EPtalk by Dr. Jayne 10/2/25

Family members who I talk to about AI are usually surprised to learn that it’s being used in healthcare. They assume that regulations for its use must be in place. I explain the threshold for when software becomes a medical device that is regulated, but I’m not sure that resonates with the average patient.

The conversation frequently morphs into the fact that AI is everywhere, and has been to some degree for a long time, but people are mostly worried about generative AI solutions. Many other advanced technologies have been introduced in healthcare, such as brain-computer interfaces, but I’m not yet ready to bring those into the conversation with most of my relatives.

From Apple Fan Boi: “Re: Apple in hospitals. Did you see this article about hospitals finally ‘seeing the light’ with regard to Mac usage for clinicians? Now I just need to talk my CMIO into enabling me.” After spending the majority of my career on Windows-centric hospital platforms, I was surprised to learn that Emory Healthcare runs an all-Apple hospital. The 100-bed Emory Hillandale Hospital in Lithonia, GA is running the full spectrum of Apple devices everywhere, from the nursing station to the clinicians’ wrists. I would be interested in hearing from anyone who is directly involved in the project, whether behind the scenes or in an end-user capacity. As expected, the Apple article made it sound like the ultimate experience, but I’ve seen enough vendor-published pieces to know that reality is usually somewhat different from what that kind of article describes.

I spotted this article from last week that looked at the privacy concerns that are associated with brain-computer interfaces. They can be used to facilitate communication by patients who have difficulty speaking and writing, but require large volumes of neural data. The article summarizes ethical concerns with such data and whether patients understand the privacy elements that they give up when sharing this information with manufacturers and researchers.

Plenty of articles have described being able to infer the activities that couples might be participating in based on publicly shared biometric or wearable data. I hadn’t seen much written about brain data and its ability to predict certain diagnoses or the risk of declining function.

The article mentions that Chile became the first country to specifically protect neurodata and mental privacy, through an amendment to its constitution in 2021. The US has no federal laws around this, but legislators and the American Medical Association have expressed interest in developing a protection strategy.

It will be interesting to see how these privacy movements advance over the coming months and years and if consumers will be as willing to give up their mental privacy as they are in giving up data about their shopping, web surfing, and other habits through the countless apps and websites that people use almost continuously.

One of my former consulting colleagues reached out to ask for a curbside consultation on tick bites and the Powassan virus, which was recently found in a human in Illinois. The virus can cause brain swelling and there’s no specific treatment for it, so prevention is the best way to address the situation. My colleague was being asked to run some reports on his EHR database to find patients who might have had the condition without being diagnosed. His practice is big enough to support a “data guy,” but not big enough to have a CMIO or dedicated clinical informaticist, so I was happy to point him in the right direction.

Ticks spread plenty of other diseases, including Rocky Mountain Spotted Fever, ehrlichiosis, and Lyme Disease. If you’re going to be outside this fall, consider long sleeves and long pants as well as repellent sprays.

Removing a tick within 24 hours of attaching lowers risk. If you hesitate to visit a physician or urgent care for help with removal, many of us have seen tick bites on nearly every part of the body and we’re happy to take care of it for you rather than have you increase the risk by waiting. We’ll even tag and bag the tick so it can be identified and tested if needed.

We also have SpongeBob bandages in our cabinets this month. I wonder whether our usually beige-loving supply chain person was feeling whimsical or if the character version was just cheaper.

In my role, I don’t follow Medicare happenings as closely as I used to. Therefore, I wasn’t fully up to speed on the fact that the Medicare ACO REACH (Realizing Equity, Access, and Community Health) model will end on December 31, 2026. The program delivers value-based care to patients with traditional Medicare and encourages physicians and healthcare delivery networks to better coordinate care delivery, improve outcomes, and manage costs. The 160,000 providers in the nation’s 103 programs will need to decide whether their ACO will transition to a different ACO model or wind down.

ACO REACH is notable for its focus on health equity and a track for medically complex patients. Other elements made it more attractive to smaller provider groups compared to the larger CMS Medicare Shared Savings Program ACOs. If you work for an impacted organization, we’d love to hear your thoughts.

I’m behind on some continuing education requirements, so I’ll need to buckle down this week and get them completed. When I was thinking about obtaining my second board certification, I was more worried about learning the material and preparing to pass the exam than I was about what Maintenance of Certification would look like over the next couple of decades. It feels like I’m in an endless cycle of quarterly questions that are coming from multiple directions, and unfortunately, 80% of the material that I am quizzed on isn’t relevant to my scope of practice or work. 

I understand that we are being held responsible for being well-rounded subspecialists, but I’d rather be spending my scarce free time reading material that would help me do my actual job better rather than frantically searching for answers to clinical scenarios I haven’t encountered in 20 years and will never encounter again.

How do you like to demonstrate lifelong learning? Do you prefer self-directed study or third-party accountability? Leave a comment or email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 9/29/25

We are approaching yet another threatened US government shutdown. In the virtual physician lounge this weekend, the hot topic was the telehealth mess that a shutdown would create.

Congress has not agreed on temporary funding for that modality, and the deadline is Tuesday at 11:59 p.m. Last Friday at 5 p.m., a colleague at a local institution received a message from the “administrator on duty” that encouraged clinics to move telehealth visits to in-person types. The timing shows little understanding of how medical offices run. Hordes of schedulers are not standing around at the end of the workday looking for things to do.

My colleague also lacks space in the clinic to convert those visits to in-person since his telehealth hours overlap with times when three other clinicians are occupying the practice’s exam rooms. Rescheduling into available space would require double-booking, which harms both the clinician and care quality, or pushing patients four or more months out.

US healthcare decision makers often miss the value of long-term policy and the realities of frontline delivery. A quote from one of my favorite movies is street racer Dominic Toretto saying, “I live my life a quarter mile at a time.” Many of us in the US healthcare system are unfortunately living our lives one Congressional budget cycle at a time.

I envy other parts of the world that take a longer view in the policy process. It’s not only in healthcare. As an avid outdoor enthusiast, I recently read an article about New Zealand and its 50-year plan to control invasive wild pine trees. The country has reached a consensus on the hazard that specific pine species create. It is working in a coordinated way to manage the issue while limiting the cost of the program and protecting the specific segments of the economy that would have been negatively impacted by expanding invasive species.

It’s the old “ounce of prevention” adage that makes both logical and financial sense, but is often lacking here in the US. Just thinking of some of the healthcare policies I’ve seen during my career makes me cringe. Medicare at times wouldn’t pay for diabetic testing supplies, which can help patients manage their blood sugars and prevent complications However, they would pay for the complications. That makes no sense at all.

I’ve spent the last couple of decades working on projects using Lean methodologies and creating cultures where continuous improvement and long-range planning is the norm. I’ve attended countless courses that addressed building high-performance teams and figuring out how to achieve consensus and move forward around specific clinical goals. 

I’ve seen that mindset do amazing things in healthcare organizations. I have watched teams continuously deliver results that initially seem impossible, to the credit of the principles of incremental change as part of a bigger effort, continuous improvement, and having a genuine desire to make things better. It’s been a privilege to work on so many high-performance teams, although I’ve certainly worked on some that haven’t been models of peak performance.

The most challenging teams I’ve worked on have been those that set ambitious goals without curating the teams that are charged with meeting them. They may take an existing team and assign tasks on top of their regular responsibilities, which isn’t a recipe for success.

Another common pitfall is to expect the team to not only be good at their principal areas of expertise, but also to be great at project and program management. I’ve seen multiple teams fail when they didn’t have the management support to keep tasks on track, ensure that project milestones were being accomplished steadily, and keep their efforts within budget.

I also see teams that focus entirely on the end point while forgetting that the team is made up of individuals who have needs of their own. Whether it’s a need to understand the “what’s in it for me” related to a project or a need to have some semblance of work-life balance, good leaders make sure that they not only understand the needs of individual team members, but that they are doing their best to ensure that those needs are met.

