the foundation for working to make sure that physicians can get help when they need it rather than worrying whether they will lose their licenses.

I missed this article the first time through the inbox, but I was glad to have caught it later. An original investigation that was published in JAMA Network Open looked at “Clinician Experiences With Ambient Scribe Technology to Assist With Documentation Burden and Efficiency.” The study follows roughly four dozen clinicians at the University of Pennsylvania Health System during two months in 2024, when they were using the DAX Copilot AI tool. Interesting tidbits: while use of the tool correlated with improved efficiency, reduced cognitive burden, and improved patient engagement during appointments, there was “mixed feedback regarding the length and quality of ambient scribe-generated notes.” Some users noted high error rates, but it’s unclear if that has any association with clinician subspecialty since there were 17 specialties represented among the 46 participants.

Notes were about 20% longer, which isn’t always a good thing, although sometimes having more details can make the difference long term. Multiple clinicians felt that the time they spent editing the notes balanced out any time savings during the workday. One of the most interesting tidbits, at least for this data nerd, was that net promoter scores (NPS) were all over the map. Thirteen clinicians were promoters, 11 were passive, and 13 were detractors, leading to an overall NPS of zero. It’s certainly not the overwhelming victory that those who are paying for it were likely hoping for.

I’d love to see this kind of project reproduced in single-specialty cohorts, matching for patient complexity and other factors. I’d also like to see it done at more than one academic institution. Another study limitation was the fact that all participants opted in, which certainly doesn’t reflect how I see physicians embracing (or not embracing) new technologies in the real world.

Have you personally used ambient documentation tools, and what did you think of them? Leave a comment or email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 3/10/25

As a primary care physician and CMIO, I understand the importance of measuring things. We measure quality metrics, efficiency metrics, and various other factors to improve healthcare

During the early days of EHR adoption, long before the Meaningful Use years, I would encounter physicians who were against expanding the use of metrics in our physician group. We only had a small number of things we were measuring at that point – antimicrobial stewardship, appropriate testing for strep throat, patient satisfaction score, and a couple of other things. No more than five or six. However, physicians were concerned that we would start measuring a host of other things that would make their lives difficult, arguing that their patients were sicker and that having to demonstrate quality would detract from the care of those complex patients.

Fast forward a few years to the Meaningful Use days. The whole country was incentivized (or forced, depending on how you look at it) to start measuring many more elements. Fortunately, our EHR was long established and we were already delivering high quality care, so it was fairly straightforward to add a few metrics here and there to meet the regulatory requirements. We made sure as many processes were embedded in the workflows as possible and offloaded the vast majority of data capture to support staff so that our physicians didn’t become data entry clerks.

“I’ve seen the consequences when clinicians apply clinical guidelines to patients for whom they don’t make sense.. As we developed EHR training documents for upgrades and updates, I always made sure that we reinforced how clinicians can exempt patients or exclude patients from certain measures. Following the appropriate process in the EHR makes sure that providers aren’t penalized in the numbers for doing the right thing for a patient even though it sounds like it’s contrary to the guidelines. Usually, providers indicate a reason for the exclusion, which quality folks and researchers can use to understand why people aren’t being included in the measurements.

People ask how quality guidelines can be hurtful, so I’ll give an example. If you’re a patient who has had cancer, and who has had the offending body part removed, you need to be excluded from future screenings of that body part. If you no longer have a colon, you do not need a colonoscopy. I’ve been in enough patient support group meetings to hear stories that no one should ever have to hear, especially when there’s an easy way to make sure they don’t get reminder messages that add to their trauma.

This is important for organizations to understand when they are designing the reports that generate these reminders. There are ways to not only look at the exclusions, but also to look at elements of the patient’s history to reduce the risk that you’re prompting patients for services or tests they don’t need.

Guidelines that are applied too strictly can also cause patient harm in other ways. I was visiting an elderly relative today at her independent living community to drop off a prescription that was missed by her usual delivery service. She mentioned that she had been eating her meals in her apartment, which is a departure from her usual pattern of going to the main dining room in the evenings. She has had intermittent issues with social isolation since being widowed, so I wanted to find out more about what was keeping her from going to eat with her friends.

It turns out that her primary care physician doubled one of her diabetes medications, resulting in some digestive distress that’s worrisome enough to keep her in her apartment. I asked what her diabetes numbers looked like and we took a trip into her patient portal, where I confirmed that her hemoglobin A1c had indeed gone up, representing higher average blood sugar levels over the last few months.

