EPtalk by Dr. Jayne 12/4/25

This week’s encounter with Big Health System brought additional frustrations, along with a profound desire to sell them consulting services.

My appointment was scheduled with a nurse practitioner. It was supposed to be set up with a link to an imaging service. The plan was to see the provider first, then have the imaging, then go back to the provider.

When I stepped off the elevator, I had my choice of two check-in desks, one for the provider and one for the imaging department. Since my appointment was with the provider, I went there first. I was told that I needed to go to the imaging desk, where they checked me in and then sent me back to my original stop.

I had to check in again even though I had already done an online check-in. They sent me to a high-tech waiting room that has an electronic board that displays the names of providers who are in clinic that day.

I thought it was odd that my provider wasn’t on the board, but I’ve seen an electronic glitch or two in my career, so I didn’t give it much thought. I realized when I was taken back to the care area that they were going to take my vital signs in a centralized vital station that was right across from the checkout desk and also adjacent to the door. Everyone can see what is going on with everyone else.

Many of us Midwesterners dress in layers because of snow. I was glad that I was wearing a short-sleeved T-shirt under my sweater instead of a long-sleeved version. Otherwise, I guess I would have been wrestling half my body out of my shirt for all the world to see. At no point did the medical assistant ask if I had a suitable garment underneath before asking me to expose my arm, which would have been considerate from a patient experience standpoint.

Medication reconciliation was performed in the open in front of two other patients. That is a patient dissatisfier in my book.

I was taken back to an exam room. I was told to gown up and that “the physician assistant will be right in.” I asked if they had the right provider on the chart since I was scheduled to see a nurse practitioner who I had seen previously. They told me that she wasn’t there that day.

You can bet that as soon as the assistant stepped out, I checked the patient portal. Sure enough, the appointment was still listed as being with the nurse practitioner.

When the physician assistant arrived, she didn’t mention the scheduling change. She seemed surprised to hear that I was scheduled to see someone else. Knowing what I know about electronic health records, this shouldn’t have been a mystery to anyone, because schedules don’t just spontaneously morph. Regardless, with a day off work and a long commute to the center, we forged ahead.

Afterward, I was told to go to a check-out desk, where no one was present. I could see through a pass-through to the other side, where a staffer had her back to me. She didn’t acknowledge me when she finished with her patient. I walked through, only to find three people in a line that I couldn’t see from where I was told to wait.

I didn’t know if they were ahead of me or behind me in line, so I headed to the back. That side of the office was a mirror-image layout of where my intake occurred. Everyone could see and hear everyone else’s business as patients were brought in, had vitals taken and medication reconciliation performed, and were checked out.

One bright spot in the visit was that while I was waiting, one of the medical assistants walking by said, “Is that you Dr. J?” She turned out to be a former member of my team from the urgent care trenches. I enjoyed seeing the photos of her children that she had on the back of her badge and catching up while I waited.

Ultimately I made it to the check-out desk. The staffer was hidden behind dual monitors with no ability to make eye contact with the patient. She proceeded to schedule follow-up appointments without confirming whether or not they worked for my schedule. I suppose they assume everyone just drops everything for an appointment at that esteemed institution.

She also let me know that they were in the process of implementing “ticket scheduling” via the EHR. She said that I would receive a notice to schedule follow-up imaging, but advised me to ignore it because it would be automatically scheduled as a linked visit with my next provider appointment.

My read on that is that the EHR team doesn’t quite have everything as buttoned up as it needs to be. Or, whoever designed the scheduling protocol doesn’t understand that some clinics have linked imaging needs that aren’t suitable for patient self-scheduling.

I have multiple EHR certifications, I am knowledgeable about ticket scheduling, and I understood the context of being told to ignore the notice. Otherwise, I likely would have been confused to see the scheduling request in my patient portal, which I checked in the elevator to confirm the dates for the follow up.

Another bright spot occurred as I logged in. A popup asked me to set a communication preference about seeing my results before they are reviewed by the care team. I hadn’t seen that before, and it’s a great patient experience feature.

From there, I was off to the parking garage. One of the two exit gates was malfunctioning, causing dangerous reverse maneuvers and a total traffic jam that was preventing anyone from exiting their spaces.The clinic that I was in sees up to 100 patients a day, each floor has multiple clinics, and the building has multiple floors. I’m thinking that the parking situation might be a little undersized.

After driving home in a general state of frustration, I was glad to see a notification that my visit note was ready for review. Although I’m an avid reader and enjoy a good work of fiction, I don’t enjoy it when that fiction is masquerading as a medical record note. The list of errors included:

• It listed an additional genetic mutation that I do not carry.
• It instructed me to continue the medications that were supposed to have been inactivated during medication reconciliation.
• Incorrect ages in the family history had been altered from what I entered during online check-in.
• It documented history taking that wasn’t done.
• A “comprehensive review of systems” was documented as negative, but they hadn’t asked me any review of systems questions.
• It contained fictitious exam elements, including head, eye, ears, nose, throat, neck, extremity, and neurological findings.
• It documented counseling that did not occur.
• It listed shared decision-making that didn’t happen, which was based on the alleged counseling.
• It documentation of answering my questions when I hadn’t asked any.

A note in the chart said that the contents of the visit were dictated using voice recognition software, but didn’t include any indication of AI usage. Actually, an ambient documentation solution might have yielded a better result since it probably wouldn’t hallucinate as many elements as the provider did.

It is possible that I have entered my curmudgeon era, but I simply don’t believe that this kind of provider behavior is appropriate. I also don’t think that patients deserve to be treated this way. When I hear people say that the US has the best healthcare system, I always think of situations like this and it makes my blood boil. What’s worse is that these things didn’t happen at a rural or underserved facility, but at a major academic medical center that has a top reputation.

While I was in the patient portal, I saw a message for a relative for whom I’m a proxy. It recommended that she have a mammogram despite being 97 years old and having had a mastectomy. I was happy to clear it out before she saw it, because she would have been incensed. Given the configurability of EHRs and individualization of care gaps, we shouldn’t be seeing things like that. Given that day’s experience, it was just one more layer of icing on the proverbial cake.

I know that healthcare providers are constantly being asked to do more with less. I live that situation on the regular. Plenty of corners can be cut when people are just trying to get through the day, but I draw the line at putting fraudulent documentation in a patient chart, or doing a bait-and-switch with providers who serve a vulnerable patient population.

I’ll be sending excerpts of this write-up to the powers that be, but I’m not at all confident that they will care.

Do you see these kinds of occurrences at your institution? If so, what are the solutions? Leave a comment or email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 12/1/25

It’s been a bumpy couple of weeks. I have spent more time than I generally prefer in the patient, family, and caregiver role.

I hate to say that I saw mostly the bad and the ugly of the processes I have encountered, with barely any of the good. A solution is available for each of these issues, but when organizations fail to see problems with their processes, it’s unlikely that patients will see any change.

The first situation I ran into was with an elderly family member who was having an upcoming procedure. I’m essentially her healthcare proxy and receive her written communications. I also manage her phone calls because of her hearing impairment.

I received a voice mail a week prior to her procedure. It said that they had sent a financial responsibility letter and just wanted to make sure that I received it. The message went on to say that if I had indeed received it and didn’t have any questions, I didn’t need to call the office.

Although I hadn’t seen the letter yet, I looked at my Informed Delivery digest from the US Postal Service and saw that it would be in that day’s mail. I read the letter and had no questions, so I did as instructed and didn’t call back. I thought that was the end of it.

I had received written materials about the procedure six weeks before it was scheduled. They stated that I would receive a pre-registration call three days before the procedure. The call arrived as scheduled, but I was seeing patients, so I called back as soon as possible. I then learned that the department manages pre-registrations only between 1:00 p.m. and 4:00 p.m. and was now closed.

I called back the next day at 1:00 p.m. I was given the option to leave a voice mail, which wasn’t going to work because I was again seeing patients. I dutifully hit 0 to speak to an operator, who told me that the nurses are “still tied up with today’s patients because we’re running behind” and to “call back in a half hour or so.”

I gave it a full hour just to be safe. I was directed to voice mail again and was asked to leave a number where I could be reached from 1:00  to 3:00 p.m. I did so and didn’t hear back, so I called back at 3:45 since I knew that they close at 4:00. I was told “If they don’t reach you, they will just do her pre-registration when she gets here. But that’s not ideal, so we really need a number where we can reach you and have you answer.”

I received a call at 4:15 p.m. I just about broke my ankle trying to answer it, only to find that it was the financial office calling to see if I had any questions about the financial letter since they hadn’t heard from me. I let them know that the original message said not to call unless I had questions. The representative acted like she had no idea why the original message contained that information.

By this point, my read on the procedure center was that they have zero respect for people who have work or life situations where they can’t just drop everything and take a phone call during a narrow window of time. Also, that they don’t have their act together in making sure that the messages they leave are accurate. It didn’t make me feel respected as a potential patient or a caregiver.

I wasn’t seeing patients the day before the procedure, so I called in at 1:30 p.m. and finally reached a nurse. She went down a list of questions asking for information that was already on the chart. None of the questions was a curveball or tricky, so all of them could have been managed through an electronic check-in via the patient portal or through a secure messaging platform.

The nurse then read me all the pre-procedure instructions that had been mailed. That explains why the registration process takes so long and why the nurses aren’t easily available when patients call in as instructed.

In addition, the nurse paused periodically during our conversation to say goodbye to people in the office who were leaving. That seems unprofessional.

On procedure day, we arrived to find that the guarantor name on the insurance that was correct in the pre-registration conversation was now wrong. The check-in person also failed to collect the patient co-pay, which meant having an elderly person with a walker get up and down a couple of times rather than just once. The check-in desk was tall and didn’t have the option for a patient to sit, which was also a negative in my book.

The nurse was trying to ask rooming questions while we were walking to the dressing room. That isn’t ideal for an elderly person who is hard of hearing and who is focused on using her walker. I had to ask the nurse to stop asking questions until we were in a situation where she could directly address the patient without distractions.

Fortunately, the procedure went without a hitch. I returned her to her home and another family member tagged in.

Meanwhile, the second situation found me waiting for my own important test results. Their arrival was dragging into the holiday weekend. Physicians don’t always make the best patients, We are as anxious as anyone when we’re waiting to learn what is going on with our health.

I had been waiting a couple of days when I received a text telling me that a message was available in the patient portal. I was driving at the time, so I psyched myself up as I returned home and woke up my laptop so I could learn my fate.

It was a blast message from the surgeon’s office to let me know their office hours for the Thanksgiving holiday. Also, to remind me to call 911 if I had an immediate medical emergency.

I initially questioned whether this is a limitation of the patient portal. A quick chat with one of my favorite experts reassured me that the practice isn’t using the tool as designed. They could have used other options to convey the information that wouldn’t potentially trigger the hundreds of patients who are awaiting pathology results.

I know the EHR leaders at the institution in question. I wonder if they are aware how various departments are using the available tools and how deviation from published best practices can have a negative impact on their patients. This is the same practice that failed to notify patients that the office had moved, which caused quite a bit of hardship for patients. This workflow adds insult to injury.