I feel particularly privileged to be working in my current environment, where the team and its leadership truly care about each other. During my career, I’ve been in plenty of meetings with the usual “what did you do this weekend” kind of small talk while everyone is gathering, but often there’s a sense that people are just talking to fill the time as opposed to really being interested in what is going on in the lives of their colleagues.

I recently had an experience where a colleague reached out on Slack to ask me about a personal event that I had mentioned in small talk several weeks prior, wanting to know how it had gone. I was humbled by that, by the idea that someone would care enough to remember the comment for a couple of weeks (or make note of it) and then take the time to reach out to ask about it. That kind of colleague interaction is worth its weight in gold. It is so different from what I often see elsewhere, which is a group of people just trying to get through the day, week, or month and not really building relationships.

I’m also impressed by leadership that wants to make sure that employees grow regardless of where they are in their careers. It’s common to see professional development for those early in their careers, but by mid-career, sometimes there’s an assumption that we already know what we need to know and just need to go about our work.

I was recently asked to put together a real professional development plan for myself, not just as a box-checking item in the annual corporate process. I was shocked. The idea of getting asked the equivalent of what I’d like to be when I grow up, at this stage of my career, really made me think. I’ve had loads of experiences, but the idea of being able to learn or do things that haven’t crossed my path yet was refreshing. It caught me off guard, and I’ll have to do some focused thinking about the question.

As the new federal fiscal year begins, and as the calendar-year fourth quarter starts for many of us, what is your organization doing to develop and retain people? Leave a comment or email me.

Email Dr. Jayne.

EPtalk by Dr. Jayne 9/25/25

Autumn has arrived in the US, and with it the corporate compliance season. Nearly all the companies I’ve worked for do their mandatory training programs in September, October, and November, so I’m getting hit from all directions.

For those of us who have a patchwork of clinical employment and appointments, it means doing training programs from different entities. There is no single national training or certification that everyone can follow.

I’ve done four “Medicare Fraud, Waste, and Abuse” training programs in the last week, and I am at the point where I could teach the class. Online offerings range from “read this document and take a quiz” to videos that have to be watched at normal speed and in one sitting, which adds to the frustration.

Just one of my employers offers a choice of modalities (video versus reading a transcript), which highlights the fact that we need better recognition of different learning styles when we’re considering our corporate training offerings. Today I’m planning to tackle all my HIPAA training, so wish me luck.

It’s also the time of year when organizations update their ICD-10 codes since updates, additions, and deletions become effective on October 1. Changing codes is usually invisible to users, although depending on the EHR and revenue cycle management systems, a fair amount of behind-the-scenes work can be required.

Ideally, the transition involves more than just code changes. Coding and billing experts should ensure that providers understand the nuances of the annual changes. They should share that information with end users in the weeks leading up to the transition date.

Early in my informatics career, it was my job to write the provider bulletin that would highlight some of the new codes. Although that was important work at the time, in hindsight it seems a bit dull compared to the AI projects and large strategic projects I’ve had my hands in more recently.

Details about disbursement of the recently approved $50 billion in assistance for rural health projects are becoming public. The initial phase has states applying for funds that they can then use to augment their own rural health initiatives.

It’s always interesting to see how things go once the money starts flowing. Several states where I’ve lived practiced the bad habit of accepting federal funds for something and then cutting any pre-existing state funds. That doesn’t do much to move projects forward compared to applying federal funds in addition to existing state-level funding.

Rural health varies widely across the US. Some states have many rural health facilities, while others have few due to denser populations. How the funds are allocated will be telling.

The program has five strategic goals that vary in their vagueness. They range from “make rural America healthy again” to “workforce development.” States will employ different approaches to goals like workforce development, recruiting, and retention given the challenges of working in a rural environment.

I’ve practiced primary care in a rural setting and it is daunting. Being a family physician without a lot of subspecialty support requires you manage more conditions than in a suburban environment or at an academic medical center. Some of my rural friends are on call nearly 24/7, which is not necessarily attractive to new graduates even though they might find the environment both challenging and rewarding.

Increasing pay, not only for physicians but for all members of the healthcare team, would improve recruiting. It would require more than $50 billion to do that in a meaningful way in the US.

Other somewhat nebulous focus areas involve “the growth of innovative care models” designed to improve outcomes and “promote flexible care arrangements.” I’m hoping that these phrases aren’t used to advance programs that lead to increasing numbers of less qualified providers in rural areas. A couple of states have put together programs to increase access that allow physicians who are not fully licensed to practice in rural areas.

As someone who did a specialty residency in primary care, I would argue that just because one graduates from medical school doesn’t mean they are qualified to care for patients in the rural environment. I come from a long line of rural folk and have seen the health challenges they face. We need to make sure that we are incentivizing our best and brightest to go to those areas rather than just trying to supply warm bodies with incomplete training.

There is room for innovation in telehealth, team-based care that might involve subspecialists consulting remotely and other worthwhile areas. I hope we see plenty of those in funding proposals.

States must submit applications in by early November, so the timeline will be tight since awards will be announced by the end of the year. Are you involved in proposal submissions? What kinds of projects are on your wish list? Do you think your odds of being funded are good? Feel free to leave a comment or drop me an email.

A recent study caught my attention. It highlights how low-tech interventions might be better than high-tech ones. It found that when trying to identify health-related social needs such as housing instability, transportation needs, or food insecurity, simple questionnaires were more effective than advanced machine learning techniques. Using a combination was even more effective. The study examined 1,200 patients from two health systems in Indianapolis and included techniques such as using natural language processing of clinical notes to identify health-related needs.

Many of the clinicians who practice the US were trained in an environment where social determinants of health weren’t routinely covered. They have gradually been added to curricula, as research has shown that the environments in which people live and work have a significant impact on health outcomes and quality of life.

Some of the elements of the rural health initiative should help address this for patients who live in those areas. But we also need more support for urban populations that are dealing with similar challenges and others such as increasing levels of gun violence.

Is your organization working on initiatives to improve health in a particular community or trying to do so across the board? What are your priorities for these efforts in the coming year? Leave a comment or email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 9/22/25

I am always up for a good read. I tend to read more fiction than anything else, but a couple of non-fiction offerings caught my eye recently.

“Superbloom: How Technologies of Connection Tear Us Apart” by Nicholas Carr came out earlier this year. It takes its title from a botanical event where a significantly higher than normal number of wildflowers bloom all at once. It usually happens when there are unusually wet conditions and seeds that have been dormant are able to come to life.

The superbloom mentioned in the book happened in California’s Walker Canyon in 2019, leading to numerous social media posts around the hashtag #superbloom and a boom in photos that went viral. The phenomenon and widespread promotion of the event drew thousands of visitors to the site and led to massive traffic jams, public safety issues, and damage to fragile ecosystems as people rushed to the area and shared posts about it on social media.

The author looks at the phenomenon and different aspects of internet-based communications and social media, countering the idea that increased communication pathways are good for society. Carr gives a history of media and communication technologies, going back to the days when movable type made mass printing a viable option. He covers the birth of the telegraph, evolution of telephones and radio, and the explosion of TV and internet.

It’s a wide-ranging discussion of how technology impacts society, changes culture, and can create division rather than bring people together. He discusses how being constantly connected can make people feel isolated and how the internet can create vast echo chambers that encourage the dissemination of hateful content.

Carr spends a significant amount of time talking about the evolution of Facebook, and in particular, the creation of its newsfeed. The platform’s users are not only the audience, but also the content creators, and ultimately a product sold to advertisers. He discusses research that looks at why increased time spent on social media makes people less empathetic.

Interesting tidbits: The phrase “social media” was first documented in the 1800s. Radio transmissions were largely unregulated until the Titanic disaster, when private radio operators interfered with the rescue, an early example of “fake news.”

I have a bad habit of seeing or hearing about a book and adding it to my reading list without making a note about who recommended it or why I wanted to read it. “Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Care” was one of these. I added it to my library hold queue at some point and was a little surprised when it turned up on the shelf.