Her last visit note, which was clearly captured using ambient documentation, noted the fact that she had consumed a three-pound jar of peanut M&Ms between Thanksgiving and Christmas, likely leading to elevated blood sugars. Bonus points to the ambient solution for capturing many of the details, as my relative is certainly a talker.

However, the note also contained what I would describe as a mini-lecture about “the importance of tight glucose control in preventing the 10-year complications of diabetes.” I thought that was funny, because this patient is just a few years shy of 100 and has had negligible complications of her diabetes, which is of fairly recent onset. She’s as healthy as a proverbial horse from a physical standpoint, but she’s at real risk for worsening depression, which has made her nearly housebound in the past.

I know her primary care physician personally, having trained him on his first EHR a decade ago, but it made me wonder a bit about what he is thinking with her care. Is he just following algorithms to drive that hemoglobin A1c to goal come hell or high water? Or does he not have a lot of experience with nearly 100-year-old patients who have different risk/benefit profiles than younger patients? Does he know that driving blood sugars too low is a much bigger risk in her age group? Does he not see depression as a risk factor in the same way that her family does? Does he see patient values and preferences as part of the decision-making process? And if they had a risk/benefit conversation and she declined to take the higher dose of medication, would he know how to adjust things in the EHR so that his paycheck won’t be impacted by her lack of tight glucose control? Having worked in the same system for years, I know how to do the exclusion, but suspect he might just be running a bit on autopilot.

My relative and I worked together to send a patient portal message to the care team outlining her symptoms and the fact that she’s been essentially isolated since the medication change. I’m glad that I’ll be able to follow along with any replies and adjustments in the portal. We joked about the situation with the peanut M&Ms, and I suggested that maybe she should fill a separate pill box with her daily ration of treats so that she can enjoy them, but not overdo it. I hope that I’m doing as well as she is if I make it to her age, but it’s important for her to be able to enjoy every day since the next one isn’t always promised.

If you make it into your 90s, what food would you use to treat yourself regularly? Leave a comment or email me.

Email Dr. Jayne.

From HIMSS with Dr. Jayne 3/4/25

Although Monday had been overcast, Tuesday dawned clear and cool but without the winds of the weekend. After declining the $14 croissant at my hotel, I found a nearby Dunkin where I could satisfy my sweet tooth via a donut with spring-themed sprinkles. It was a quick walk to the convention center, and from what I understand, that took about half the time that it took to arrive on the HIMSS-sponsored shuttles.

I had a chance to visit with Edifecs #2451about their #WhatIRun campaign. This year’s shirts feature Audrey Hepburn. I enjoyed hearing about the company’s efforts to empower women in the workplace and around the world. They’re a friendly bunch and great to talk to, so be sure to drop by.

From there, I was off to meetings with clients and prospects. I made a few key introductions that will hopefully turn into future engagements. Although organizations have been fairly conservative in their spending lately, they are realizing that optimization and adoption projects have value, and if they are able to keep physicians from burning out, the cost savings can be enormous. As a boutique consultancy, I’m significantly more cost-effective than the big firms, so hopefully that will resonate as well.

The day was also full of booth visits. I thoroughly enjoyed my visit at PointClick Care #3454. Their rep, Tasha, is an emergency department nurse who clearly gets it as far as understanding how their solution can play a role in healthcare. The demo data they were using sent me right back to the days when I was working in the ER. She also was able to banter back and forth with my physician colleague even though we took her well off script, which is refreshing to see. Their demo data was great with a realistic portrayal of the patient journey, rather than a sanitized one, and I was glad to see their level of detail. It’s a slick solution to help clinicians understand where their patients might be seeking care other than with them. If you’re in the market for a tool that can bridge across disparate EHRs and other data sources to help you get a single picture of the patient, it’s worth a look.

If you’re less interested in tracking your patients outside of the hospital and more interested in knowing where they are within your brick and mortar establishment, I enjoyed learning about Kontakt.io #2250. They have what I can only describe as an RTLS on steroids, with the ability to track patients, staff, equipment, or any other assets using a variety of disposable or durable sensors. It made me reminisce about my days performing hospital rounds, when you could never guarantee the patient would be in their room and sometimes had to go back multiple times during the day to try to find them. The idea of using AI to take that RTLS data and do things like creating intelligent rounding lists has huge potential. Props also to the booth team that was clear, concise, and hospitable as they invited us to step out of the aisle and onto their plus carpet, which was much appreciated since we were well into a long day.

The footwear game was strong in the exhibit hall. I was envious of these animal print kicks.

Lightbeam Health had new corporate hosiery.

Relatient snuck in with a sharp shoe/sock combo.