Does your organization consider patient preferences and impact when creating patient-facing workflows? Do you leverage patient and family advisors to help you review new features? Leave a comment or email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 11/24/25

I wrote earlier this month about an article that examined whether physicians think their peers who use AI are less competent. I brought this up in a recent conversation with other clinical informaticists to see what they had to say.

The responses were interesting. Although the general answer was “it depends,” opinions differed depending on the type of AI.

Many of the individuals who were part of the conversation are knee-deep in AI solutions as part of their work. They have a different level of understanding of exactly what constitutes AI compared to others who aren’t as engaged with the technology.

For most non-generative AI solutions, the group had a level of comfort that was commensurate with the time that the solutions have been in use. No one questioned the utility of AI in situations where pattern recognition is key, such as in the review of cervical cytology specimens or in diagnostic imaging. No concerns were voiced about AI-powered search tools that help clinicians dig into large data sets and provide verbatim answers.

Peers also raised no concerns about AI being used for natural language processing tasks, as long as the systems are non-generative. These can be used for analyzing the output of interviews or feedback sessions and have been used for years. One colleague specifically called out spam filters, challenging people who are afraid of AI to go a couple of days without one to see how they like it.

Another colleague mentioned a “smart buoy” that is located on a lake near his home. It determines if it’s safe to swim by monitoring temperature, wind, water pH, and turbidity while analyzing the correlation of those elements to bacterial counts.

As far as generative AI, people were generally positive about AI-assisted responses to patient portal messages, as long as the system requires a clinician to click the send button to indicate that they read the response and agree with it.

They were less confident about AI-assisted chart summarization tools because of the potential liability if data elements are missing or incorrect.

Some good discussion arose around the fact that it’s a trade-off since humans might miss or misinterpret something when reviewing bulky charts. Studies of this are not widely known in some clinician circles. Everyone agreed that we need better data that compares the performance of AI versus humans for specific tasks to better understand the risk-benefit equation.

The conversation drifted away from patient-facing generative AI to the tools that clinicians are using as they complete their Maintenance of Certification (MOC) activities. In response to the question of whether peers perceive physicians who use AI tools as less competent, one person noted, “If you’re not using AI to do your MOC, you’re crazy.” Maintenance of Certification questions often take the form of a block of questions that must be answered quarterly, or annually in some circumstances, and many physicians feel that it’s a make-work activity that doesn’t necessarily reflect the realities of their practice or expertise.

For example, in family medicine, the questions cover the whole scope of the specialty, even though most family physicians tailor their practices to include or exclude certain procedures or populations. The majority of us don’t provide obstetric care. Those who practice in student health clinics likely don’t see patients in the geriatric demographic. Some don’t see infants and young children. Some practice exclusively in emergency or urgent care settings.

Some who are in full-time clinical informatics had to give up clinical care due to lack of access to appropriate part-time opportunities. They are required to maintain their primary certification to retain board certification in clinical Informatics. That creates a significant burden for those who aren’t still seeing patients.

For those who have stopped seeing patients, MOC is a “check the box” activity. Most boards allow users to answer the questions in an open-book format, so using AI tools is a natural evolution. They help physicians get to their answers faster, just like they would in the clinical world, although in this case they’re helping reduce an administrative burden.

No one in the conversation had seen any specific prohibition on using AI tools to answer the questions. The only limitations are that you can’t discuss the questions with another person and you must answer them within the provided time limit.

All agreed that a pathway is needed for those who boarded in clinical informatics to allow their primary board certification to lapse after some amount of time. However, they also agreed such a change is unlikely before their anticipated retirement.

When asked specifically about using AI to create notes, such as with an ambient documentation solution, no one admitted to thinking badly about clinicians who do so. There was a general consensus that ambient documentation solutions are one of the few things that CMIOs have rolled out that generate thank you notes rather than emails of complaint and that the technology isn’t going away anytime soon. The concerns were more about the cost of the solution.

Some spirited discussion was raised about whether they will have a negative impact on physicians in training. Some firmly asserted that learning to write a good note is essential for physicians and that the note-writing process serves as a reasoning exercise. One residency program director noted that several applicants have asked him if residents are allowed to use the technology, so it may become a differentiator as candidates assess potential programs.

Anecdotally, I don’t think patients think worse of physicians who use AI solutions. A friend recently reached out with his experience. “I just got back from my annual visit with my PCP.  He’s using some new AI tool that transcribes the entire conversation during the visit, then cobbles the important parts together in the after-visit summary.  It was done cranking that out in the time it took him to listen to my lungs and look in my ears and down my throat, and everything was correct.  It even transcribed non-traditional words like ‘voluntold’ correctly.”

As a patient who has had inaccurate notes created by physicians who were in a hurry while charting, I would prefer AI if it meant not having imaginary exam elements added to my chart.

It’s always gratifying to meet with others who are doing work in my field and to learn how those from different institutions approach a problem differently or have different outcomes. I wish I could have those kinds of robust conversations more often, but I’ll have to settle for only having the opportunity a couple of times a year.

If you had a group of clinical informaticists captive for an hour, what topic would you want to see them discuss? Leave a comment or email me.

Email Dr. Jayne.

EPtalk by Dr. Jayne 11/20/25

Hot off the presses, the new Oracle Health EHR has received certification for ambulatory use and approval for electronic prescribing of controlled substances.

Oracle claims that the EHR was built independently of the original Cerner platform and that it has AI integrated within the system rather than being an add-on. The tool includes AI-supported information retrieval using voice commands and contains information on diagnoses and lab results that are specific to an individual patient context.

The EHR was certified by the Drummond Group, and details about the certification can be found here. For those who may have seen it, I’m curious how different it is from the current Oracle offerings and how the usability compares. If anyone from Oracle Health is interested in sharing a demo, feel free to reach out.

I recently learned that the AMA Journal of Ethics will cease publication, with the December 2025 issue being its last. The news was unexpected, especially considering that authors and editors were planning issues through 2026 and into 2027.

The journal was unique because of the involvement of students and trainees who worked in partnership with professional editors to create themed issues. Speculation is that the Journal’s demise is largely due to financial issues, since it is open access and generates no advertising revenue.

Many physicians are skeptical about the value of the American Medical Association in today’s healthcare climate, and the Journal could have been viewed as something they funded purely because it was the right thing to do. Eliminating it brings up questions about the direction of the organization and the other factors that might have been at play in the decision.

The Minnesota Department of Health is preparing to include wastewater data in its disease surveillance reporting, although I haven’t seen it appear yet on the department’s website. Wastewater sampling gained widespread attention during the COVID pandemic as a method of detecting potential outbreaks. It has also been used to monitor the spread of influenza and respiratory syncytial virus. Given waning vaccination rates, having passive capabilities for early detection is essential.

Medical students are panicking after the news that an AI tool that is used for residency application review and screening has made errors in the display of student grades. The tool was designed to transfer grades from academic transcripts to a summary page. The vendor did its best to minimize the issue, stating that, “there is no current evidence that applicants’ interview outcomes have been impacted.”

The company plans to form an AI advisory board with student members as well as representatives from medical schools and residency programs. They are also building a portal that will allow students to see how their data is displayed and indicate whether it is accurate. This is slated to be live by the summer of 2026, but I imagine the incident will result in a lack of confidence among users.

For those of us who worked on the front lines during the worst parts of the COVID pandemic, speculation continues about the potential long-term side effects of the virus given its impact on so many tissues and body systems. It may be decades before we know, similar to when researchers discovered that shingles is linked to the chicken pox virus.

Along those lines, a recent article in Science Translational Medicine looks deeper at the evidence that links Epstein-Barr virus and the development of systemic lupus erythematosus. Given the high rates of exposure to the virus and the many different impacts of lupus, this is exciting research.

Speaking of academic pursuits, a research letter in the Journal of the American Medical Association looked at the impact of social media posts on the promotion of certain prescription medications. Social media content is more challenging to regulate than old-school TV or radio commercials since influencers often do not declare the sources of their funding.

The authors looked at a sampling of social media posts from 2023 and found that “drug promotion content is frequently posted by individual creators, lacks essential risk information, and bears the hallmarks of undisclosed marketing.” Physicians are already burned out, and having to educate and counsel patients about the veracity of claims by individual content creators is just one more thing weighing down on them.

Another AMIA Annual Symposium is in the books, and I have to say I’m tired. It was five days of full-throttle clinical informatics presentations, punctuated by ad hoc conversations, sharing ideas, and meeting new people.

I had an unusually chatty Uber driver on my way back to the airport and was surprised to learn that he is a former healthcare executive from one of Atlanta’s larger integrated delivery networks. After 20 years in the business, he decided that he didn’t want to be part of a process that was causing moral injury to physicians and limiting options for patients. He is doing contract work for a medical publishing company, but enjoys occasional Uber trips for the social outlet. I’m not sure if his other fares this week were healthcare-adjacent or not, but it was an interesting conversation.

Although sessions formally concluded midday Wednesday, many of the attendees wrapped it up at the AMIA Dance Party on Tuesday night. As I was catching up on email, I was delighted to see a conversation on the AMIA Connect forum that looked at what kinds of playlists various large language models might generate for such an occasion.

Based on a prompt about attendees ranging from their 20s to their 70s, Gemini 3.0 referred to the multi-generational dance floor as “the Holy Grail of JD scenarios.” Gemini offered commentary on each of the selections (referring to Neil Diamond’s “Sweet Caroline” as “the ultimate drunk uncle song” and offered two “emergency rescue” options should the DJ lose control. It also offered to convert the list into a Spotify-ready format.

ChatGPT 5.1 offered a list to make attendees “happy and mildly dehydrated,” but didn’t offer song-specific commentary. It did offer tips on actually making the mix happen.

Claude Sonnet 4.5 promoted its list by saying it “avoided jarring genre jumps that would empty the dance floor” and had some descriptions with the song list, but they weren’t as expansive as what Gemini offered.

Meta Llama 4 offered an oddly numbered list that had little commentary.

I’m curious if anyone else has done an event playlist using AI and whether it delivered as much fun as you hoped. Will we see AI replacing DJs in the future? Inquiring minds want to know.

What song should no dance party be without? Leave a comment or email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 11/17/25

It’s that time of year when clinical informatics types come together to let their freak flags fly, otherwise known as the AMIA Annual Symposium.

This is one of my favorite conferences, largely because it doesn’t take itself too seriously. This is obvious from the moment you pick up your registration credentials and head over to the stash of wacky badge ribbons. These are a heck of a lot more fun than those from other conferences that say boring things like “delegate” or “speaker.”

Attendees were cracking up at one that said “CEO” since it’s rare to see attendees with that title. The event is in Atlanta this year, so the “this is my southern charm” ribbon was a new addition.

It’s a long conference, with a host of pre-conference workshops on Saturday and Sunday. Monday’s opening keynote then kicks off two and a half days of high-intensity programming.