Still, it sounded good. I was excited to read it until I saw that it was published in 2012. I decided to read it with an eye towards understanding how far we’ve come since, although as I got into it, I quickly realized that we haven’t come very far at all.

Author Marty Makary introduces himself as a medical student who left medical school during his third year, disillusioned with the “dangerous and dishonest” behaviors that he saw during his training. He began graduate work at the Harvard School of Public Health and quickly fell into the movement around quality measurement as a mechanism of healthcare improvement. He returned to medical school after a year and began residency training in preparation for a career in surgical oncology.

On page 2 of the introduction, he describes “patients increasingly fed up with a fragmented healthcare system littered with perverse incentives,” which is what grabbed my attention in making me feel like we haven’t come far at all.

He describes situations where dangerous attending physicians aren’t confronted due to hospital politics. That still happens, although at least in my area, it seems to be less of a factor than it was when I first entered practice. He talks about patients winding up at hospitals that aren’t a good fit for their specific medical needs. Although there might be more transparency now with hospitals reporting quality measures and payers publishing that data, it still happens quite a bit due to the narrow networks that many insurance plans create.

Even today, people are talking about patient choice and how important it is for patients to do their research. However, when you are facing an expensive procedure, many in the US make their decisions on where to receive care based on insurance coverage and financial necessity.

He hits on one of my pet peeves, which is hospitals that shamelessly self-promote by naming their own departments “centers of excellence” without actually being accredited or recognized by an independent third party for any specific level of excellence. He puts it right out there: “Patient satisfaction surveys do not capture quality medical care, and ‘top’ scores and rankings in magazines are often paid for.” On these points, nothing has changed in the last decade.

He is open about his role in a few episodes of poor care. I admire his willingness to share this information since many physicians wouldn’t write about those events in a non-protected document. He looks at those episodes of care in a systematic way and identifies how individual decisions can be influenced by systems failures.

One passage in the book gave me a flashback from my own medical training. I was a lower-level resident on call, and the senior or supervising resident failed to provide the backup support that they should have. In my case, the resident told the interns not to call unless something was “really bad,” but didn’t give us any definition of the term.

In Makary’s case, he called his senior resident, who told him to go back to handling his workload (even though what is described in the book is more than one physician should be managing at a given time unless you’re in a disaster situation).

He goes on to skewer some of the same things that we are still skewering, including inflated CEO salaries. He takes particular issue with hospitals that aggressively fundraise from the public while spending money on all kinds of things other than actually treating patients, and finds it “unethical to raise massive monetary surpluses from local schools and charities while making cutbacks to frontline workers.” There’s still plenty of that going on these days.

He also laments “the culture of doing stuff” that is still pervasive in certain subspecialties, although the quality movement and greater patient advocacy are helping chip away at that trend.

Parts of the book were dated, but it still served as a good reminder that there is much work to be done in healthcare and that we need good and thoughtful people to do it. Overall, I’m glad I read it.

What nonfiction book would you recommend to a healthcare or technology colleague? Leave a comment or email me.

Email Dr. Jayne.

EPtalk by Dr. Jayne 9/18/25

This week marks the fifth annual Telehealth Awareness Week with the American Telemedicine Association hosting numerous online events. Many of the clinicians I know didn’t have any awareness of telemedicine prior to the COVID pandemic and some of them had to be diligently persuaded to offer video visits. I had been doing telehealth work (both on the IT side as well as clinically) for several years prior to its significant expansion in 2020, so I was used to working with that modality and was able to do some provider coaching and education when things started getting busy. It’s important to remember that there are many different varieties of telehealth beyond the traditional patient/provider video visit. I’ve worked with organizations using telehealth for referral/consultation visits where the referring provider is in the room with the patient, for physician triage in the emergency department, for additional expert coverage in the intensive care unit, for lactation support, and more. The benefits of a well-run telehealth program are substantial, and I hope organizations continue to refine their telehealth offerings.

In celebration of the event, I’d like to share a classic article from Smithsonian Magazine, which reports that the idea of telemedicine was initially predicted in 1925. Radio pioneer Hugo Gernsback envisioned a device called the “teledactyl” that would allow physicians to view patients but also perform remote examinations via robot arms. As I read the article, I noted the similarities between this and surgical robots, which can be used to perform surgery when the surgeon is at a remote location. The article is a quick read and there are some links to similarly interesting articles at the bottom detailing “The iPad of 1935” and “The Episode Where George Jetson Rages Against the Machine,” which covers some topics that are still relevant more than a decade after the piece was written.

Speaking of TV, I’m a big fan of the show “Call the Midwife,” which depicts community-based nurses and midwives in London’s East End from the 1950s to the 1970s. The series’ writers do a great job showcasing different healthcare events of the various eras including major happenings such as the availability of oral contraceptives and the injuries caused by the drug thalidomide. It’s a window into how healthcare has been delivered in the home and how having nurses and physicians who actually know their patients can make a difference. Although a lot of health systems are expanding home health offerings, including “hospital at home” efforts, they still feel more fragmented than the community-based approaches with which patients may have even more benefits. Since the midwives in the show support home deliveries (as well as ones at the community maternity hospital), they also provide postpartum care in the home, so a recent article about “How home-based postpartum care could improve health for women and children” caught my eye.

It looks at how home visits can support patients who just gave birth as well as their infants, how they can improve breastfeeding outcomes, and how they can reduce emergency visits. I always think about the fact that in the US you have to take a test (both written and skills-based) to become licensed to operate a motor vehicle, but it’s assumed that everyone has the skills to take home a newborn without any formal training or scheduled support. Things may be different in situations where new parents live close to family members or have community support, but I often encounter new parents who feel like they’re adrift and end up having an urgent care visit to try to make sense of what’s going with their own body or with their infant.

The article mentions a 2024 study that looked at newborns and caregivers in South Carolina and found that those participating in a home-based program had fewer emergency department visits in the first twelve weeks postpartum than those who weren’t in the program. It also mentions lower costs and better outcomes for infants receiving home visits. I don’t see a lot of insurance companies advertising these kinds of benefits, so if there are readers whose organizations are involved in similar programs, I’d love to hear your thoughts.

There have been a few studies looking at the number of problems a patient mentions at the average primary care visit compared to the number of problems documented in the medical record and the number of diagnoses that make it to the billing screens. In general, physicians talk about more issues than they document, and bill for even fewer. A recent article in JAMIA titled “Comparing patient-reported symptoms and structured clinician documentation in electronic health records” caught my eye. I agree with the authors as to the importance of these types of information, especially with the focus on real world data, which relies on what is documented in EHRs. Patient-reported outcome measures (PROMs) are a way of getting more structured data into the chart rather than relying on clinicians adding structured elements as they gather the patient’s story. The authors set out to see how symptoms reported via PROMs compared to those reported by clinicians via EHR data entry.

The study looked at 913,000 adult primary care visits for “annual physical” done between January 2019 and December 2023. With that specified visit type, there should have been a lot of preventive care going on, with possibly a smattering of chronic condition management depending on how strictly the clinicians interpreted the concept of the annual physical. Regardless, most visits have a Review of Systems that is designed to elicit additional symptoms beyond what the patient volunteers as part of the History of Present Illness, and one would try to document them accurately. Unsurprisingly, the authors found that patient-reported symptoms for some conditions (joint pain, headache, sleep disturbance) were more numerous than those reported via clinical documentation. However, other symptoms had a higher frequency via clinical documentation (anxiety and depression). Researchers noted that “agreement between symptom self-report and clinician-documented structured codes was low to moderate.”

Most medical studies need to be replicated across diverse populations and in different care settings in order to have maximum validity. They also often lead to discovery of additional questions that need to be researched. Given the push for ambient documentation across all facets of healthcare today, one could hypothesize that ambient should do a better job of helping clinicians capture all the symptoms that patients report. I’d love to see this research replicated in an organization that is exploring the use of ambient documentation tools and perhaps comparing two sites that have the same EHR setup, but only one has access to ambient documentation tools. I think it would make for a fascinating read. I’d also be interested to see whether organizations that use tools specifically designed to capture PROMs have better agreement with clinical documentation, especially if they have workflows where the patient-generated data is reviewed as part of the visit. If you’re doing work using patient-reported outcome measures, I’d love to hear from you.