Ultimately, however, the team from IMO won the day with this amazing entry.

I was happy to see sponsor CTG showing off their HIStalk credentials.

I found a corner of the exhibit hall that had edgier clinical solutions than I’m used to seeing at HIMSS. I declined the offer to stand barefoot on the body water analysis sensors even though they were being wiped down between patrons.

This vibrating light therapy cocoon was enticing, but I again took a pass.

Dr. Nick van Terheyden @drNic1 was brave and took the plunge in a red light therapy bed. He and I had a great time strolling through the booths looking at things like smart medication boxes to better enable remote patient monitoring, and of course, all things AI.

We were both impressed by the rep from Lightit.io, who engaged us and drew us into a conversation. It’s good to see sales pros on the floor. I liked their kicky luggage tags, which was the only piece of swag I picked up today.

The best booth of the day, however, was this one that was populated only by a screaming fax machine. It was attention-grabbing and nostalgic at the same time.

The day ended with some in-booth happy hours, and after that, I was ready for rest. Hopefully the rest of the trip to HIMSS will be as productive as Tuesday was.

From HIMSS with Dr. Jayne 3/3/25

It was a chilly opening day at HIMSS, punctuated by high winds and a splash or two of rain. The check-in process was smooth for those of us who had our barcodes at the ready. This year’s conference bag is definitely on the smaller side, with my hand model noting that it would probably make a good lunch bag.

Temperatures were in the low 60s, and people were fairly bundled up for the outdoor opening reception. HIMSS is under new management and the opening event wasn’t its finest effort from a food and beverage standpoint. Offerings were minimal (sliders, spring rolls, hummus cups with vegetables that weren’t long enough to scoop the hummus) and ran out early. Napkins and utensils were nonexistent.

Lines were long and the buffets frequently ran out of food, waiting for staff to bring more trays. Having worked as a “cater waiter” in a past life, it’s easier to work an indoor conference space because there are usually access hallways that let you replenish food from multiple points. In this arrangement, staff had to wade through the crowds to bring food to the buffets and could only do so from one side of the venue.

The entertainment consisted of circus-type acts and a band, which was good but so loud you couldn’t have any kind of sustained conversation despite the outdoor location. The hula hooping dancer was good, as was the performer in the mirrored suit balancing on a giant ball that he rolled throughout the venue.

As the evening unfolded, it became apparent that there weren’t enough trash receptacles or bus trays for people to drop off their plates, so they were piling them up underneath serving tables and on lighting stanchions. It felt more like a trip to the ballpark than a professional networking event. It’s a good thing the entertainment was solid because that distracted people from the fact that the food serving tables were broken down before the reception was even over.

Overall, I give the event space (which was basically a large concrete patio adjacent to the High Roller observation wheel) a B-minus and the food and beverage a solid C.

A reader shared this pic from inside the exhibit hall during setup. It looks like Epic’s iconic hanging butterfly artworks travel in style. I’ve been backstage at other trade shows but never at HIMSS, and from what I understand it’s a mammoth effort to get it all together. Can’t wait to see it in person tomorrow!

Email Dr. Jayne.

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.

EPtalk by Dr. Jayne 2/27/25

I’m deep into my HIMSS prep this week, figuring out what vendors I need to visit and of course which booths will be having the best happy hour offerings. I was excited to see that my friends at Edifecs will be running their #WhatIRun campaign again this year. The initiative highlights all the things that women “run” in the world, whether it’s meetings, departments, companies, projects, or carpools.

Especially for those of us in healthcare IT, it’s important to remember that women play a role in 80% of all healthcare decisions made, but only fill 19% of C-suite roles in healthcare IT organizations. If you’re at HIMSS, stop by and see them in booth 2451. If you’re not able to attend, share your story with the #WhatIRun hashtag and Edifecs will donate $1 to the brightpink.org in efforts to focus on women’s health.

I also downloaded the HIMSS app today after receiving notifications via email about people who were messaging me through the HIMSS platform. I get what they’re trying to do with their one-stop shop for communications, but it’s annoying. I don’t have time to keep up with appointments coming in through email, text, and now from the HIMSS app. I wish that colleagues would just stick with whatever usual method we use to communicate if they want to reach out about a HIMSS meeting. I live and die by my Outlook calendar, which is the single source of truth for where my body needs to be and what my mind needs to be doing at any given time.

I was interested to see that the HIMSS opening reception is being hosted at an outdoor venue this year. Although hopefully it will make for easier chatting than the traditional “try to yell over the music and entertainment in a cavernous ballroom” experience, the forecast for Monday is looking cloudy and cool. Temperatures for the rest of the event will runn mid-40s to mid-60s for us Fahrenheit-using folks.