My favorite so far has been the “Designing and Evaluating Trustworthy AI for Consumer Health: Ethical Considerations Workshop.” The session addressed case studies around AI-driven consumer health tools such as fitness apps and mental health chatbots, with an eye to assessing ethical gaps and the potential for the tools to impact health disparities in a positive or negative way.

As one might imagine, algorithmic bias was a focus. Several speakers addressed the biases that inherently exist in datasets that are drawn from large academic centers and the risks of using that data to train AI tools. Also, that training datasets are inherently “old” as soon as they roll out the door, along with the lack of consistency among consumer health vendors for updating those datasets.

Another concern was that data from EHRs is inherently biased since it is structured to support insurance requirements in addition to purely clinical ones. One of my tablemates and I were having a sidebar conversation about how this might impact platforms that use real-world evidence since it changes constantly.

The conversation shifted to understanding the training data that is used in the AI that underlies consumer-facing tools. The point was made that it’s not just about knowing where the data came from, but understanding that it can be harmful if the training data doesn’t reflect the population that is being served.

An example of that was a behavioral health app that was trained predominantly on data from middle class white patients. That left it unable to recognize cultural differences in how patients might express that they are experiencing distress.

Another discussion involved how individuals aren’t experiencing a true informed consent process when they are asked to give up the rights to their data. People aren’t going to read a 40-page terms and conditions document. They are also unlikely to deny consent when they are in a coercive situation, such as needing medical care. One of the speakers noted that users are being treated as data sources rather than as people to be respected.

A speaker who talked about AI’s ability to replace clinicians noted that in an observational exercise, one-third of physician visits contained documentation that was intended to aid coverage negotiations with an insurer or other entity on behalf of the patient. He posed the question of whether AI will do this.

He also noted that in cases where patient histories are unreliable or incomplete, experienced humans have developed the skills to balance those factors, but it’s not clear if AI can do the same. Another hot topic was whether AI will be able to handle conflicting test results or care plans and to manage situations where different patient-side stakeholders, such as patients and their families, have conflicting care priorities.

This flowed into a discussion of how to train new physicians to use AI. It used a driving analogy to pose a good question about how to address older ways of information seeking: Should we require all new drivers to learn how to drive a stick shift?  I’ve been in plenty of conversations recently about how younger folks versus older ones are embracing AI. This is a good example that I hadn’t seen.

It reminds me of writing term papers back in the olden days, when you were expected to have a stack of 3×5 cards of your notes that you used to create an outline. Only then were you supposed to start writing the paper itself. The arrival of word processing software and laptops made it easier to take notes electronically and to perform multiple parts of that process in parallel rather than linearly. We don’t teach students to write term papers in the old way anymore, so why should other academic endeavors require potentially outdated processes? 

I don’t know if anyone in the room is employed by EHR vendors or other technology companies, but these are “let’s get real” discussions that need to be heard. It feels like vendors don’t get into that level of depth with their stakeholders, or maybe they do and they just aren’t swayed by the conversation. Otherwise, we would see fewer of those lengthy consent forms and more that are like the one-page “truth in lending” forms we see now for certain consumer loans.

During one of the breaks, I had the chance to connect with a friend who was instrumental in my development as an informatics leader, although he always worked more on the practice management and efficiency aspects of healthcare IT. I hadn’t seen him in several years, but it was like we picked up right where we left off. This is a testament to the relationships that were built during the “trial by fire” days when organizations were just starting to go paperless. Although I don’t miss a lot of the things that happened during those days, I treasure the friendships that I’ve made along the way.

The AMIA Annual Symposium is also a great opportunity to connect with the next generation of clinical informatics professionals. In my afternoon session, I was surrounded by residents who are interested in the field, as well as clinical informatics fellows. As we were doing introductions, a few were surprised that I became board certified without completing a fellowship. It hadn’t registered with them that many of us learned our craft largely through on-the-job training when there were fewer opportunities for formal learning. Those of us who fit that description didn’t typically set out to practice clinical informatics. We either fell into it or were gradually pulled in by forces that are not unlike those that are found in a black hole.

I’m sure I’ll appreciate the residents and fellows even more when the AMIA Dance Party happens Tuesday evening. They are more likely to be out on the floor than those of us whose skills lean towards more structured dance forms.

Are you attending the AMIA Annual Symposium, and if so, what is your favorite part? Leave a comment or email me.

Email Dr. Jayne.

EPtalk by Dr. Jayne 11/13/25

NCQA is accepting public comments on the AI standards that it is proposing for its 2027 Health Plan Accreditation and Health Plan Ratings program. Patients, health plan stakeholders, healthcare professionals, state agencies, and others are invited to weigh in as the program is being created. You have until December 5 to share your thoughts on topics such as AI program structure, governance, pre-deployment evaluation, and ongoing monitoring and intervention.

I’ve been through several NCQA recognition processes on the provider side. The staffers I’ve met are genuinely invested in improving healthcare quality and are responsive to organizational feedback.

My hospital is considering the addition of a new C-suite role, partly in response to escalating conflicts and violence against healthcare workers. There is debate around several potential job titles, but no consensus on whether the title should focus on safety or security.

A particularly vivid conversation ensued when the use of “public safety” in the title was brought up, since that mimics some state law enforcement agencies and might indicate the role has more authority than intended. Concern was also expressed that the use of “public” was more focused on patients and visitors rather than employees and caregivers. Future meetings will further discuss the role, so we’ll see where the wordsmiths land.

Earlier this week, Mr. H mentioned the Black Book Research survey on AI governance. I wanted to weigh in from the CMIO chair, although I’m not sure that I should call it a chair anymore because I’m spending more of my time lately in the clinical work areas sitting on a rolling stool that I swiped from an exam room.

One theme of the survey is that hospital budgets are underfunded for AI governance and safety, with a median 4.2% of IT quality and safety budgets devoted to AI oversight for 2026. Although that sounds like a small number, I’m curious as to what other line items are funded either higher or lower.

It’s hard to derive meaning from numbers out of context. Governance is likely a line item that scales better than others because it becomes a sustainable process after creation. It’s not like an implementation line item, which may vary dramatically across facilities or service lines as well as for applications or solutions that are being implemented.

As expected, large health systems with 10 or more facilities have a higher share of spend, but I would bet that’s because of the number and complexity of AI applications rather than the process itself. For those who have dug into the full report, I would be interested to hear your thoughts.

PerfectServe recently released a report on “The Rise of Emoji in Healthcare Communication.” From informal research via my texting app, folks from The Silent Generation and Baby Boomers are the most likely to send me messages using standard emoji. It’s hit and miss with my Millennial friends, although they tend to use a lot of GIFs. My Generation Z contacts are most likely to communicate through memes, although I do see a fair amount of photomoji use in that population, which is always entertaining.

The report recaps the use of pictographs and symbols in communication going back to 3000 BC, and highlights the pictographic elements that are already found in healthcare, such as the Wong-Baker FACES Pain Rating Scale.

It shares some interesting data points, such as an estimate of 10 billion emoji being sent every day. It also mentions Adobe data that shows that healthcare workers are losing their hesitancy around including emoji.

I’m glad it mentioned the early emoticons we once used that cobbled together colons and parentheses to look like faces. Younger generations probably find that quaint.

The authors set out to look within the PerfectServe ecosystem to see if they could identify trends in emoji use and if it could be tied to clinicians who are under stress or burned out. They concluded that rather than being potentially unprofessional, emoji were “used to convey politeness and positive intent.”

Other interesting tidbits included the “thumbs up” being the most frequently used symbol in medical communications. Internal medicine clinicians were more likely to use symbols than their peers. Other emoji making the top 10 included the “person facepalming” and the “person shrugging,” which makes me smile.

The authors also looked at explorations of emoji use in the medical literature, namely an article in The Journal of the American Medical Association (JAMA) from 2021 that cites emoji as containing “the power of standardization, universality, and familiarity, and in the hands of physicians and other health care providers could represent a new and highly effective way to communicate pictorially with patients.”

I learned that a lot of my correspondents might be confusing the “tears of joy” emoji with the “cry-laugh” one, which is fairly easy to do depending on the level of zoom in your messaging app.

The paper has a lot of other interesting information, including emoji frequency by subspecialty and day of the week. It will be interesting to see how this evolves over time. I would also like to see information on geographic variations or seasonal trends.

I’m always on the lookout for interesting uses of AI. A friend mentioned SessionKeeper, which uses ambient listening capabilities to create session summaries for tabletop role-playing games such as Dungeons & Dragons. In addition to capturing plot points and character details and building a knowledge base, it offers “story insights” that create a podcast-style analysis of play. I got a kick out of learning about the cultural background of trolls and how it can impact conversations, as well as seeing some of the AI-generated artwork.

I was pleased to see a clear data privacy statement in the FAQ, with the company clearly stating, “We’ve made sure companies like Anthropic, Google Cloud AI, and OpenAI can’t use your gaming sessions to train their systems.” 

What creative uses of AI have you seen? What do you find most useful in your non-work life? Leave a comment or email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 11/10/25

The hot news around the telehealth virtual water cooler this week was the new CMS billing requirement that telehealth physicians list their actual location rather than an office address. The previous requirements allowed us to avoid using a home address. This not only protected our personal information, but also provided uniformity for our practice organizations.

For those telehealth physicians employed by hospitals or health systems, this could lead to requirements that they physically go to the campus to provide telehealth services. This creates additional load on the hospital, which may not have space for telehealth providers. Allowing them to practice from home, while repurposing clinic space for additional providers, was one of telehealth’s benefits. The CMS rule does not address the needs of physicians like me who work for independent telehealth organizations that don’t have a campus or building in our local area. 

Although CMS claims it will protect the home addresses, I’ve been a victim of data breaches and identity theft enough times that I don’t trust anyone to keep my information private. Plenty of other government agencies don’t have appropriate policies to deal with people who practice from their homes, including the Drug Enforcement Administration and many of the state controlled substance agencies. Their regulations haven’t kept up with the times, but I don’t think anyone is surprised by that.

Also, there is no guarantee that a physician who is not in the office is doing telehealth from their home. I have done it from hotels in at least a dozen states, from the homes of family members, and from a docked ship. I certainly don’t expect my employer’s credentialing organization to keep up with that.

Other conversations around the water cooler continue to revolve around the ongoing government shutdown. Some clinics are seeing higher-than-usual rates of no-shows and cancellations. In lower income areas and the academic faculty clinics, patients are citing financial issues as a barrier to transportation.

Although some of our clinics can provide cab vouchers for patients to get home, it’s more difficult to arrange transportation to the clinic. Now that we’re over a month into the shutdown, we should start to see data on patient prescriptions and fill rates, and whether those have been delayed by all of the issues. I’ve seen data from at least one military facility that showed a clear impact, but I’m not able to access that kind of data for my own facility. It would be an interesting research project, however.

The hot clinical topic of the week was the news that the American College of Cardiology and American Heart Association have updated the hypertension guidelines. The new numbers mean that many more patients will qualify for a hypertension diagnosis. Depending on how much of a focus an organization has placed on the management of hypertension, this could potentially mean a fair amount of work will need to be done in the EHR and elsewhere in clinical applications.