What’s a topic that you really wish healthcare technology researchers would sink their teeth into? Leave a comment or email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 9/15/25

I recently got together with some of my longest-standing healthcare IT colleagues. We were reminiscing about “the good old days” when health systems implemented EHRs because it was the right thing for patients.

Our organization took that further. We knew that when we could better demonstrate that we were doing the right thing for patients, we could legitimately claim top-decile quality. 

Our health system was supportive of the effort. It believed that proving better care and lower costs would justify higher contracted rates. We had seen similar moves by organizations that had already ditched paper charts, and we were impressed by their ability to generate quality data without expensive manual audits. We wanted those successes.

A couple of offices had chronic problems with “missing” charts. One file clerk spent most of her day looking for charts that had last been touched by a specific provider. It turns out that he was taking charts home to complete his documentation. Sometimes they would be in the trunk of his car, sometimes at home on his dining room table.

It’s funny that so-called pajama time documentation predated EHRs, but I’m sure fewer people were taking physical charts home. Most likely they just stayed at the office to do the after-hours work that is often required to care for patients.

When we implemented the EHR in his office and couldn’t find charts to scan, we became the bad guys for identifying the problem. Until then, his office manager covered for him, which is amazing in a post-HIPAA world with charts being left on a dining room table where a family member could browse.

We also reminisced about the vendors we had worked with over the years, some in a good light and some with less than positive sentiments. All of us had encountered unscrupulous sales reps, vaporware pitched as real, and systems that didn’t remotely perform as advertised.

Initially, all of the companies we worked with on our EHR project were publicly traded. That gave us visibility into the financial health of the company and whether it was likely to be around to support us in one, three, or five years. This was before health tech unicorns were even a thought.

In retrospect, I’m glad we were doing our project during that time. It was hard enough to deal with the operational challenges and trying to perform clinical workflow transformation magic without worrying that a vendor was spinning nonsense or likely to go out of business mid-implementation. This has become much more difficult during the startup era, as we’ve seen so many companies deliver empty promises that eventually translate to negative financial margins.

We talked about the vendor executives we’ve worked with. The industry has archetypes – the wild dreamer, the steadfast engineer, and everything in between. There are those whose actions stick with you because their way of conducting business was so impossibly bad.

I remember one executive who tried to tell us that as customers, we were at fault for his company’s defective software because “your thinking is constrained by the technology of today.” Unfortunately, that happened at a point in my career where I hadn’t fully honed my poker face and was irritated on behalf of my physicians. I’m told him that it wasn’t about my thinking, but his half-baked tools that made caring for patients harder.  

I remember one vendor exec who used the word “synergy” every few minutes in a way that wanted me to channel my inner “The Princess Bride” with a response of, “You keep using that word. I do not think it means what you think it means.” Among this small circle of healthcare IT friends, I can make them laugh by simply making a hand gesture that one vendor executive made all the time, as if a professional coach told him to do it regardless of whether it was appropriate to the situation.

Some executives went above and beyond to care for customers. They provided daily updates when things weren’t going well and took personal accountability to ensure that solutions were delivered.

We worked with one vendor that had members of their support, product, and development teams camped out at our facilities for weeks following a challenging upgrade. I’m proud to be friends with some of those folks to this day, and I am grateful for a partnership that was deeper than today’s vague use of the word. Sometimes it’s the little things that make a difference, and knowing that someone is trying to make things right is worth its weight in gold.

Ultimately, our conversation landed on the idea of integrity and the vendors that were honest even when it was difficult. It’s sometimes challenging to tell the truth when it puts you or your company in a bad light. Too many people sacrifice the truth to stay liked or to avoid de-installs. 

I’ve also run across a couple of companies that are so morally and ethically focused that it makes you think twice, because consistently taking the high road is something that feels like an exception rather than a rule. I’ve come out of a handful of meetings during my career where I’ve wondered whether I was in some kind of alternate universe, but in a good way. Those situations are rare, but I’m grateful to model them in my own work.

Among my group of friends, we have well over 100 years of healthcare IT experience. We thought of the advice that we would give to the current crop of vendors that are trying to earn our business. The concept that resonated the most was that of honesty, being willing and able to tell the truth even when it is difficult or unflattering to the company. 

Sometimes good people make decisions that hurt others. Simply admitting what happened goes a long way, whether it was personally your fault or not. We respect leaders who say “I am sorry” more than those who make excuses or go silent hoping things blow over.

In a complicated industry, plenty of companies could benefit from adjustments to what they think is business as usual. As a decision-maker I’m glad to steer business to those who do right not only by their customers, but by patients.

What is your most memorable example of vendor integrity? Have you worked with a company that stands head and shoulders above the rest? Leave a comment or email me.

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EPtalk by Dr. Jayne 9/11/25

Most of us have seen images created by AI, whether we realize it or not. Sometimes they’re easy to spot, such as when people don’t have the correct numbers of digits or have atypical facial expressions.

Those who use stock images in their work rather than AI-generated images may have higher quality options, but a recent article in Hypertension looked specifically at the accuracy of images that are used to educate patients on how to monitor their blood pressures outside the medical environment.

The authors visited the websites of 11 major online stock photo providers and analyzed the first 100 images on each after searching for the term “blood pressure check.” They found that only 14% of the images were accurate as far as the patient being correctly positioned and with an appropriate device, but scores ranged from 7% to 28%.

Some of the most common issues were patients whose backs weren’t supported, feet weren’t on the floor, forearms weren’t resting on a surface or level with the heart, and legs were crossed. The authors call for better education, not only for patients, but for media organizations and website developers.

From Patagonia Sweater: “Re: professional attire. Right after I saw your mention about that and the role of white coats last week, my office administrator shared this article about the potential for medical coats to aid in the spread of drug-resistant infections. Nearly everyone in my office wears a monogrammed jacket courtesy of our academic department. Unlike white coats, the heathered appearance makes it much harder to tell if they’ve been cleaned lately so I think there’s a bit of an “ick” factor there.” The study looked specifically at contamination of healthcare personnel gowns (as they are called in the country where the study originated) by gram-negative bacteria and the relationship of that contamination to growing antimicrobial resistance. The observational study looked at 321 hospital workers and found a contamination rate of 61% for the gowns, with medically important bacteria found more often on those worn in operating suites and intensive care units.

The authors concluded that healthcare personnel gowns are a significant reservoir of pathogenic bacteria at the hospital in question. They stated that “It is essential to implement infection control strategies that include improving the cleaning and laundering of gowns and ideally eliminating them from clothing to reduce the risk of transmission of nosocomial infection.”

There’s some irony to this when you consider the origin of the white coat as mentioned in the article that such attire has “been considered a symbol of authority, respect, cleanliness, neatness, commitment to health, and perceived patient safety” and that it dates back to the 1800s when Joseph Lister promoted its use during surgical procedures as an element to combat the presence of germs.

From AI Skeptic: “Re: AI. I’m one of the curmudgeons sitting in the back row and eating popcorn while waiting for the AI bubble to burst. There have been examples of AI creating bogus citations for scholarly articles and legal filings, but I got a kick out of this piece that looked at how an AI tool flagged journals for ‘questionable’ conduct.” The article proposes that making use of the algorithm “could help scientists avoid publishing in shady titles.” The underlying study looked at 15,000 open access journals to identify those that could negatively impact scholarly work by prioritizing profits over scientific integrity. More than 1,000 journals were flagged as potentially problematic. 

The work is receiving praise from organizations that promote quality and transparency in scientific publishing. The article mentions shifts in publishing business models, where authors pay a fee so that their articles are free to read, and notes that such a model has created incentives to publish high volumes of papers fast at the expense of ensuring quality. 