Other than including comfortable but sparkly shoes that I’ve had picked out for weeks, I have no idea what I plan to pack. A fair number of my customers have adopted the low-key tech wardrobe with jeans, sneakers, and fleeces or other jackets. Several still tend to wear full business dress. We will have to see what inspiration the closet and the forecast give me. I think nostalgically about the days in my past life when I could just wear scrubs and running shoes every single day and no one batted an eye.

I’m still digging through the lists of sessions and presentations to figure out where I’ll be spending most of my time. I’ve long complained about the length of the lead time for HIMSS educational presentations, which results in the risk that content is outdated before it ever gets presented. I’ve identified quite a few good sessions to add to my list, but unfortunately, it seems like there are several good ones that are scheduled at the same time and then long gaps without anything in which I am particularly interested. I bought the cheapest badge this year so I won’t be getting the on-demand versions, but in the past, the quality has been low so it seemed like the right decision at the time.

Pet peeve of the week: One of my consulting clients asked me to sit in on a vendor demo this week as they begin the process to solve a pesky business problem. We were minutes into the demo when the sales rep bungled a couple of industry terms and company names. Rule of thumb: if you’re going to name drop, make sure you know how to pronounce the names of companies and products that you’re citing. If you’re going to use clinical terminology, make sure you are able to pronounce the words. Appearing as if you don’t know what you’re talking about is one of the fastest ways to lose credibility during a pitch. There are plenty of references out on the interwebs to help you learn how to pronounce pesky words. And for company names – if you’re in doubt, pronounce it the way the CEO says it. YouTube is your friend here.

A friend of mine who knows I’m a clinical informaticist but also knows I’m a huge fan of reading sent me this interesting piece on the intersection of ChatGPT and literature. It reviews recent work that looked at whether GPT was better at reproducing the style and tone of male authors than female ones, as well as follow up work that looked at other attributes of GPT-generated writings. The authors ultimately looked at 10 well-known 19th-century authors including Jane Austen, Louisa May Alcott, Charles Dickens, Mark Twain, and others. A generative AI tool was asked to create new works in the style of each. The authors noted that prompt writing was somewhat challenging, but were able to move forward. They also identified ways to classify the writings based on sentence length, selected words, and other factors.

Ultimately they were able to develop a model that was 99% accurate in identifying synthetic versus author-created texts. Interestingly, they also found that GPT was surprisingly good at imitating Mark Twain, which a higher proportion of synthetic writings being mischaracterized as authentic. The researchers plan to explore this further in a future phase of the project, but hypothesize that the phenomenon was caused by the fact that there isn’t as much Twain-adjacent material online compared to the other authors. Hopefully my friend will keep an eye out for the future research since it’s nearly impossible to keep up with everything going on in the world of GPT.

I recently completed a series of novels that seemed to have a break in the middle where it felt like a ghostwriter stepped in and the editors were AWOL. Characters changed names, plot elements morphed, and there was a lot of confusion. Was it GPT or just sloppy writing and editing? I wasn’t the only one who noticed the change, based on some online review sites. We may never know, but the idea of GPT did cross my mind.

Would you want to read a GPT-created novel in the style of one of your favorite writers? If so, what writer would be on the top of your list? Leave a comment or email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 2/24/25

I’ve written previously about the cost of healthcare and health tech conferences and the need to make sure that attending is worth your while. I skipped ViVE in favor of HIMSS primarily because more of my clients or potential clients will be attending HIMSS and it’s a great way for me to have in-person meetings without having to fly across the country.

Still, it’s a substantial investment from both a monetary and time management standpoint. I usually stay at the Palazzo when HIMSS is in Las Vegas, but I went with a more cost-effective option this year even though it’s a bit of a hike to get to the convention center. I’m sure I’ll be questioning that choice when I’m walking 10 miles a day, but my accountant will be happier. I’ve already mapped out the best way to make it to the sessions without having to walk through a smoke-filled casino, so that’s something especially since my route takes me past a spot where I can grab some gelato if I need a boost.

A reader recently asked Mr. H his thoughts on the value of attending health tech conferences as a frustrated patient. He provided a summary of why it might not be the most productive way to advocate on behalf of patients, and I agree with his points. However, I’d like to add a few thoughts of my own for people working on the vendor side:

Although patients aren’t your target market since they’re not paying your invoices, they should be part of your product management and development processes. Similar to the patient and family advisory groups that many care delivery organizations have, they could provide valuable insight into whether the features and functions you’re planning are going to hit the mark or whether they’ll just result in spending that doesn’t move healthcare forward.