Even if we’re talking about modifications to EHR-based alerts, the lift could be significant if the organization hasn’t standardized the EHR or has created different alerts for different locations, specialties, or types of visits. It can also mean modifying dozens or hundreds of reports, patient outreach campaigns, and patient education materials.

Although these two organizations have reached agreement on the recommendation, a number of other organizations have not endorsed the new guidelines. They include the American Academy of Family Physicians, the American College of Physicians, and the International Society of Hypertension. If your organization follows one of their guidelines, you probably have some time before these groups get on board with the new, lower numbers.

It’s still a good opportunity though to take inventory of your hypertension-related alerts, reports and outreach programs to get ahead. I’ve peered under the hood of a number of the EHRs of large healthcare organizations over the last 20 years and some of you have your work cut out for you.

It will also be interesting to see how long it takes consumer-facing healthcare apps and tools to update to the newer guidelines, or if instead they will just stay where they are. I’ll be keeping a close eye on my wearables to see if there are any changes and will report in when I see them. I only use a couple of apps, so if readers see anything before I mention it, please share.

Regardless of the technical ramifications of updated guidelines, there’s also the real-world clinical practice element related to a change like this. How do we as physicians convince our patients to lose more weight or take another medication to bring them into compliance? Many patients find it impossible to reach the previous goals, so there’s not much of a chance of them meeting the new ones.

It will also be interesting to see if the prior authorization processes for weight management medications follow the new goals right away or whether payers gravitate toward the guidelines with more lenient goals.

One of my informatics colleagues asked a question about how real-world evidence (RWE) fits in a situation like this where the proverbial cheese has been moved. Certain EHR vendors have pressured everyone to get on the RWE bandwagon. I’m no expert in the field, but if you’re looking to see how clinicians treated patients with a blood pressure that used to be normal but now isn’t, they’re not likely to have done many interventions because the blood pressure was viewed as normal. We will see how long it takes for real world evidence to shift and for there to be patterns that align with the new thresholds.

If you’re an expert in real-world evidence, I would love to hear from you, and I’m happy to keep you anonymous. Maybe a fireside chat on the hamster wheel of clinical guidelines is in order? Or just some good old-fashioned ranting about the challenges of practicing medicine in an era where physicians are seen as less knowledgeable than TikTok celebrities?

What do you think of the new clinical guidelines, the ramifications to your health IT systems, and their impact on real-world evidence tools? Leave a comment or email me.

Email Dr. Jayne.

EPtalk by Dr. Jayne 11/6/25

Physicians around the virtual water cooler became excited earlier in the week when we heard that ChatGPT was going to start restricting how it manages medical and legal queries. The headlines were great, including gems like “OpenAI Bans ChatGPT From Giving Medical, Legal, or Financial Advice Over Lawsuit Fears.”

OpenAI clarified its position later in the week, explaining that the system will continue to provide general information on those topics, but it will also refer the user to appropriate professionals. The company also stated that users shouldn’t use the tool for “provision of tailored advice that requires a license, such as legal or medical advice, without appropriate involvement by a licensed professional.”

I test drove ChatGPT myself with the above question, along with several others. I was glad to see that it recommended consultation with a healthcare professional.

Looking at its use from the healthcare provider perspective, however, issues remain. I fed ChatGPT a clinical scenario that was chock-full of Protected Health Information (not from a real patient, of course) and asked it to operate from the persona of a medical resident. It didn’t even blink, giving me a list of initial assessments and interventions to perform. It even offered a more detailed management plan and checklists, and when I asked it to generate those, it included the patient’s name in its response.

ChatGPT isn’t Covered Entity, so it isn’t subject to HIPAA regulations. Still, the response tells me that the company doesn’t have many physicians on staff who are guiding its development.

Autumn is upon us, and those in the US who partake of Daylight Saving Time have shifted our clocks back to standard time. That means that some of us will endure weeks of people using the wrong convention when discussing options for scheduling meetings because they don’t fully understand the difference between using “EST” versus “EDT” in writing. I tend to take the lazy route and just say Eastern or Mountain for the date in question, which generally helps avoid the issue.

As a side note, given the number of healthcare organizations that operate nationally, include the appropriate time zone when offering meeting times unless you are sure that everyone on the email is in the same one. I wish I had a dollar for every reply I had to send asking, “Are these options Eastern?” rather than being able to simply indicate my availability.

The fall season also brings my annual complaint about the mammogram reminder letters that are sent by the health system where I receive most of my care. Despite spending hundreds of millions of dollars on an upgraded EHR, they still can’t figure out how to run their reminder letters from a report that takes into account whether patients have already scheduled their next study.

In addition to being a waste of money for the health system, it also creates anxiety for patients who wonder if their appointment was scheduled incorrectly, inadvertently canceled, or fell victim to some other IT misadventure. I have to log into my patient portal every year to confirm that my appointment is still there, which doesn’t build trust or confidence in the health system.

Speaking of complaints, one of my neighbors reached out for advice on how to handle a negative interaction that she had at a local medical practice. I won’t generally weigh in on the interaction or the specific clinical issues since I know that every story has multiple sides, but I’m happy to give advice on how to best provide feedback since most patients don’t understand the different practice structures in our area (academic practice, private practice, employed practice owned by a health system, employed practice owned by private equity, etc.)

This one threw me for a loop. Although the patient thought she was at physician-owned private practice, it was actually a private equity situation. The mid-level provider she saw doesn’t have a collaborative relationship with the physician the patient originally asked to see. Even though four physicians were in the office on the day of the visit, the NP’s supervising physician practices in an office 70 miles away and is never physically present at this location.

I’ve seen these kinds of arrangements in rural areas, but not in the city. I recommended feedback to the practice manager and the supervising physician, but the patient still feels like it was a bait-and-switch situation.

I’m familiar with the particular private equity organization that is involved, so I let her know that I’m happy to help when she gets her bill. It will be confusing and sent from a name and location that bears no resemblance to the site where she received care. It’s a sad commentary on the complexity of our healthcare system and how patients regularly find it confusing and unsettling.

From Jimmy the Greek: “Re: employees using AI to create fake receipts for expense reports. Companies are using AI to try to catch the fraudsters.” I hadn’t heard about this particular phenomenon. I quickly went down the search engine rabbit hole to see what kinds of scams people were pulling. We’ve come a long way from the days when taxi drivers gave you a blank paper receipt so you could fill in your own numbers, but dishonesty will always be there. For most of my career, I’ve reported to other physicians, and it has been interesting seeing which ones made a point of commenting on the contents of expense reports. One of my favorite supervisors mentioned on a team call once that too many of us were eating fast food and needed to make some changes to our meal choices.

It sounds like many of the expense report management vendors such as Expensify and Concur are using tools to catch these types of fraud. Coupling those kinds of audits with a company-issued credit card where expenses flow straight to the expense management platform seems like a fairly straightforward way to dramatically reduce the number of incidents.

Traveling employees who like playing the points and miles games don’t like to use a company card, but given the scope of fraud, I can see why organizations might require it. My hospital phased out company credit cards several years ago, but I wouldn’t be surprised if they bring them back based on stories like these. Younger employees missed out on some of the silliness we experienced when filing expense reports, like taping paper receipts to a sheet of copy paper so we could feed them through the fax machine.

From AI Naysayer: “Re: attitudes about peer physicians using AI. Did you see the Johns Hopkins article? I can’t say that I’m surprised. Plenty of people at my institution do dumb things with AI that make them look less competent.” The piece explores the tension between clinicians who are pressured to be early adopters of generative AI technologies and those who are skeptical about its benefit. I thought it interesting that the promotional article mentions the underlying study but didn’t have a link, but it’s unclear if this was intentional or just sloppy writing. Either way, the piece leans toward there being a social stigma that may be blocking the growth of AI in healthcare.

It was fairly easy to find the publication in question. It was a small study, with only 276 clinicians participating. They were placed in three groups: one with no AI use, one with AI as the primary decision-making tool, and one using AI for verification only. Participants worked through diabetes care scenarios. The authors found that the verification option helped mitigate negative perceptions, but it didn’t eliminate them completely. They also note that this study was simplistic and that more research is needed, including creating specific measurement instruments and examining behaviors outside of the single participating health system.

Would you be more or less confident in a physician who used generative AI tools to create your plan of care? Leave a comment or email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 11/3/25

The American Medical Association recently announced the launch of its Center for Digital Health and AI. It stated that it was “created to put physicians at the center of shaping, guiding, and implementing technologies transforming medicine.”

AMA leaders went on to say, “The new Center will tap the full potential of AI and digital health by embedding physicians throughout the lifecycle of technology development and deployment to ensure it fits into clinical workflow and physicians know how to utilize it.”

It’s a nice sentiment, but it feels aspirational. I don’t think the AMA has the resources to embed physicians anywhere, let alone in the spaces where this kind of development is happening.

The statement add that AMA will create policy and provide leadership in the regulatory space; provide “knowledge and tools” for physicians and care delivery organizations to integrate AI into their practices; collaborate with tech, research, government, and healthcare to drive innovation; and creating opportunities for doctors to shape AI and digital tools so they work within clinical workflows and enhance patient and clinician experience.

The latter is particularly interesting to me. How, exactly, will they be creating these opportunities? Some US care delivery organizations refuse to acknowledge the value of the CMIO role, so perhaps they can start by lobbying those folks. Oracle Health has eliminated a tremendous number of physician roles. Will the AMA demand that product teams receive adequate input from physicians who have formal informatics training and experience?

If you surveyed a room full of physicians, I’m not sure they would identify the AMA as an organization that looks out for the interests of frontline clinical providers. In the 1950s, approximately 75% of practicing physicians were members of the AMA. The best estimates I could find for recent years had estimates between 12% and 20%. If that’s accurate, it shows that physicians are voting with their pocketbooks. Dues are $420 per year for practicing physicians, which is a lot to ask from folks who don’t feel that the membership brings value.

It seems like an uphill battle advocate for more physician involvement in the development and implementation of AI tools. Organizations that already see the value of having physicians involved in the process are doing so. Given the cost of hiring a physician, it would be a hard sell for those that don’t already have a line item for that expertise in their budgets. A number of my physician informatics colleagues are concerned about keeping their current roles, since we’ve seen numerous CMIO and informatics roles eliminated either as part of the ever-growing list of health system mergers and acquisitions or just as a part of general restructuring efforts.

It will be interesting to circle back to this press release in six to 12 months to see if the AMA has gained traction with its efforts.