That last sentence really resonated with me. I’ve seen too many examples lately where quality is being devalued in favor of incentivizing other factors, such as patient reviews, facility aesthetics, and speed of treatment. No one wants to spend more time waiting around for healthcare services than they have to, and inefficient processes are maddening to me whether I’m wearing my patient hat or my physician hat. However, I also don’t want to be rushed through the care process by an organization or care team that’s cutting corners because they’re trying to meet an outsized metric.

The article mentioned that the algorithm isn’t as strong as it could be, noting that there were 1,700 false negatives, but also some false positives. Attempts to tune the model weren’t as effective as they hoped. Researchers in the field note the need for ongoing development of the model in order to combat unscrupulous publishers who change their titles or processes in an attempt to avoid being identified. The article notes that such publications will persist as long as research institutions base tenure and promotions on the number of papers published.

I’m always on the lookout for articles about wearable health devices. This one brought up a point that I hadn’t thought of previously. One of the physicians interviewed commented that, “When you become too dependent on what you perceive to be objective data … you lose a certain relationship with your body, such that it becomes hard for you to discern how you feel apart from what a device is telling you.”

We as physicians are always counseled to treat the patient, not the numbers, as a way of reminding us that we need to look at the entire picture of a patient’s history, symptoms, and exam and not just lab values. Maybe we need to incorporate some similar messaging into the conversations we have with patients about the best way to use health trackers in the real world.

Speaking of wearables, I’ve written previously about the Oura Ring, but a recent item mentions that the new facility in Forth Worth, TX is needed to support the company’s expanding relationship with the US Department of Defense, which is referred to as the company’s largest enterprise customer. The partnership has been around since 2019 and focuses on stress management, resilience training, fitness optimization, fatigue risk management, and early illness detection. The Texas facility is being purpose-built to fulfill defense orders and will have additional security.

I reached out to some active-duty military personnel, including ones for whom disrupted sleep is the norm. It sounds like the decision to purchase them is handled at the unit level. One officer mentioned that although he has heard about it, he’s never seen one in the wild.

Another mentioned that some human performance staffers showed interest in obtaining them, but it was determined to be a questionable use of funding, noting that “people who work in a SCIF (Sensitive Compartmented Information Facility) are probably most likely to be stressed, but can’t wear one. Nor can those at high risk of fatigue, such as air crew and special operations personnel.”

I would be interested if other military folks would like to weigh in. If you’re an Oura user and you feel that the device is making a difference for your health and well-being, give us a shout.

Do clinicians in your organization recommend fitness trackers or other wearables for patients? Have you used one to help manage your health? Leave a comment or email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 9/8/25

Several readers have reached out about my recent piece that mentioned cell phone bans in schools. One reader shared an article that cites outcomes data from high school that had a previous ban in Texas, which has banned phones for all public and charter school students this year.

That school saw increased student participation and reduced student anxiety, in part due to students not being “afraid of being filmed at any moment and embarrassing themselves.” As a proud member of Generation X, I’m glad that our failures and missteps weren’t captured for wide digital dissemination and that those awkward moments passed fairly through the word-of-mouth rumor mill compared to the permanent records that young people can be stuck with now.

Still, there are concerns about enforcing the bans, especially if not all teachers are on board. It reminds me of the many work environments I’ve been in where personal cell phone use is supposed to be banned, but where compliance is minimal. It creates a different power dynamic asking healthcare workers to police each other versus in a school, where teachers are clearly the authority in the classroom.

Personally, I’d rather see a lot less use of cell phones in most environments, whether it’s having staff in the emergency department who are too engrossed in their phones to respond quickly to rapidly changing situations or whether it’s people who nearly walk into you on the street because they’re heads-down on their phones.

One of the key reasons that parents oppose cell phone bans is their inability to reach their students during the school day. Although I’m tempted to cite my own bias in that millions of us survived not being reachable 24×7 by our parents (and actually enjoyed that freedom), I can see the point that parents are trying to make. One reader shared a savvy way of avoiding the ban by creating a shared Google document with their child, where the parent and child were effectively messaging back and forth all day since the student’s school encourages nearly all work to be done on school-issued Chromebooks.

Another reader shared an article written by a physician-professor who banned cell phones from the classroom. I found it interesting that the author is a professor of medical ethics and health policy, areas where there is usually a lot of deep reflection on whether or not we “should” do various interventions and also on whether certain interventions should be required. Dr. Ezekiel Emanuel teaches a course to undergraduate, MBA, medical, and nursing students and has been doing so for 10 years. Last year was the first with a cell phone ban, however, and Dr. Emanuel notes that course evaluations were better than previous years.

I found it interesting that it wasn’t just cell phones that were banned. Students couldn’t use computers to take notes unless they were using a device where they would write with a stylus. There was an exception for students who might be waiting for a critical phone call, but otherwise, phones had to be out of sight.

Additionally, the classes were recorded, and transcripts were accessible to students in addition to their personal notes. At the beginning of the semester, Dr. Emanuel presents data comparing notes taken by hand to notes taken by computer and how handwriting your notes forces the writer to mentally processing which elements are worth writing down, which improves retention.

As you might expect, this made me think about ways that might parallel what we’re seeing with AI, whether doing the research helps your brain build better patterns for information retention than if you just ask a question and get the answer via AI. (I won’t go into the potential risk of using AI to get a wrong answer and baking that into your mental model.)

There is also discussion of how cell phones can be distracting even if they’re face down. I’ll admit that I wasn’t familiar with that research. I’m not one who typically leaves my phone on the desk, but I can see how it could be distracting, and the literature backs that up by showing that students whose phones were out of sight performed better on memory and attention testing than those who had phones visible. Those who performed best had their phones in a separate room.

Another reason cited with data is the ability of smartphones to negatively affect in-person social interactions even when not in use. I’ve certainly experienced that and dread having to meet with relatives that are constantly on their phones or staring at them on the table.

Dr. Emanuel mentions the bans at the primary and secondary school levels, but found only one college that had an institution-wide phone ban, going on to note that “while most college students are legal adults, neuroscience teachers us that they are not biologically adults. Their prefrontal cortices, the part of the brain that controls planning, executive functioning, and risk taking aren’t fully developed. They sometimes exercise poor judgment, act impulsively and make decisions that damage their social relationships and learning.”

Recent studies have looked at whether “AI is making us dumber.” I would be eager to see one that examines different age bands within the young adult population to see whether certain groups are more negatively impacted.

At the University of Pennsylvania, where Dr. Emanuel teaches, students in the religion class “Living Deliberately: Monks, Saints, and the Contemplative Life” are asked to give up their phones for a month as part of the curriculum. I certainly appreciate the value of being off the grid and do it regularly when I’m hiking or camping, but that would be a pretty significant sacrifice for the average college student.

Having been on the bleeding edge of healthcare IT for more years than I care to count at times, I’m not a Luddite by any stretch of the imagination. Still, as someone who values evidence-based medicine and understands the importance of a well-crafted clinical trial, I can’t help but think that recent increases in technology and social media use are putting us in a position where we’re essentially subjects in a large, uncontrolled trial.

Unfortunately, there’s no institutional review board or other governing bodies looking out for our well-being. Plenty of entities with a lot of funding have a vested interest in trying to make us behave in a certain way. I’d love to be an anthropologist one hundred years in the future to see what they think about humans in the early 21st century.

With the exception of patient-related communication devices, does your employer have a ban on cell phone use in the workplace? Is it something that should be considered? Leave a comment or email me.

Email Dr. Jayne.

EPtalk by Dr. Jayne 9/4/25

In the spirit of “no good deed goes unpunished,” insurance giant Cigna Healthcare creates a new reimbursement policy that adds additional scrutiny for certain high-level evaluation and management codes, which could lead to those visits being downcoded.