If one is going to spend a decent chunk of change enhancing your product, doesn’t it make sense to deliver the best value possible so you don’t have to revise it in the future? I don’t always trust the provider organizations to really understand what patients need, nor do I trust them to understand what their staff needs. I’d be out of a consulting job if they did this well in the first place, but I’m happy to educate them.

There need to be better ways to make sure your customers understand what new features were intended to do and how to implement them in a streamlined fashion. There also should be better incentives to help your customers use things properly. Consultants have made a tremendous amount of money coming through after a botched implementation and reworking things so that workflows are effective and efficient.

Unfortunately, there are some oddities in certain EHR software that if you don’t do it right the first time, it’s nearly impossible to correct. Anyone who had to work with the McKesson Horizon orderable pick lists, which displayed in the order in which they were built and had no mechanism to reorder, knows what I’m talking about. If you’re a vendor who still has content like this, please, for the love of all things, do something about it.

Although I agree with Mr. H’s comment that software vendors can’t fix the problems that are inherent with our dysfunctional US healthcare system, I do think that vendors can benefit from understanding how that system impacts patients, clinicians, and other users of the systems they produce. Understanding the baseline level of frustration experienced by users can help influence intuitive design as well as features and functionality.

I’ve been in this industry a long time. I’ve seen how the attitudes of my friends who are on the product management and development sides of the house have changed now that they’re older and have had more encounters with the healthcare system. It could be a little thing, like making sure that an error message is helpful and informative versus obnoxious and interruptive, that makes a difference in a user’s day.

The healthcare industry needs to do a better job of addressing the needs of frustrated patients, regardless of whether they attend a conference. I had an absolutely awful experience at a local institution last fall, complete with HIPAA violation. I returned a scathing response on my patient satisfaction survey and checked the box requesting a call from someone at the officel. I never heard from anyone. I also sent a letter to the departmental administrator, with zero response.

Want to know how I finally got a response? By taking the solicitation card from their annual alumni campaign, writing “no donation this year due to poor care at the institution,” and mailing it back in the business reply envelope. Patients shouldn’t have to resort to that in order to get attention.

Over the last several years, I have seen more people attending conferences in the role of patient advocate. Although some may be merely symbolic, others are using the opportunity to shine a light on what really happens in the industry and to raise awareness of chronic conditions where technology can really have an impact, such prenatal care and treatment of mental health. I would be interested to hear more from patient advocates that attend conferences to learn about their strategies for trying to drive change. Individual patient needs and opinions may not drive markets, but if you had strong advocates representing large cohorts of patients, we might see the needle move, even if it’s just a little bit.

In talking with some of my industry colleagues about their HIMSS plans, it sounds like many of them have cut back on their booths this year. Many have booked private meeting rooms in which they can meet clients, while others are just planning to be in town and host lunches and dinners to meet with prospects and customers but still save on costs.

I tried to look up the pricing for a 10×10 booth and it looks like you can’t see it directly on the website this year. Instead, you have to talk to the HIMSS25 sales team. I noticed on the exhibitor page that they’re listing 26,800 registrations under the Attendee Highlights section, which is a far cry from the HIMSS heyday when we used to see more than 40,000 people in attendance. When you’re a health system running at a 1% margin, it’s easy to see how conference budgets aren’t a priority.

What are your HIMSS plans, and how have they changed from previous years? Are there any particular sessions to which you are looking forward? Leave a comment or email me.

Email Dr. Jayne.

EPtalk by Dr. Jayne 2/20/25

As someone who has been practicing medicine via telehealth since pre-pandemic days, sometimes I am placed in the wise elder role and asked to explain how things started and how they came to be the way they are. It can be a bit of a journey down memory lane, but then again, everything changed when COVID arrived and telehealth will never be the same.

Although large healthcare delivery organizations see telehealth as an extension of what they are doing in brick and mortar facilities, players in the direct-to-consumer space have dramatically shifted the options that patients can choose from in their quest for prescriptions and other services. In my own practice, I’ve seen it shift from being a partnership between physician and patient to being a transactional consumer activity where an outcome is expected and the patient/consumer becomes irate if they don’t get exactly what they think they need.

This is often frustrating to physicians who are new to third-party telehealth and thought it would be an easy way to pick up some extra money while making use of the medical license they spent hundreds of thousands of dollars in tuition payments to acquire.