Speaking of look-back efforts, I took a look through my own retrospectoscope this week when I was digging through some paperwork. I found a sheet of notes from an AI symposium last year. It was about the impacts of generative AI on physicians, and featured a couple of physician executives talking about their health systems’ use of AI. I have a habit of capturing quotes when people are speaking. Some of the comments still ring true, but others haven’t stood the test of time. Let’s take a look:

• “AI-powered analytics are great, but individual reporting freaks physicians out.” Many physicians have been resistant to seeing individual measures for years, so no surprise here. This will continue to be true as far as I’m concerned.
• “I’m cautiously optimistic about generative AI in clinical applications; it seems like just one more thing.” I’d say this one is 50/50. We’ve seen tremendous growth in AI over the last year, but we’re also seeing a little bit of a backlash in some circles.
• “AI is going to bring back the humanity in medicine. We will actually have time with patients rather than just taking a bill-and-go approach.” I’ll give 50/50 on this one as well. Studies have shown that where AI does provide some reduction in note generation times, physicians aren’t necessarily having longer patient-facing appointments or even spending less time in the EHR. We need more and better research in this regard.
• “By 2025, this is totally going to bring the joy back into medicine.” I’m giving a thumbs down to this one, since we are well through 2025 and there are plenty of ways in which physicians still find the mechanics of medical practice to be soul-sucking.
• “Data quality isn’t attractive. It’s not going to wind up on a movie poster.” I know quite a few people who thrill at the sight of beautifully normalized clean data, so beauty is in the eye of the beholder on this one. As a side note, I once saw a revenue cycle team that had shirts that said, “We put the sexy back in billing,” so I bet those folks would find data quality attractive too.
• “Vendors kind of care about health, but really want to make money.” All too true, although it’s a continuum.
• “Just because it has AI in the name doesn’t mean it’s useful.” True on this one as well.
• “I hate the subscription model. You used to be able to just buy stuff.” This one is just as true today as it was last year.
• “I’m tired of hearing about ‘move fast and break things.’ Vendors need to move fast, but also heal their broken things just like hospitals do.” I don’t think there’s a CMIO out there that would disagree with this one.
• “AI is just giving us an escalating arms race of appeals and denials. They say we’re diagnosing too much sepsis even though they wanted us to find sepsis sooner.” The arms race is real. There’s a headline almost every week about care delivery organizations and payers taking approaches that counter each other. It reminds me of ‘’Spy vs. Spy” in Mad Magazine.
• “Ambient documentation adoption will be limited because the operations people want a tangible ROI. How do you put a dollar amount on physician wellbeing? Our arguments about turnover and recruitment fall on deaf ears. They’ll probably just pass the cost on to clinicians.” I’ve seen health systems charge physicians for their ambient licenses or alternatively demand increased productivity in order to stay licensed, so I’ll say true on this one.

My favorite quote was when one of the speakers encouraged the audience (which included not only clinicians but also IT, operations, and finance colleagues) to “go play with ChatGPT and try to make it do the part of your profession that you hate.” It’s an interesting challenge, although I struggle with trying to find ways to add AI tools to my non-clinical workflows. I’m curious what others have done and whether it’s really making your work life better or if you have seen unintended consequences.

What odious parts of your work have you outsourced to AI tools? Have you been unsuccessful in automating others? Leave a comment or email me.

Email Dr. Jayne.

EPtalk by Dr. Jayne 10/30/25

Sometimes reader comments make my day. One did earlier this week, when Data Diva accused hospital boards of “trying to cosplay as tech bros” and suggested that we consider “automating leadership bloat before automating bedside care.”

This inspired me to see whether a large language model could do a better job than hospital administrators at certain tasks. I asked Microsoft Copilot to assume that I am a hospital administrator trying to figure out how to make life better for the nurses who work at my hospital. I then asked, “How would they like to be rewarded for their hard work?”

I was pleased with Copilot’s response. Nurses deeply value recognition that feels personal, meaningful, and supportive of their well-being and professional growth. A mix of financial, emotional, and developmental rewards works best.

The response went on to suggest a combination of authentic recognition and appreciation, such as peer-to-peer recognition programs, along with fair compensation and financial incentives. Competitive salaries were specifically mentioned, along with ensuring that pay aligns with industry standards and reflects experience and performance. Performance-based bonuses and spot rewards were listed, as were tuition reimbursement, paid training, and clear opportunities for promotion and skill building.

Other suggestions included flexible scheduling, additional time off, and mental health support. Copilot went on to recommend that recognition be embedded into daily culture, “not just during Nurses Week,” and that rewards should be tailored to individual preferences to “ensure all staff feel seen and valued.”

It went on to ask if I wanted help designing a nurse recognition program tailored to my hospital’s culture and budget. I threw out a random number and asked what I could get for $100 per nurse. Suggestions included a customized thank-you box; a voucher for an experience, such as a massage or yoga class; branded gear, such as a high-quality fleece jacket, tumbler, or tote; a continuing education stipend; extra PTO, a coupon for a flexible shift swap; or a gift card for healthy meals.

Nowhere did it recommend pizza parties or challenge coins. For that alone, I can conclude that LLMs are better than actual hospital administrators. I ran these items past a couple of nurses and they were on board. Administrators should take note before they wind up being replaced by an AI assistant.

I was feeling a little punchy, so I went on to ask, “Do nurses like pizza parties?” Copilot was again accurate: pizza parties are appreciated as a kind gesture, but most nurses view them as insufficient on their own. They prefer meaningful recognition, support, and resources that address their real challenges. Copilot went on to suggest that pizza parties are “symbolic but shallow” and “can feel tone deaf” since they don’t address deeper needs such as burnout, staffing shortages, and lack of support.

Without prompting, it instead recommended authentic recognition, work-life balance elements such as flexible scheduling and adequate staffing, professional growth and career advancement opportunities, and mental health support. It went on to recommend that “if you still want to host a pizza party” that leadership should pair it with something meaningful and also make it inclusive and convenient, specifically recommending making sure that the night shift can participate. Winning the hearts of the night shift is pretty smart, so two points for Copilot.

I’ve had some medical adventures over the last year and have several important physician appointments pending. I’m always tuned in when I receive an email or text saying that I have a new message in my chart. I admit it triggers a bit of a fight-or-flight response. I was less than thrilled when I logged in to find that the message was letting me know that the hospital is having phone issues I should use the patient portal instead if I need to contact a physician. Health systems should be able to flag these kinds of communications as “non-urgent” or “a general communication from your health system” header so that patient anxiety isn’t provoked. 

Pet peeve of the week: people who keep sending broken web links even though you’ve told them that the link is broken. I have been working with a vendor rep who keeps sending me documents to review. I dutifully report the broken links, but each subsequent includes the same broken links. If I can’t trust that you’re reading my emails and taking action on my requests to send content that I can actually view, I’m not sure you’re the kind of person or organization with whom I’d like to do business.

This article about AI-free periods for physicians caught my eye. It points out concerns for “deskilling” that is due to overreliance on technology. Singapore’s National University Health System has been implementing the AI-free periods after studies found that physicians who relied on AI tools during endoscopy were less able to use their own skills to detect polyps when the tool was taken away. By removing AI tools occasionally, leaders hope that physicians will maintain their core competencies and avoid being overly reliant on tools.

The article also mentions tracking physician performance to determine whether AI tools are having a negative impact. Anyone who has had to navigate a downtime situation when it hasn’t been practiced for a while knows what it feels like when technology is taken away, so I think that considering AI-free practice on occasion is a good idea. And if you haven’t had a downtime drill in a while, there’s no time like the present.

My hospital recently did a user survey to gather information on how well the informatics team did as they implemented a new feature. We’ve used anonymous surveys before and have always found them to be a good way to get direct user feedback and ideas for improvement. We don’t usually receive a lot of free-text user feedback, but we always get a few constructive comments.

This time, however, I was completely floored by how hostile some of the free-text responses were. Some of them even included personal attacks on members of the training and implementation teams. 

I’ve seen enough anonymous posts on social media to know that societal rules are evolving to a point where people feel emboldened to say whatever they feel, but I haven’t seen these kinds of borderline threatening responses from our medical staff. It makes me wonder about the overall stress level of providers in the organization and whether we need to take additional steps to ensure the welfare of our employees.

Have you noticed a change in the level of civility at your institution? Have steps been taken to improve communications and ensure that staff members are safe? Leave a comment or email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 10/27/25

Dr. Jayne Goes to Las Vegas

Most healthcare IT people were aware of the HLTH conference in Las Vegas last week. I would bet that only a few knew that the National Association of Community Health Centers was holding its 2025 Workforce Conference just down the street at Caesars Palace.

The conference was formerly known as the FOM/IT — Financial, Operations Management / Information Technology Conference & Expo. It is significantly lower key than HLTH. It focuses on the challenges that community health centers face.

If you’ve never worked in that part of healthcare, I would summarize it as being populated by some of the hardest working and most genuine folks I’ve ever had the pleasure of meeting. They tend to think of situations in a glass half full manner. Even if the glass is less than half full, they are committed to figuring out how they can fill it. They are also focused on patients, outcomes, and figuring out how to do more for their patients with less.

I’ve attended this conference a couple of times. Since the attendees include quite a few CEOs and COOs as well as IT folks, I was looking forward to reconnecting with a couple of friends from medical school who have gone on to the community health center CEO role. The conference is really only a single day, although there were some pre-conference workshops the day prior, so it also presented an opportunity to connect with friends who were attending HLTH since the schedules overlapped.

One of the first things that I did when planning my trip was to compare the two conferences. It’s not surprising that the one focusing on community health centers had a registration fee that was half of that of its glitzier counterpart. The CHC conference featured meaty-sounding sessions on topics such as workforce burnout, building healthy teams through smarter workflows, electronic case reporting for communicable diseases, interoperability, navigating tough financial times, working with aging and underserved populations, using AI to reduce burnout, and financial stewardship.

I certainly didn’t see anything about financial stewardship on the list of topics for HLTH, but I did see some session titles that were a bit edgier. GLP-1 drugs featured in sessions with titles such as Longevity Wonder Drugs and Buy Now, Weigh Less Later. Other longevity-themed sessions included Longevity Reimagined: The AI-Powered Personalized Health Moonshot, Longevity Beyond the Boys’ Club, The Longevity Preparedness Index: Are We Ready for the 100-Year Life?, and Death Becomes Optional. 

Other interesting titles included: Decoding the MAHA Movement, Bot Fight Club, Women are Not Octopuses. Care Beyond the Stirrups, Trust Me, I’m an LLM, and Picking Up Uncle Sam’s Slack.

A couple of titles that were interesting to me but didn’t fit my schedule were From Gray Areas to Red Flags: Hot Topics in Fraud & Abuse, The Big Bill Fallout, If Everything is AI, then Nothing is AI, and Is Wearable Data Hitting a Dead End.

The award for best abstract goes to Longevity Beyond the Boys’ Club for this entry:

While tech entrepreneurs dump millions into experimental supplements and cryogenic chambers like modern-day alchemists chasing immortality, the rest of us are left wondering if living longer is reserved for those with venture capital portfolios. Women, who already outlive men by several years without fancy biohacking protocols, are watching this testosterone-fueled quest for the fountain of youth with bemused curiosity, as researchers scramble to figure out why nature already gave half the population a longevity advantage that no amount of ice baths can replicate.