We saw this type of review during the early days of EHR adoption, prior to Meaningful Use. Physicians began using the power of the EHR to more accurately document the work they had been doing, but perhaps not documenting as well as they could have. When practice management systems picked up on that additional documentation to suggest higher billing codes, there was a bit of backlash in some parts of the country. Fortunately, my health system had a detail-oriented coding and compliance department that was willing to go to the mat for our physicians, so we didn’t see much negative impact.

I wonder if this is partly being driven by increasingly detailed documentation that is being generated through ambient documentation systems. I am curious if organizations are changing internal revenue cycle management policies to get ready. Feel free to reach out if you’re doing something different to prepare for this or if you feel targeted.

With recent changes to federal vaccine recommendations, some professional and clinical organizations are coming out with their own guidelines, including the American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Obstetricians and Gynecologists.

It used to be easy to pick the guidelines that would be used to inform your EHR’s health maintenance and vaccine reminder features, but things just got a little trickier. I’m interested to learn if organizations will be incorporating these varied guidelines or instead will stick with the revised federal guidelines and leave physicians to shoulder the cognitive burden of remembering the other guidelines.

Sometimes I see headlines that don’t make sense. This one from CMS promotes its “Crushing Fraud Chili Cook-Off Competition.” I went to the linked website to see if it helped me make sense of it. I get the cook-off analogy (or bake-off, as some describe it), I don’t know why they doubled down on the “chili” aspect, which is also included in the challenge’s logo.

The competition is designed to identify ways to reduce labor-intensive processes. As someone who has cooked a lot of chili in her life I wouldn’t define it as a particularly challenging dish. I guess “steel cage match” didn’t resonate with the CMS folks, but it would draw more attention than a chili cook-off with no chili.

I’ve been in healthcare a long time, but somehow I missed out on this annual Most Beautiful Hospitals competition. The 2025 winners that were announced this week range from pediatric subspecialty to critical access hospitals. I’m sure people prefer to get their care in places that are aesthetically pleasing or provide a more healing and recuperative environment, but based on my last few care encounters, I would settle for one that has decent wayfinding and communication that go beyond the bare minimum.

From AI Troll: “Re: Taco Bell. It is using AI in its drive-throughs.” The piece details the issues the company has had in trying to implement AI-powered voice ordering. It has been used at 500 locations, and although some implementations have been successful, others have been challenged by people placing wildly inappropriate orders such as 18,000 cups of water.

I used to work at a healthcare facility that was next door to a Taco Bell. I saw many orders being placed by our paramedics and other support staff. The franchise couldn’t even get orders right with humans in the loop on both sides of the order, so I don’t have a lot of confidence that AI would be helpful there. I would personally rather order through an app than argue with interactive AI, but then again, I’m not the demographic that Taco Bell is likely looking for.

From Mascot Wannabe: “Re: health systems and stadium naming rights. Here’s a weird one.” People have spotted stickers around Chattanooga, TN that promote the naming of the new minor league baseball stadium after Erlanger Health. However, the health system denies being behind the stickers, which say, “We bought the best baseball stadium naming rights in Chattanooga” and feature an outdated Erlanger logo.

The health system’s CEO is quoted as saying that it’s “an investment that’s going to have a create return for Erlanger and the community,” but I haven’t seen anyone quantify the ROI of such deals. If you’re in the know, feel free to reach out anonymously.

Turning to a non-tech topic for a change, this BMJ Open article on physician attire caught my attention. The authors did a systematic review of patient perceptions of physician dress to see if it impacts the physician-patient relationship. They identified studies that were published from 2015 to 2025. They found that patient preferences varied based on specialty, clinical context, and physician gender.

Some studies have found that combining casual dress with white coats may signal approachability in primary care and ambulatory settings. Scrubs were favored for emergency and operative environments, where they signaled preparedness and professionalism. Male physicians were perceived as more professional when wearing formal attire with white coats, while female physicians in similar attire were often misidentified as nurses or assistants.

I recall a dustup in a large California-based integrated health system a while back. A new OB/GYN department policy specified that female physicians must wear “hosiery,” but had no similar recommendation for males. Administrators couldn’t justify the change since unspecified hosiery isn’t considered personal protective equipment. If they had a Victorian aversion to bare ankles, it would have made more sense to require coverage with clearer language. Physicians responded by wearing silly socks to prove a point, and the policy quickly vanished.

What do you think defines professional attire? Should physicians consider ditching the white coat or keeping it for historical value? Leave a comment or email me.

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EPtalk by Dr. Jayne 8/28/25

Researchers from Indiana University have created an algorithm that helps clinicians search through patient data from health information exchanges and other sources. The tool identifies the most relevant data for a given visit such as in the ED, where surfacing key information quickly can impact treatment decisions.

It also suggests next search terms based on those used by other clinicians, similar to what we’re used to on retail and commercial platforms. The team has earned two patents for its work.

Public health informatics is a key domain that must be mastered to obtain board certification in clinical informatics. I hadn’t done much work in that area when I prepared for my board exam, but I found it to be fascinating. It’s also challenging due to limited US public health funding and the need to work across disparate systems — state registries, public health center clinics, disease surveillance platforms, and environmental data sources.

I’d like to give a shout-out to the public health informatics teams in Mississippi that provided the data that led state health officials to announce a public health emergency from rising infant mortality rates. That declaration lets the state mobilize resources it otherwise couldn’t.

Mississippi has previously been on watch lists for its high numbers of preterm births. It also a “maternity-care desert,” with wide regions lacking hospitals that offer obstetric care. 

Informatics will underpin many of the proposed solutions, such as improving standardization of care, expediting transfers to different levels of care, monitoring prenatal care opportunities, expanding home visit programs, addressing gaps in maternal care, and improving patient education and engagement around safe sleep practices. If you’re working on any of these healthcare IT projects in Mississippi, we’d love to hear from you.

Speaking of love, props to one of my favorite PR people, Grace Vinton, for channeling her inner Swiftie into healthcare advocacy with a series of reflections on what has become the social media story of the week. I was excited to see a healthcare tie-in so that HIStalk wouldn’t be the only media outlet that didn’t do at least some kind of coverage.

Other captions included: “When prior auth says immediately yes;” “When there’s a telehealth option; “When there’s a patient access quality measure;” and “When the war for patients to get full access to their own data is finally won”. I never thought I would see the day when I would add “Swiftie” to my Microsoft Word dictionary, but here we are.

Mr. H called this recent sponsorship announcement to my attention last week. I’m always leery of hospitals that spend their money on stadium-naming rights or on partnerships that seem nebulous. This one seems to be more than just name recognition, with a Mount Sinai Health System web page detailing the ways they’ll be supporting the event.

There will be a booth for player meet-and-greets, a Children’s Sports Zone for family activities, and a broad swath of Mount Sinai physicians on standby, representing specialties including orthopedic surgery, emergency medicine, sports medicine, anesthesiology, psychiatry, radiology, and urology. There are also some health and wellness videos including one on “how to prepare for a day at the US Open” and another one on “heart health and tennis.” Kudos to the health system for turning this into more than a name-on-the-wall moment. 

From Lost in the Archives: “Re: medical records requests. My hospital is being absolutely crushed by requests dating back decades, since the Radiation Exposure Compensation Act (RECA) was extended to cover hazardous exposures in St. Louis. The Department of Justice is requiring that hospitals certify all the medical records for patients to receive cancer-related compensation. Most of the records being requested have already been purged. This is a nightmare for patients and our skeleton crew in medical records.” I did a little digging to find that the legislation adds eligibility for residents in 21 ZIP codes in and around the St. Louis metropolitan area that were contaminated with uranium waste after processing that was related to Cold War efforts. The compensation program, which is administered by the Department of Justice, previously covered certain cancers for patients who lived in New Mexico and other areas that were affected by release of radiation during atmospheric nuclear tests.

I cold-called one of the academic medical centers in the area. They are putting together their own guidance for patients since the phone number for the program doesn’t work. The rep I spoke to declined to be identified, but said that the stories are “heartbreaking” and patients “just start sobbing” when told that their records have been purged. She mentioned that they are directing patients to the Missouri Cancer Registry, which started gathering data in the 1980s. I’d be interested to hear from anyone who is working there to understand how they’re managing the request volume.