I was in an online physician forum the other day and this topic came up. A physician was asking what it’s like to work for one of the direct-to-consumer companies that is well known for prescribing medications for erectile dysfunction. The company has added pre-visit questionnaires to gather information, often with somewhat leading questions that coach for patient answers that will generate a prescription. It’s a win-win for profits since the company is selling the medications as well as the professional services.

In some states, clinicians don’t even have to interact with patients in real time. They can treat them based on the equivalent of a one-way message. The medical board of a neighboring state has disciplined dozens of physicians for this since it’s not allowed in their state, but that doesn’t seem to have dissuaded people from doing it.

It always amazes me to see physicians who have no idea what is going on in their own industry and have little visibility beyond their personal practices. I found a recent article about the phenomenon and shared it to the forum. It was clear based on the comments section that people were having their minds blown.

One of the facts from the piece that drew quite a bit of attention was that together, three well-known telehealth companies spent more than $1.5 billion on advertising, sales, and marketing in 2023. Physicians in the forum also had no idea that direct-to-consumer telehealth companies were getting into clinical conditions that involve more complexity, such as mental health or obesity.

One of the physicians in the forum is the chief medical officer at an online weight management program. It works strictly through payer-based contracts and provides a multidisciplinary care team to address patients’ varying needs. She shared horror stories about patients who came to them after being seen at more commercial enterprises, where patients were basically told to use the medications that were shipped to their doorsteps but weren’t given any other counseling or support.

She made some great points. It’s not just that the treatments are ineffective, but that in some situations, they introduce side effects, including metabolic abnormalities that could have been avoided if a more thorough evaluation were performed prior to treatment.

Patients don’t always understand the knowledge and experience that is behind why physicians do or do not recommend a treatment. That’s especially true when they have seen dozens of influencers and paid spokespersons tell them exactly what they “need.” They don’t know the difference between one obesity management telehealth company that only hires physicians who have extensive formal training and years of experience in weight management versus another that is willing to onboard any licensed provider who willing to sign on the dotted line and accept $20-$30 for writing a prescription and a brief chart note.

The article has some great comments from Ateev Mehotra, MD, MPH, a public health professor who focuses on telehealth. He describes the transition from patients who work with their physician to make a treatment plan to a situation where the patient makes their own diagnosis and consults a transactional service whose clinician is a screener who is paid only to make sure that the medication is safe for the patient. That’s the lowest possible expectation for healthcare.

Not to mention that “safe” is a relative term. Is it safe because it probably won’t kill you? Or is it safe because you aren’t likely to have complications that dramatically impair your quality of life, whether briefly or for a longer period of time?

The article mentions situations where a screening-type approach might make more sense, with one of them being the provision of reproductive health services. Especially in states where it might be difficult to obtain reversible contraception, those services can be popular.

For medications that are over the counter in many other nations but remain prescription-only in the US, it’s easier to see that the risk/benefit equation for certain drugs might tip in favor of more streamlined access. I don’t have the statistics in front of me, but would bet that for many healthy non-smoking females in their 20s, the risk of morbidity and mortality from oral contraceptives is likely less than that of pregnancy, given the current state of maternal and infant health in the US.

I’m looking forward to seeing how the conversation unfolds over the next couple of days, which is about the typical length of time one of these threads survives. I’ll certainly make note and share if there are any particularly thought-provoking comments.

I enjoyed reading Mr. H’s recap of one of the Donors Choose grants in which reader donations provided microphones and speakers for a classroom in North Carolina. In addition to students being able to hear their teacher and peers clearly, learning how to use a microphone properly is a life skill that everyone should have.

Conferences that I’ve attended usually have microphones distributed throughout the audience to ensure that people can be heard when they ask questions. Invariably, at least one or two people will declare, “I don’t need the microphone.” They try to talk loudly, but don’t succeed, or they inadvertently sabotage the recording or broadcast for attendees who are not in the room. Some hold the microphone too far away from themselves or place it right up against their lips, both of which are never great for the audience or others who actually would like to hear what the speaker is saying. Hopefully incorporating those skills into the school setting will pay dividends for those students down the road.

If your organization expects you to confidently approach the microphone, do they provide any instruction in how to effectively do so or to avoid the dreaded screechy feedback? Or do they just hope you were a member of the A/V club in high school or that you channel your inner rock star? Leave a comment or email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 2/17/25

I spent some time this weekend doing something that I’m sure many techie readers have done at least once. I supported an elderly relative who was having technology issues.

My particular relative is in her late 90s and still lives fairly independently, which is impressive in itself. Even more impressive is the fact that she understands the value of the internet in helping her stay connected with the rest of the world, especially as she describes it, “now that my friends who actually used the telephone are all dead.”