While some tech bros are trying to engineer our way to 150 years, health leaders are working to democratize more proven, practical interventions that don’t require a billionaire’s budget. Because turning longevity from an exclusive club for the ultra-wealthy into an accessible public health priority might just be the difference between extending life for the few versus extending healthspan for the many. Spoiler alert: there’s no silver bullet that works the same for everyone, even those with Y chromosomes.

This brief write-up sums up a lot of what is going on in the health tech space lately. Hats off to whoever penned the blurb with phrases such as “testosterone-fueled quest for the fountain of youth.” Although the whole thing is over the top, I like the idea of making it possible for more people to live longer healthier lives since that’s what primary care is all about in the first place.

Unfortunately, we’re still at the phase where we can’t even guarantee that all people can receive proven interventions such as vaccinations and nutrition counseling to address obesity, so it will be a long time before we increase the average lifespan from its current mid-70s to 150 years.

In the interest of good reporting, however, I did make sure I had a chance to meet up with some of my favorite HLTH attendees for a booth crawl or two. Here is the highlight reel:

Intelligent Medical Objects (IMO) once again brought its A game with an outstanding shoe/sock combo. The pic also highlights the bare concrete floor and the thin foam aisle runner, which didn’t do much for reducing foot and ankle fatigue.

Nordic Consulting CMO Dr. Craig Joseph enjoyed learning about Plated,  which aims to improve food service quality for institutional environments. Its frozen meals are warmed via a unique cabinet that prevents overcooking and nutrient loss. Technology includes menu management as well as interfaces with the most common senior care EHRs. Dr. Joseph also gave a thumbs up to their swag, which was an ergonomic vegetable peeler.

Vulvai is a relative newcomer, highlighting health conditions that can impact half the population and which can take upwards of seven years to diagnose. Female patients offer suffer with these conditions in silence, so I applaud their work and will continue to follow them. Extra credit to their booth rep, who had a Las Vegas spin to her outfit.

Weight Watchers, which is back to its original name following the WW branding debacle, sponsored a pickleball court next to the puppy petting area. It also sponsored a cocktail hour with boozy and sugary options, which I thought was ironic.

Disease management company Abacus Health had adorable water bottles as swag.

OpenLoop Health understood the assignment for attendees who prefer a cold Diet Coke.

An honorable mention in the footwear category goes to this gentleman from InterScripts. I wasn’t able to assess his sock game, but I’ll keep an eye out for him at future conferences.

On a more serious note, I take my attendance at these conferences seriously since the cost is substantial. It’s not just about looking for the hippest booth, the coolest swag, or the most fun party, but rather identifying solutions that might be helpful and to cut through some of the hype by speaking to companies in person. I was able to learn more about companies that serve parts of the industry outside of large health systems. 

I was impressed by the team at PointClickCare, which serves the senior living and skilled nursing environments. Founders, Dave and Mike Wessinger grew up learning about the long-term and post-acute care space from their mother and found a need to improve solutions there. I happened to be chatting with some of the company’s Canada-based leadership team while the Toronto Blue Jays were in the process of winning an important baseball game and it was great to see the smiles on their faces as their team advanced. to the World Series.

I also checked back in with Linus Health as they continue to refine their digital cognitive assessment tools. The company was featured in a research article in the Annals of Family Medicine earlier this year following an early detection study that was done across seven sites, including Indiana University Health. The study found that half of all patients scored as impaired or borderline for cognitive impairment. For a condition that can benefit from early diagnosis, it’s great to see a product that can be easily implemented within my own specialty without a lot of fuss. 

Emtelligent’s solution marries natural language processing with AI tools that can turn unstructured chart notes and reports into useful information, including patient summaries. I was impressed by the ability of their booth team to engage about different parts of the industry as well as their own. It was refreshing in a world where most industry folks want to focus on whether you’re ready to spend money with them.

I didn’t make it to the HLTH industry night performance by Big Sean, but I did close out the night sharing espresso martinis with industry long-timers who have become friends. We typically only see one another at conferences and it’s amazing how we can pick up right where we left off last time. Here’s to wrapping up my last work trip for 2025 with a mellow evening.

If you attended HLTH, what did you think about it? Was it worth your time and your company’s investment? Leave a comment or email me.

Email Dr. Jayne.

EPtalk by Dr. Jayne 10/23/25

Despite the government shutdown, healthcare providers remain subject to CMS timelines, including those for the Merit-based Incentive Payment System (MIPS).

CMS has just released payment adjustment documentation for 2026, which is driven by 2024 performance. Providers can use the Quality Payment Program website to find their 2024 MIPS scores. Practice representatives can see individual, subgroup, and group performance information.

Those who don’t believe that their information accurately reflects their performance or that their submission might contain errors can request a Targeted Review, although reviews will be “delayed in most cases until normal government operations resume.”

The American Medical Informatics Association (AMIA) has released its 2025 awards, recognizing key contributors to medical informatics. Signature Awards recognize new investigators, thought leadership, health policy contributions, informatics, innovation, and informatics team science. Doctoral dissertations are also recognized. The Leadership Awards recognize volunteer leadership and service to AMIA, the field, and the profession of informatics.

Recipients will be recognized at the Annual Symposium in Atlanta next month. I’m looking forward to catching up with my informatics colleagues, and of course seeing what the annual AMIA Dance Party has to offer.

Voices that are discussing AI vary widely in knowledge and credibility. Some talk about the promise of AI, while others focus on the technology that is needed and the infrastructure and environmental ramifications.

Others address societal impacts. One voice that I didn’t expect was Pope Leo XIV, yet his comments add needed perspective. Reports say he calls AI “the exceptional product of human genius,” but warns that it might “interfere with the proper human and neurological development of young people and children.” In June, he called for the “urgent need for serious reflection and ongoing discussion on the inherently ethical dimension of AI, as well as its responsible governance.”

I’ve had the pleasure of working with a couple of healthcare ethicists over the years. I wish there were more of them in the field to be able to address some of the perspectives that I don’t always see represented.

Pope Leo raised concerns about the impact of AI on “humanity’s openness to truth and beauty” and “on our distinctive ability to grasp and process reality.” Anyone who has visited the comments section on more than a handful of social media videos knows that plenty of people can’t identify videos as being AI-created. Some videos are sophisticated, but others are so obviously fake that I wonder if comments about their veracity are intended to be ironic or are truly reflective of someone’s beliefs.

I appreciated reading the Message of the Holy Father that was delivered to the AI for Good Summit, which summarizes Pope Leo’s position. It notes that while we’re grappling with issues like AI, 2.6 billion people around the world don’t have access to communication technologies. He calls for consideration of the “anthropological and ethical implications” of AI and recognition that such technology “cannot replicate moral discernment or the ability to form genuine relationships.”

Plenty of people are pushing AI in situations for which it is not well suited. I am glad to see a strong reminder that AI should be helping people and that we need to keep humanity at the heart of decisions that we are making as we add AI-driven solutions into our daily lives.

Speaking of keeping humanity at the core of our thought processes, it’s time to shine a light on situations that could stand for a little improvement as far as recognizing the humanity of workers and respecting their time and intelligence. I was recently on a call with an external consulting group that made me extremely uncomfortable. The team leader called out specific attendees to remind them that “this is a cameras-on call.” He then added, “so I expect that no one will have their cameras off, as I need to see your faces.”

I’m sure my face showed a less than positive expression when I heard that. It reminded me of what teachers would say during the lockdown phases of the COVID pandemic, when students were required to attend classes virtually. The environment did not feel supportive and respectful.

Even if compliance was an issue, it should have been handled better, especially with external attendees. A simple reminder in the chat of “Just a reminder that our Team Operating Agreement recommends that we all have our cameras on” or a private message to those not in compliance would have been a better way to approach the situation.

The team leader should also be careful what he wishes for. I immediately checked to see how many people were off camera. Instead of seeing engaged participants, I saw people who looked bored, were obviously multitasking, or were making inappropriate facial expressions.

As the meeting unfolded, other leadership problems surfaced beyond cameras-on. The meeting barely followed its agenda and ignored time blocks. My team wasted an hour because we never reached our agenda item.

From Finance Whiz: “Re:: failed attempts at team building. I wanted to share an example from my employer. Mind you, this organization recently sacked over 800 workers through job cuts and layoffs, making remaining employees do the work of those who departed, on top of their existing workloads. Oh yeah, and we all have to return to office to do so, even if we were hired as remote employees.” The screenshot was from a nationally-known firm that asked employees to complete a “State of the YOU-nion” survey on “If you were a fall-themed emoji, which one would you be?” Choices included “Turkey with a to-do list – busy, festive, and slightly frazzled;” “Jack-o-lantern with a plan – bright ideas and spooky good vibes;” “Leaf in the wind – just going with the seasonal flow”; and ”Cozy scarf energy – wrapped up in warmth and good intentions”.

I’m betting that the remaining employees had some other seasonal options they would offer instead, like: “Skeleton with a spreadsheet – tracking my job applications elsewhere” and “Snow plow on the sidelines – preparing to be overworked and salty.”

What’s the worst morale-impacting maneuver you’ve seen in the workplace this year? What’s the best? Leave a comment or email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 10/20/25

It’s open enrollment season for Medicare. Patients and their family members inundate physicians with questions about whether they should switch plans.

Most outpatient office visits are too short to have a meaningful conversation about the topic, especially when you’re trying to address a handful of chronic conditions and maybe a new problem, too. I refer people to the Medicare.gov. It contains solid resources, but does not explain that Medicare Advantage plans are generally for profit. They offer some extra bells and whistles such as vision and dental coverage, but they provide these by closely controlling costs in other areas.

I looked at health systems in neighboring states to see if they offer resources for educating patients and what they have available online. It’s a good reminder that health information technology isn’t just about helping clinicians document, but includes all of the digital assets that we use to engage patients as well.

I tried to put myself in the persona of someone who is new to Medicare and looking to understand their options. One system, which we’ll call The Sisters, appeared at the top of the sponsored listings when I searched for “Is Medicare Advantage for profit,” so I decided to start with them.

I went straight to a Medicare Readiness page, which offered a downloadable document. Once I entered my information, it said that the document would be emailed, but I could also click to access it right away. That is a nice feature for patients who may not be used to finding things in a download folder or having to go back to them later.

The download page also offered a physician search, links to Medicare.gov and other websites, and a list of plans for which the health system is considered in-network.

Out of fairness to the other systems in town that didn’t have sponsored search results, and for whom I’d be starting my exploration with a visit to their main website, I visited The Sisters’ home page. Although it had a reminder to get a mammogram and a headline about the system being the official provider of a local sports team, there was no mention of Medicare open enrollment, even in the “news” section. To my colleagues in marketing: this seems like a missed opportunity.

My next stop was Big Health System, which also didn’t have anything about Medicare open enrollment on their home page. I used the page’s search page to find “Medicare” topics and the top listing was for Annual Wellness Visits, followed by an entry for Medicare. Following that link took me to an extremely basic page that provided little information other than directing patients to call 1-800-MEDICARE. Given the government shutdown, that may not be the best resource for patients right now.