OSF Healthcare is using virtual care solutions at some of its facilities in an effort to reduce emergency department wait times. Patients are screened to ensure that they are appropriate candidates for virtual services. Those who opt in receive their care in a dedicated virtual exam room. Patients can be examined by the virtual physician using electronic stethoscopes, otoscopes, and ophthalmoscope technology as well as standard audio and video tools.

As someone who has worked in various emergency settings with a wide range of acuity levels, it makes sense to have lower-acuity patients seen virtually if doing so helps the overall staffing model while providing the same quality of care.

People often don’t realize that a fair amount of the care that goes on in the emergency department these days is really primary care. Hospitals have been caring for these patients in fast-track units for years. Unfortunately, even those units get saturated.

During the years I worked fast-track, I was usually the only physician on the unit. Patient care could have been so much more efficient if we’d had another 0.3 or 0.5 FTE physician working, but staffing half a human is hard to do. These virtual approaches allow that additional human to provide staffing to two or more facilities, which makes it more cost effective.

Have you ever had a virtual visit in the ED? Would you object if it were offered? Leave a comment or email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 8/25/25

Like many  practicing physicians, I use a variety of tools to research clinical questions. This might be for patients I’m seeing or for board certification questions (which thankfully allow the use of references now).

I received an email from OpenEvidence the other day that announced “a new feature purpose-built for the patient visit” to deliver real-time evidence, help draft your clinical notes, and connect with patient context. It went on to say that the tool can act like a digital assistant and add medical intelligence into notes and other documentation by “automatically surfacing the latest clinical evidence and guidelines directly within your documentation workflow.”

As one would predict, my clinical informaticist sense was tingling. I had to go check it out.

What I found was a potential compliance nightmare. I hope practice leaders are aware of the potential risks and are educating their physicians accordingly.  I’ve spent enough time as a physician executive to know that many frontline physicians aren’t aware of compliance issues beyond what they see in annual HIPAA and Fraud, Waste, and Abuse training. Those only touch the surface of all things compliance.

Upon clicking the new visit button in OpenEvidence, I got a pop-p that said that the visits feature “can record patient encounters” and that it requires a “free BAA between your practice and OpenEvidence.” It asked me to input the name of my practice and then told me to “Contact your CMIO” to have my organization establish a BAA, even going as far as providing me a draft message to cut and paste to my CMIO.

If I sent that email to my CMIO, or anyone empowered to manage Business Associate Agreements on behalf of my clinical employer, I’d be laughed right out the door, especially since the preformed letter had the name of the practice wrong.

It also provided the option to say that I am in solo practice rather than with a corporate entity, which is also true for me, since I’ve maintained a legal entity over the years that would enable that should I want to use it. It gave me a one-click option to sign a five-page BAA, but you can bet that I’m not going to be doing that anytime soon.

I’m always skeptical when a service is free because I know money is being made one way or another behind the scenes. Unfortunately, that doesn’t keep people from just clicking and thinking that they’re good to go without fully understanding what is happening with their data.

Once I left that pop-up, I was greeted by a stealthy little pop-up below the search bar that again gave me a one-click option to accept the BAA. Based on how it looked, I can imagine that physicians might just accept it without fully understanding what they’re agreeing to in that innocuous little pop-up.

The experience made me think of other free services that may run the risk of needing a Business Associate Agreement, including Doximity. Plenty of physicians have signed up to use its free services, which include Fax and Dialer. The latter lets physicians call patients without revealing the physician’s contact information. It also allows physicians to send secure texts. 

Video testimonials on its website talk about physicians using it to share lab results or other important communications. I hadn’t thought about using that service, but it made me wonder how much physicians are really thinking about it and how they’re documenting these communications in the medical record without there being integration. It made me wonder about the potential liability risks of these services and if physicians are sacrificing accurate documentation for convenience.

Doximity also offers a GPT feature. I tried it a couple of months ago and didn’t think it was that great, so I decided to give it another go.

I asked it one of my favorite dermatology-themed board questions and found it to be utterly unhelpful, giving an answer that essentially said, “it depends.” That certainly wouldn’t be good enough to get me credit for my board certification question block, which had a very specific answer in mind. Fortunately, I had previously used a stronger reference to help manage that question, and I’m grateful that I went with that strategy rather than relying on this one.

I asked a question about electrolytes in a specific medical condition and got a much more satisfying answer, with the response nicely calling out some important details specific to the clinical scenario. Other AI tools I’ve used haven’t done that well with that particular scenario. I still wonder what the company might be doing with my data and my search history.

I don’t remember what was in the Doximity terms and conditions when I signed up. I did it many years ago for a free fax number so I could submit expense reports during a particularly annoying consulting engagement where they wouldn’t accept them in PDF format.

They were easy to find via a link located at the bottom of the screen. They were 23 pages long, so I just skimmed through them looking for interesting tidbits. One was a clause that the user agrees not to use the tools “in any way that violates or conflicts with any agreement to which you are a party, including any agreement with your employer.”

I’ve been involved in enough physician online forums to know that a good number of physicians have no idea of some of the key details in their employment agreements, such as the number of days of notice they have to provide if they’re quitting, or how their bonuses are calculated. I would be surprised if the majority of physicians know the details of clauses that might be lurking in those agreements with respect to tools such as these.

One of my favorite sentences in the agreement: “We do not guarantee the accuracy or reliability of this content and information.” That’s certainly something right there.

The agreement also clearly says that the AI tools are “for informational purposes only” and shouldn’t be “used as clinical decision support tools or for diagnosing, preventing, or treating any medical condition.”

The agreement also linked out to the company’s privacy policy, which clearly states that the company may use de-identified data and share it with third parties for purposes that include to “support commercial opportunities, generate insights and identify trends, and promote our business.” I’m no lawyer, but I’m guessing the part about commercial opportunities allows them to sell that de-identified data for whatever purpose they see fit.

Additionally, they’re clear about how they work with “commercial clients” to target physicians. Although I’m not crazy that the platform enables marketing, it’s not like they’re hiding what they do.

I got tired of reading about two-thirds of the way through, especially since I have a pile of better things to read sitting on my nightstand and at least one novel was actively calling my name.

I’m sure that various company terms and conditions contain other interesting examples. I would be interested to hear from users on some of their favorite or least-favorite clauses.

What do you think about free services that are monetizing your information? Is everyone so used to it by now that no one cares anymore? Leave a comment or email me.

Email Dr. Jayne.

EPtalk by Dr. Jayne 8/21/25

The big story of the week was the Epic User Group meeting, which sported a sci-fi theme this year. The four-day event started with the traditional welcome picnic on Sunday, with Advisory Councils and Forums on Monday.

Tuesday’s Executive Address, as one might have predicted, was full of Star Trek-style costuming. Judy Faulkner looked like she would be right at home in the Ten Forward lounge in the “Next Generation” series, sporting a lavender wig, neon glasses that coordinated with her shoes, and a sparkly vest paired with silver lamé pants.

Her Executive Address paid homage to problem list pioneer Larry Weed and included a summary of all the AI components that are already within Epic as well as the 160+ AI-powered components that are under development. She mentioned a focus on trying to keep software costs reasonable for health systems. My own health system spent a quarter of a billion dollars implementing Epic, so everyone’s mileage may vary on that definition of “reasonable.”

My favorite quote of the presentation was “Poor training leads to unhappy physicians.” I wholeheartedly agree. I’ve worked in organizations with vastly different training strategies and have seen the difference that good training makes.

The Epic team also emphasized that personalization is important in the EHR. Despite that advice, I still see organizations that try to restrict the ability of users to configure the EHR to make it easier to use. The most common reason I hear is that personalization makes it more challenging to provide support, but I’ve seen enough installations of enough EHRs over the years that I’m not buying that.