We’ve seen plenty of data on the fact that older people do indeed use technology, and we know that utilization numbers are growing as the population ages. Still, actually spending time with someone who is nearly 100 years old and watching them interact with technology was particularly educational.

She called me initially to say that she thought she had a virus on the tablet she uses for internet access, Based on her description, I knew it would be easier to just go see what was happening myself rather than trying to figure it out over the phone. For some of my other older relatives who primarily use PCs and laptops, we’ve installed remote access solutions so we can troubleshoot when they have issues, but I have exactly zero experience doing remote access on tablets.

I had a couple of thoughts about how I could help her, including doing a factory reset on her device versus buying a newer tablet versus replacing it with something else like a touch screen laptop. I’m not a fan of tablets because I think the user interface is clunkier than what you get on a Windows interface, plus the ability to install remote access software would be a plus. Like many older people, she’s significantly hard of hearing and also has a tremor, which can make it interesting when the user interface requires fine motor control. I packed a bag of different devices and headed out.

The first thing I identified was the fact that she actually has two tablets, although it was initially unclear why she needs two or how she decides which one to use. Seeing them jogged my memory, as I remembered hearing about this from another relative who had  helped her manage two email accounts and two Facebook accounts. She didn’t understand then that accounts can be accessed across different devices, so she had just made new accounts when she got the second device.

I asked her to show me how she uses each one and what kinds of sites she accesses with them so that I could see it for myself and not make any assumptions about her technology needs. As I watched her, we had some good conversations about how Facebook actually works and the fact that it primarily exists to make money off of people’s viewing habits, by way of explaining why her feed was entirely clogged with junk and not things she actually wanted to see.

In addition to social media, she’s a fairly heavy user of MyChart, which always impresses me. She gave me access to her account many years ago so I could help explain some of her lab results. Although Epic has proxy functionality, she prefers that I use her login and password.

That made sense once I saw her password management system in person. She uses an old Rolodex to keep track of her passwords, with a card for each website or app. Thank goodness she doesn’t write down her usernames right next to the passwords, but still it was enough to make me cringe. She writes down new passwords when she changes them, but doesn’t always cross out the old ones, which added to the adventure as I was trying to gather all of her important information in case we had to do a factory reset on her devices.

It was interesting to see the password choices of someone in their 90s, especially for sites that require some degree of complexity. I laughed when I came across a password of “OldLady” plus her age to satisfy the numeric requirement of her last password reset. There were plenty of passwords with names of people who I’ve never heard of and also words in another language. I was glad that I didn’t see “Password123,” the name of her late spouse, or other easily guessed options. We talked a little about how the Rolodex probably isn’t a great idea unless she’s willing to keep it in her lockbox, but I made a note to myself to explore password manager solutions for tablets.

One of the issues that she was having with the tablet interface was not being able to unsubscribe to emails or easily mark them as spam. As a Windows user, I can see clear links in the different email clients I use. For her, she would need to press and hold on the screen to get a dialogue that would allow her to do this, which was difficult given her motor abilities even though she is using a stylus.

She agreed to let me access her email from my laptop so I could rapidly clean up her inbox and take care of a lot of junk mail. As we began that process, I discovered how difficult it is when you don’t have a smart phone and systems want to text you a code to confirm that you are logging in on a new device. Although some of these platforms also allow you to receive a phone call for a verbal code, you can imagine the comedy of errors that ensues when the person is using a landline and a telecommunication device for the deaf to receive her phone calls.

After clearing up her primary problem — which was annoying popup ads that were being generated by a solitaire game that she didn’t remember installing — and working to clean up her tablets, we decided to send the older one to the next electronics recycling event to reduce any future confusion. Now that we had her back in action with a device she knew well, I decided to forego auditioning new devices since I have good hopes that we can probably get another six months of use out of this one. No need to upset the proverbial apple cart if we have something that meets her needs. I know from experience that the future value of a problem can sometimes be worse than the current value of a problem, but I’m willing to play the odds on this one.

The experience was a good one to remind me that although many of the elderly have access to technology, they may not understand how it works or how to stay out of trouble when they’re online. It also gave me a new appreciation for people with mobility and sensory challenges who are trying to access technology platforms. That will give me some things to think about the next time I have to write scripts for end user testing. I’m glad I could help her and she treated me to an ice cream at the end, so you can’t go wrong with that.

If you work for a technology vendor, do you consider the needs of the elderly or those who have additional needs as you design your solutions? Leave a comment or email me.

Email Dr. Jayne.

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.