The page was full of acronyms. Although they were explained, it was a dense page that didn’t give anywhere near the clear information I had seen on the competitor’s site.

My third stop was University Health System, which also didn’t have anything about Medicare open enrollment on its main web page. I liked the fact that online scheduling and virtual care options were prominent, however.

One unique feature on the site was a mention of how and why the organization posts substitute breach notices for HIPAA issues and a link to their breach information site. There I was surprised to learn of an incident that I hadn’t seen mentioned in local media, and although it made me think about going down the rabbit hole to do a comparison of breach notification strategies for the different health systems, I was able to refrain.

A search for Medicare brought up a couple of screens of links. The only mention of Medicare was in the context of Accountable Care Organizations.

My last stop was at National Health System. Their home page caught my attention with a prominent link to “Price Transparency.” I couldn’t find a search box, so tried using the site’s chatbot. None of the options fit, so I chose “other.” That put me into a flow that was more about helping me find a location of care than providing general information.

I decided to go wild and request a live chat. I asked, “Do you have any information on Medicare Advantage versus traditional Medicare?” The agent said that they don’t provide insurance information and suggested reaching out to the insurance company directly.

As most readers have surmised based on my posts over the years, I’m a huge fan of patient engagement and patient empowerment. The lack of information across these sites represents a big gap, not only in helping patients advocate for themselves, but also in the health system’s ability to position itself as a partner with patients where they help them understand their options for coverage and the US’s healthcare economic realities in the US.

I don’t know whether that lack of information represents a local deficiency or a nationwide trend, but I’d be interested to hear from organizations that are doing a better job putting such information out there, as The Sisters website does.

Back on the system’s site, I found the document highly readable and well formatted, with pages that fit on a single screen and using a font that would be easily readable for older patients. It had good contrast, clear explanations, and some interesting historical facts about Medicare sprinkled throughout. It also included a couple of pages of general Medicare FAQs that made me think it would also be a good resource for younger folks who are helping their parents navigate the system.

I have quite a few years before I’m a Medicare beneficiary, but I hope resources like this are available to me when it’s time. In the interim, I will steer patients towards this resource, regardless of whether it’s related to the hospitals where I’m on staff.

Does your employer provide digital health resources to help patients understand insurance and other information about how care is delivered and funded in the US? Do you have something you’d like to showcase for our readers? Leave a comment or email me.

Email Dr. Jayne.

EPtalk by Dr. Jayne 10/16/25

As the US federal government shutdown continues, I’m encountering military members who are having difficulty filling prescriptions for long-term medications. I’m certainly not an expert in how federal appropriations work, but most people on the clinical side of healthcare policy would agree that having a system where people might have to skip important medications through no fault of their own is problematic.

Based on social media posts from several military installations, pharmacies are only dispensing 30-day supplies for prescriptions even if the prescriber had approved 90-day supplies. Reasons cited include “to best serve the maximum number of beneficiaries for what could be an extended period of time,” which suggests that pharmacies are unable to replenish their stocks. Some bases are redirecting members to Express Scripts or to retail pharmacies where others have messaging that isn’t more helpful than “thank you for your understanding.”

Plenty of evidence demonstrates the benefits of 90-day prescriptions, including improved patient adherence to the medication regimen, better clinical outcomes, and reduced complications. From a non-clinical perspective, it also saves money and time for both patients and pharmacies. I feel for those pharmacy technicians who are going to have to fill many more prescriptions than planned, most likely without additional staffing, because they can only dispense a 30-day supply at a time.

Shifting to non-military pharmacies isn’t necessarily the best answer either. Those pharmacies also are not likely able to increase staffing on short notice as they start receiving increased requests. Back-and-forth conversations sometimes need to happen between prescriber and pharmacy when prescriptions are transferred, and that particular game of phone tag is never fun.

The answer is having comprehensive health policy that is funded so that patients aren’t penalized every time Congress reaches an impasse. Once Congress gets its act together, ensuring continuity of care for our military patients and their families should be a priority.

From Telehealth Scramble: “Re: Medicare telehealth. Our place is trying to get people to switch to an in-person visit right away, but they are specifically saying that patient care has to come first if they can’t. For the telehealth visits that would be unpaid, they are holding off on submitting the charges hoping that this will end soon and the re-upping of telehealth will be retroactive. It’s been a particular challenge for mental health because about 80% of our patients are still telehealth. We have many providers who do telehealth from home several days a week, and some are contracted as full-time telehealth from home, so we don’t have offices for them and they live a significant distance away. We also have a reasonable number of patients who are in the state but a far drive away, including college students or patients who are older and don’t really want to drive an hour on the freeway. Fortunately the insurers that we contract with have specifically said they will continue telehealth coverage unchanged, so we just have to reschedule the patients with straight Medicare. Also, our mental health providers are having to check insurance status and reschedule appointments with patients themselves because we don’t have enough clerical support.” I suspect that many organizations are taking this kind of pragmatic approach. Still, I wonder how many members of Congress would be able to articulate these issues that are happening in their states or districts or would be able to provide advice to their constituents on how to navigate the healthcare system?

From Vampire Gal: “Re: BloodGPT. The name caught my attention as I perused my inbox, wading through all the spam emails that have resulted from my HLTH conference registration.” The headline on the website is, “Smarter blood test interpretation for everyone. ”it offers several sentence fragments indicating that it’s intended to address lab tests of varying complexity with a target audience of “individuals, doctors, and healthcare providers.”

Scrolling further, it offers patient-facing offerings for blood test interpretation, diet plans, and personalized recommendations. Clinicians can use the solution to deliver branded interpretation reports for patients. It also promises tracking for lab trends and “AI-powered chat for instant patient insights.” The company promises “medical-grade accuracy and zero hallucinations” even though it is powered by multiple LLMs. Having done a fair amount of AI work, I’m surprised at the claim of zero hallucinations, especially since none of the contributing LLMs (Claude, Gemini, OpenAI) report much higher hallucination rates when they’re talking about them.

I was considering digging deeper by downloading their sample report package until a clickbait type item caught my eye: “Always tired? These 3 Blood Markers Could Explain Everything.” Attention-grabbing statements like that always raise the hair on the back of my neck. When seeing patients, the number one reason most patients are tired is lack of sleep or lack of quality sleep, not lab values that you need to tinker with (after unnecessary spending to order the tests). This simple eye-catcher on the website makes me think that this vendor doesn’t appreciate the concept of evidence-based medicine.

The blog post that addresses this claim, which appears to be AI-written, cites other websites like the Cleveland Clinic and MedlinePlus, making it rather generic. After scrolling through a couple of pages of content, it closes out with, “Focus on evidence-based changes, balanced nutrition, regular sleep, stress management, and appropriate medical follow-up. With patience and proper guidance, your energy levels can improve and the fog of chronic tiredness may finally lift.” Unfortunately, that’s too little too late for my evidence-based medicine heart. My parting impression of this company is negative.

After some email correspondence, Vampire Gal shared some of the other companies that have been reaching out. One name that caught my attention was Eggmed, which is apparently an EHR/PM system designed for private practices. The website was a little vague in saying it was about “helping wellness professionals focus on their clients,” which makes me think it’s more for therapists and coaches and less for physicians. I also didn’t see anything about EHR certification, interoperability, or data sharing, which are becoming increasingly important for delivering comprehensive and coordinated care.

Kaiser Permanente workers began striking earlier this week, making the case for improved working conditions and greater pay. The healthcare giant has been negotiating with unions for several months and claims it has plans to continue operations without interruption. I reached out to a few colleagues in the field who confirmed reduced office hours, staffing challenges, and pharmacy closures. I guess the definition of “interruption” might be different for administrators than for patients or frontline physicians.

I spent more of the last few days than I wanted to performing Windows upgrades, moving multiple devices from the workhorse that is Windows 10 and onto Windows 11 now that the former has reached its end-of-support date. The latter is less awful than it was when it first came out, but it still lacks some of the niceties of its predecessor, such as the start menu.

The internet is full of articles that try to help users navigate the change. It also offers several third-party applications that allow bypassing the offending start menu. Those of us that feel Windows 11 is a bit of a backwards maneuver are just shaking our heads.

I have multiple laptops as well as a desktop PC. The laptops were easy, but the custom-built desktop posed a few challenges. I did get some laughs out of the process, though, because every time a Windows article told me to “consult your manufacturer’s documentation,” I fired off a text to the college kid who built it and asked where my documentation might be. I was offered an operating system with a tuxedo-wearing penguin in response, so I told him he was off the hook for documentation.

What’s the best operating system for a mid-career clinical informaticist living in a largely Windows world? Should I contemplate a switch? Leave a comment or email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 10/13/25

Nearly every physician I meet wants to talk about AI scribe solutions, and whether I think they will truly help put the joy back in medicine.

The first thing I think about when confronted with those kinds of questions is how we define joy in medicine. For some of the older physicians I know, that would be represented by the years prior to 1992, when the Evaluation & Management codes came into being. Before that time, medical coding was much vaguer than it is now, using phrases such as “brief, limited, and extended” to describe how physicians should code a visit. That level of detail evolved later in the 1990s, when physicians had to start using rules that felt more like a mathematical exercise in choosing various numbers of elements from different categories than actually caring for patients.

For those who entered practice later, such coding exercises were the norm until the widespread implementation of electronic health records (EHRs), which were in part designed to help free us from those coding burdens. Instead, they brought other burdens, many of which individually might serve to extinguish joy, but that in aggregate, became downright soul-sucking.

Organizations initially implemented EHRs because they thought it was the right thing to do. Along the way, they had to build consensus and achieve buy-in. I think those clinicians had more joy than those who implemented EHRs later, when it was a mandate and there were fewer focused efforts to ensure that systems worked well, or to ensure that users understood what their implementation was supposed to accomplish.

Moving beyond coding concerns, many of us feel that the rise of consumerism in medicine is also somewhat responsible for sending the joy of medicine on the run. I’m not talking about patient engagement and patient empowerment, which are good things. I’m talking about a focus on consumption and an attitude that the customer is always right.

When looking at excessive consumption as a factor, we saw it increase with the rise of insurance premiums, and also with the rise of high-tech medical interventions. I started to hear comments like, “I’m paying a lot for my insurance and I want an MRI to know for sure” even when an MRI was the most expensive test with the least likelihood of actually improving a patient’s outcome. Economic factors aside, there was a point where technology seemed to become a proxy for good care, and where clinicians’ skills, especially those in the realm of physical diagnosis, started waning to some degree.

Patients didn’t want to have their heart murmurs diagnosed by a physician listening to and interpreting a pattern of sounds, which had been the way prior to the invention of ultrasound. Instead, they wanted an echocardiogram so they could know for sure. Parents who previously would have been content with their child’s physician telling them a murmur was “innocent” and would not cause issues instead wanted tests that in turn drove up the cost of care. Clinicians began to over order certain kinds of studies, which resulted in the creation of clinical decision support rules to help them know when tests were indicated and when they weren’t.

A great example is the Ottawa Ankle Rule, which helps rule out clinically significant foot and ankle fractures and avoids unnecessary X-ray studies. Even after explaining it, however, patients still demand films, even though the risk of those films telling me something that I don’t already know is low. And if you are an employed clinician and don’t order the study, you’re likely to generate a patient complaint, which is going to be a problem. You get in the habit of ordering the study “just to be sure” which is not only clinically questionable, but drives up the cost of care.

These things have taken the joy out of medicine, and they are are unlikely to be impacted by AI scribes. I don’t disagree that spending hours documenting makes your job more difficult, and that people don’t like it. But in speaking with physicians who are using AI scribes, I am hearing more stories of late where they’re replacing that documentation time with other clinical tasks rather than truly taking their day back.

One of my colleagues told me last week that he’s still working from home in the evenings, but now he’s using that time to prep charts for the next day and to begin the documentation process for those visits. He wasn’t sure whether that time was showing up in organizational metrics about time spent in the system outside of work since he might not be actively documenting while doing that work. It’s an important point for CMIOs, physician wellness leaders, and other quality folks to look at as they look at how they are reporting on physician behavior before and after implementation of new documentation technologies.

A recent study in JAMA Network Open looked at EHR documentation and improved efficiency for AI scribe users. It found that although there were “reductions in the time spent in the EHR system and time in notes (per appointment),” there were no changes in “after-hours time spent documenting per appointment, mean time to close encounter, mean appointment length, or monthly number of completed office visits.” The study was relatively small and was conducted at a single site over a three-month period in 2024, so it would be interesting to see how it plays out across diverse sites of care or over a longer period following implementation of an AI scribe solution.

We also need a deeper dive into the factors that didn’t change, such as the after-hours work and the time needed to close encounters. Many physicians complain about so-called pajama time when they’re documenting at home in the evening, but if after- hours work didn’t change, do the physicians still perceive that pajama time improved? I would be interested to see some qualitative research overlaid on the quantitative elements to see how those correlate. Are clinicians really satisfied with working the same number of hours from home, or does it just seem different because they’re doing activities other than writing notes?

The authors did note that some subjects “may exhibit an ‘early adopter’ phenotype,” which may have differed from the control group. They also found that measurements of work in the EHR could not differentiate between active work and times when the EHR was open but unused. They also didn’t account for patient-level factors that can influence documentation burden and noted that the study was done at an institution that already had voice-to-text documentation that might have had an influence. I would be interested to hear from others doing similar work if trends show where and how the work shifts when AI scribes enter the room.

Do you think AI scribes are living up to the hype, and will they will truly help put the joy back in medicine? Or are they just the shiniest thing in the room with us now? Leave a comment or email me.

Email Dr. Jayne.

EPtalk by Dr. Jayne 10/9/25

The US federal government shutdown continues, and with it, the loss of payment for telehealth visits for Medicare beneficiaries.

I reached out to a few of my CMIO friends to understand how their systems are addressing the issue. The first health system moved telehealth visits onto the regular schedule by just updating the resource and place of service. It doesn’t sound like it went well. Administrators made the decision without assessing staffing, and although they had enough exam rooms, they didn’t have staff to complete registration or intake functions.

The second organization is honoring scheduled telehealth visits, but is not scheduling new ones. It will absorb any losses that are generated by lack of payment.

The third site is offering patients an in-person visit that is near their scheduled telehealth day at one of its convenient care locations, or a later in-person visit with the original provider. This may work for primary care, but not for subspecialists, although the institution reports that few subspecialists use telehealth. 

From a patient perspective, honoring existing visits but not scheduling new ones is the least interruptive. I’m curious how many other organizations have taken that approach. If you’re knee-deep in managing Medicare telehealth limitations, feel free to weigh in.

Mr. H mentioned this article about the administration’s opposition to private-sector vetting of healthcare AI tools. I see the risk of big vendors sidelining startups, but these organizations are competitive and independent enough that “cartel” overstates it. The Coalition for Health AI lists 3,000 industry partners from big tech, health systems, medical specialty groups, standards organizations, and even startups.

No federal organization is resourced to monitor healthcare AI, which leaves it largely unregulated. Waiting for our elected leaders and their appointees to get something in place creates a lot of patient-facing risk in the interim. Given current priorities, lawmakers are unlikely to address this soon.

Also in the AI realm, a reader shared this piece about how the use of AI tools is impacting energy and infrastructure. For those not familiar with the organization, IEEE is the Institute of Electrical and Electronics Engineers and has its roots in professional organizations of electrical engineers and radio engineers. Its goal is to advance technology “for the benefit of humanity,” and members hail from 190 countries.

The infographics estimate that one day’s per-user consumption of AI resources by ChatGPT, based in 25 queries, is enough to run a 10-watt LED bulb for an hour. Globally, that year of use requires the annual electrical output of two nuclear reactors. The page notes that it’s difficult to calculate these needs because high-intensity queries can consume far more resources. At scale, the numbers become immense. I’ve made a conscious effort recently to only use AI resources when they’re likely to be of more benefit than traditional ones, but it’s hard to avoid the convenience and easy access to AI.

AI research article of the week: JAMA Network Open published an article looking at whether a hybrid chatbot using both AI and rule-based elements can help encourage patients to receive pneumococcal vaccinations. The study was small (under 400 individuals) and focused (Hong Kong residents over 65 years of age), but the authors found that subjects who interacted with the hybrid chatbot, which included real-time answers to patient questions, were more likely to receive the vaccine than those who received a standard chatbot intervention. It will be interesting to see this work replicated in different locales and age groups, although I suspect the results will be similar.

Most consumers don’t read the Terms and Conditions thoroughly each time they sign up for a new online profile or service. We have seen a gradual but persistent devaluing of individuals’ privacy as their data is bought and sold almost constantly. In discussing apps and solutions, I will often ask, “What is your privacy worth?”

A recent class action settlement that involves Facebook sharing user data with third parties puts a number on it of just $34 per claimant. That, my friends, is how much your privacy is worth.

I had a chance this week to visit a former colleague who retired from the healthcare software industry. It was great to hear what life is like on the other side. She and her husband have been traveling the world in a low-key way and sharing most of their adventures with friends and family via social media. They’ve done some cool things, although she mentioned that she didn’t completely leave her life as a road warrior behind because she’s had plenty of arguments with rental car agencies and challenges with airlines.

They say that they would have retired earlier if they had found a better way to buy health insurance before Medicare eligibility. Unless you are a multi-millionaire, that sentiment is shared by millions of workers in the US. The fact that people feel forced to stay in unfulfilling jobs or in bad relationships because of access to healthcare is something to think about.

I didn’t attend last week’s Becker’s Health IT + Digital Health + RCM Meeting, but happened to be in town for a bit of baseball. I was able to swing by a couple of conference-adjacent events. A special shoutout to Ambience Healthcare for putting on an elegant rooftop event complete with ice artists carving the Chicago skyline.

I’ve been to many vendor events, but this one felt different. It had plenty of tables and seating, which encouraged deep and meaningful conversations among people who are working to solve the same problems. There was no loud music to shout over, although there was some occasional chainsaw noise from the artists.

I had a great conversation with someone who is deep into the implementation of ambient documentation solutions at their organization. They invited me to come see it in action, which I might do. Extra points to the company’s marketing team, to Charlotte who kept the event running smoothly, and to whichever marketer decided to use Phineas Gage as a patient name on the company website.

What’s the most creative event or marketing effort you’ve seen recently? Leave a comment or email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 10/6/25

Last week was a busy one. My already packed schedule was hit with meeting requests related to the US government shutdown.

There were discussions whether our organization should continue delivering telehealth services to Medicare beneficiaries. That led to talking about the pros and cons of telehealth in general.

Whether physicians like it or not, patients like it. I can’t imagine going back to a pre-2020 situation where all of our visits were conducted in person. Several of our practice locations added clinicians without adding exam rooms due to everyone having half days in which they deliver only virtual care, so that’s a win for lowering overhead.

Unfortunately, some juggling was needed to accommodate everyone’s clinic schedules, and not every clinician is thrilled. We will have to see how that shakes out over time.

I was also pulled in to deliver some unanticipated patient care after a colleague was injured and her backup was diagnosed with COVID. I did locum tenens coverage for this group and was still listed on their medical liability insurance policy, so I was happy to step in.

The practice is one of a growing number of Direct Primary Care sites, so they don’t have issues with credentialing or billing when they have to bring in outside coverage. It has been quite some time since I’ve used their EHR, but documentation was easy because I wasn’t worried about compliance with coding and billing metrics.

I was surprised by how many patients were more worried about their physicians than their own health issues. Most wanted me to pass along their wishes to get well soon. I’m used to having patients be irritated or annoyed when schedules are altered or delays come up, so it was a refreshing change.

The weekend brought some cooler temperatures in my world. It was time to catch up on yard work, then spend a couple of hours making sure that I can remain a practicing physician in 2026 and beyond. I had to do my state license renewal and my DEA number renewal. I decided to tackle the most recent bunch of “continuing knowledge assessment” questions that released on October 1 rather than waiting until the end of the quarter as I usually do.

I had a little fun with it. I fired up a couple of AI tools to see if one was better at answering board-style questions. I tried a couple of approaches, including taking the question and distilling it down into a concise prompt versus using the question nearly verbatim. Both approaches seemed to deliver the same accuracy in results and took about the same time to provide an answer.

It made me wonder whether physicians who cut-and-paste to get their answers learn as much as those who read the questions in detail and create a custom prompt. I haven’t seen studies that address that specific approach, but it would be interesting to see if retention differs.

I changed my tactic after a few questions, trying to figure out ways to use AI tools while still getting a good learning experience. I used traditional tools to look for the answer, then used AI tools to validate the choice that I thought was correct. This made the process faster even though it took a little longer to create the prompts.

This particular module is pass-fail, but many physicians have that competitive streak and want to have a perfect score. I liked the idea that I was validating my thought process rather than just searching for the answer.

I’m big into environmentalism and sustainability, so I think about the impact of AI tools. A friend recently mentioned data center projects in her state that are being blocked because of environmental impacts. This got me thinking about my own information-seeking behaviors and whether I should be more diligent about using traditional tools where possible rather than just jumping to AI tools because they are at my fingertips. I’m conscious of the environmental impact of products I choose in my daily life, everything from yogurt to sunscreen, so being more mindful about information resources isn’t a big leap for me.

I’m off to Anaheim for the American Academy of Family Physicians FMX conference, which was formerly known as Family Medicine Experience. Unlike healthcare IT conferences, the main stage lineup doesn’t feature celebrities or businesspeople, but actual physicians, including 19th and 21st Surgeon General of the United States Vivek Murthy, MD, MBA. I have to admit I’ve had a little crush on him since he appeared with Elmo teaching us not only how to cough into our elbows, but also about the importance of regular preventive visits and vaccines. You can bet I’ll be in fangirl mode.

Who would you like to see speaking on a conference main stage? What would you like to hear them cover? Leave a comment or email me.

Email Dr. Jayne.