Curbside Consult with Dr. Jayne 2/10/25

I attended a regional medical society meeting this week where the agenda was entirely taken over by physicians who are concerned about the fallout from the recent deluge of executive orders. The American Academy of Pediatrics and other groups have called for the restoration of federal health information online. Two of my former colleagues have spun up a website that hosts archived copies of the missing and edited documents so that clinicians don’t have gaps in the resources available to treat patients.

Since our part of the country is chock full of research institutions, there was also concern about the National Institutes of Health slashing research funding, with concerns about the larger economic impact of immediate funding changes. Most of those who are speaking about the topic understand that while the way research is funded needs to be reformed, yanking the rug out from under research institutions with no warning isn’t the way to go.

Others were concerned about potential cuts to Medicare and Medicaid and the devastating effect that would have on patients who already have trouble getting care because physicians are opting out of those programs due to low payments and attached federal and state penalties. The wait in my area for subspecialty care for a patient on Medicaid is usually anywhere between nine and 18 months. That assumes that the clinics, which are usually teaching clinics that are affiliated with the local medical schools, even agree to put a patient on a wait list. I was impressed by the number of physicians who normally don’t speak out about that topic who were engaged in the conversation.

There were plenty of other concerns, but as I listened, I realized one significant fact: this was the first medical society event I’ve been at in the last 20 years where no one has complained about EHRs, insurance companies, or hospital administrators making decisions that negatively impact patient care. Usually at least one person tries to bend my ear about EHRs or government incentive programs. I had to conclude that there is finally something that physicians detest more than computers, which really says something.

I was catching up on some email this week and had a note from a friend in Colorado, who mentioned that her state lawmakers were again proposing legislation to explore the potential of developing a statewide universal healthcare payment system. The proposed legislation calls for the Colorado School of Public Health to examine a model for a system with a single payer that is designed to be non-profit, publicly funded, and privately delivered. The School would have until the end of 2026 to complete the analysis detailing costs, benefits, and impacts on residents, care providers, and the healthcare industry in general.

The review would also examine how such a system might coexist with current federal and state requirements involving the Affordable Care Act, Medicaid, and Medicare. It will be interesting to see if it passes and if so what the analysis yields. Colorado readers: what are your thoughts on this? Does it have a chance to pass?

I’ve mentioned this before, but I really dislike it when publications promote a link to what appears to be a news article but then turns out to be a video without any kind of transcript. I was lured to an article about new things planned for HIMSS25 only to find a video interview with HIMSS CEO Hal Wolf that included neither captioning nor a transcript. I wonder if HIMSS has thought about the message this sends – that those who require captioning or written communication aren’t valued. Although I don’t require written communication, I definitely prefer it because I can read faster than I can listen to the talking heads of HIMSS TV,  so I guess my needs and preferences aren’t respected either. Especially in the age of AI transcription, there is no reason to have a video without captions or a transcript. Do better, HIMSS.

The Super Bowl is now behind us. I am aware of at least two health systems that dropped significant amounts of cash on ads. NYU Langone Health had a spot championing the idea that “Better Health Starts with a Better Health System,” while MUSC Health ran a commercial focusing on heart and vascular care.

I don’t know the details of the advertising agreements, but I would hope that these were just local ads, which are lower cost than national ads. That would still be an outrageous amount when you consider how much preventive care could be delivered for the same amount of money. The Washington Post offered a list of “best, worst, and weirdest” commercials that was paywalled, but I know I can count on the folks I’ll be on calls with tomorrow to share their ideas about what was the weirdest thing they saw.

My personal favorite ad was the one for On sportswear, where Elmo debated the merits of the logo with tennis great Roger Federer. Elmo said what a lot of us are thinking, that the logo looks like a Q and a C. You can always count on Elmo to have a positive message, so he closes by saying, “Elmo loves you, Mr. Roger Federer. Even if you don’t know your alphabet yet.” Elmo has been a public health ambassador for years, teaching about germs, handwashing, covering your cough, and the importance of preventive vaccines.

I’m not a huge fan of NFL football given the negative health impacts of the sport. However, I do enjoy getting together and sharing food that is usually delicious although not typically heart healthy. Still, I’ve never seen anyone shamed for their food choices as a Super Bowl party and there’s usually at least one green vegetable present in my area, even if it is in the form of celery served with Buffalo chicken dip or wings. I was happy to contribute some baked goods to the effort this year, trying a new recipe and bringing home an empty plate, so I didn’t end up eating the whole thing myself.

What’s your favorite game day food? Leave a comment or email me.

Email Dr. Jayne.

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.

Email Dr. Jayne.

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.