Sessions continued into Wednesday and Thursday, but word on the street was that people’s energy was flagging after Tuesday’s Starlight Dinner. The event is a major production for the Epic employees who step out of their usual roles to support attendees and make them feel welcome. I always enjoy talking to some of the folks working the logistics and food service roles and learning what they do in their usual work since UGM is an “all hands on deck” experience and people often contribute in ways that are vastly different from their day-to-day. If you have pictures or comments about this year’s UGM, feel free to send them my way.

Apple announced  earlier this week that it would introduce a redesigned blood oxygen feature on certain Apple Watches starting immediately. The issue impacts watches that were sold in the US after the International Trade Commission enacted an import ban as part of a patent infringement allegation by medical device maker Masimo. There may be additional legal wrangling to come based on suits and countersuits, but for now, users can enjoy an additional element in their quests for the quantified self.

Industry watchers are still trying to figure out how telehealth will ultimately fit into the healthcare delivery systems of the future, at least until another pandemic appears. Hims & Hers Health shares dropped last week following publication of details related to a Federal Trade Commission investigation. Consumers have long complained that the company makes it hard to cancel subscriptions and that some of its marketing practices push the limits of what is legal.

Regardless of legality, many of my primary care colleagues find their marketing to be a bit grating, with phrases such as “telehealth for a healthy, handsome you” and a focus on so-called lifestyle medicine that leads to high numbers of subscription-based prescriptions with nary a mention of coordinated or chronic care on the company website’s About page. Their care model is largely asynchronous, which means they don’t perform a physical exam that is certainly indicated for some of the conditions they treat.

I ran across another article this week that looked at a potential growth area for telehealth: caring for patients who are afraid of immigration enforcement actions at healthcare facilities. A physician who was interviewed for the piece notes an increase of patients who require emergency department-level care because their families are avoiding office visits.

The piece also quotes a policy analyst who notes that this phenomenon is happening across the country in the community health center space. The National Association of Community Health Centers is hosting its Community Health Conference & Expo this week in Chicago, and I anticipate this might be a hot topic in that forum. If you work in a community health center and want to share your thoughts, feel free to reach out.

From Left My Heart in San Francisco: “Re: Providence. Did you see this article about their accusing Kaiser of shorting them on payments? I would love to see these two square off in a steel cage match.” Kaiser Foundation Health Plan Inc. is accused of underpayment, but the payer responded that the hospitals are “seeking payments above fair and reasonable levels.” This occurs when the facilities treat patients in situations where price agreements are not in place. Kaiser argued in court documents that Providence is trying to group claims from disparate facilities across broad geographies, with variable economic elements at play. Kaiser is advocating for resolution through a federal program created by the No Surprises Act in 2021, but it’s no surprise that Providence wants to have its day in court.

OpenEvidence reported that its AI model has scored 100% on the US Medical License Exam (USMLE) and has achieved “super high-grade medical reasoning.” The company is offering a free explanation document that is targeted to medical students. I didn’t find the document terribly interesting. It looked a lot like the test prep books that I used to study for my own trip down USMLE lane back in the day. That’s not entirely surprising since the company’s founder previously worked for the Kaplan test preparation company.

The company offers a free AI-powered search platform to US clinicians that is made possible by its advertising relationships. I’m not super keen on having my eyeballs monetized, but will be watching to see what moves the company makes next.

I’ve been an anonymous blogger for more than a decade. As Mr. H has said, what we do is a fairly solitary pursuit. Most people in my “real life” have zero interest in healthcare IT, although I do have one ride-or-die friend outside the industry who reads regularly and gives me feedback, which is always a gift.

I’ve been asked in the past whether I’d ever want to drop the cloak of anonymity and join the ranks of medical influencers. I’m glad that I have no delusions of being TikTok or Instagram famous. I can barely remember to take my daily multivitamin, let alone be mindful of the need to constantly generate content to solicit likes. Without my trusty Outlook calendar appointments, I would probably not stay on track to send my posts to Mr. H each week. I will leave the medfluencing to the next generation.

Who is your favorite physician influencer and why? Leave a comment or email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 8/18/25

As a clinician, I often have difficult conversations with parents about how to reduce the amount of time that their children spend using screen-based devices every day. Many of the parents I encounter are unwilling to limit their children’s screen time because of a perception that children who don’t have devices will be “left behind” or potentially ostracized by their peers.

I see a fair number of folks who use devices to entertain their children rather than interacting with them, which I find sad. When I walk into an exam room and see a kid poking away at a tablet while their parent sits in a heads-down position with their own phone, it makes me wonder what happens when they are not at the physician office. Ultimately, kids become dependent on devices for interaction and this can be a problem when they reach school age, when teachers spend a good chunk of time policing phone-related behavior.

As of the start of this school year, more than half of US states have passed legislation or created policies regarding the use of cell phones in K-12 classrooms. These range from requirements that school districts create guidelines of their own to outright bans. Among the reasons for such bans, lawmakers cite the need to create a distraction-free learning environment, a desire to curtain social media use, and a hope that such strategies will have a positive influence on youth mental health.

My own local district had a well-researched plan that had been created after stakeholder listening sessions with students, parents, and teachers. It was pre-empted by a maneuver at the state level that is significantly stricter. When my district was creating its policy, it used its health advisory committee to comment on the potential risks and benefits of restricting cell phone use.

Physicians raised the issue of the use of cell phones for medical reasons, including students and faculty who use apps to manage health conditions like diabetes. It’s clear from looking at some of the state laws that these kinds of needs might not have been considered by legislators. Needless to say, people aren’t happy about it, and I’m sure there will be some settling in once school starts.

With that in mind, I ran across this article that covers the topic from the youth point of view. Although it mentions the fact that devices have addictive properties, it also digs into the ways in which childhood in the US is changing. It reviews a Harris Poll survey of 500 children ages 8-12, with the majority saying they had smartphones and half of the older members of the cohort saying that social media use was common in their peer groups.

One of my favorite quotes from the piece states that, “This digital technology has given kids access to virtual worlds, where they’re allowed to roam far more freely than in the real one.” As a proud member of Gen X who had the stereotypical “come home when the streetlights come on” childhood, this resonated with me. The article notes that many children haven’t so much as gone down a grocery store aisle alone and that a good number aren’t able to play unsupervised in their own yards.

The authors note that children expressed a desire to socialize in person with minimal supervision, but due to restrictions by their parents, they instead use their phones to socialize unsupervised. Of course, there are reasons that parents have become more restrictive with their children, including fear of injury or abduction, but one of the statistics mentioned in the article is that “a child would have to be outside unsupervised for, on average, 750,000 years before being snatched by a stranger.”

It goes on to say: “Without real-world freedom, children don’t get the chance to develop competence, confidence, and the ability to solve everyday problems. Indeed, independence and unsupervised play are associated with positive mental-health outcomes.”

The authors mention the creation of parenting networks where kids are encouraged to get together for unsupervised play and community organizations that are promoting screen-free time. The deeper I got into the article, the more I wondered what tech companies think about these efforts and whether they feel that such advocacy for unstructured device-free play might ever be a threat to their respective bottom lines.

I’ve been a volunteer in youth-serving organizations for over 20 years, and I would say that any threat wouldn’t be a serious one. To get kids to put down their phones, we would likely need to see parents doing it first. On second thought, though, maybe if there was a TikTok influencer that started telling parents it was cool to let their kids run around the neighborhood and dig holes in the yard as some of us did once upon a time, we might see a change.

I recently read the book “Klara and the Sun” by Kazuo Ishiguro. It’s a complex novel told from the point of view of Klara, who is an Artificial Friend purchased to serve as a companion to a child with a chronic illness. I won’t throw out any spoilers as to the nature of that illness, but it was an interesting read.

There are already enough ways that technology is impacting childhood, so I hope we don’t get to the point where life starts imitating the novel. On the other hand, there are some scenes in the book where the main human character is allowed to go outside to play with only the supervision of the Artificial Friend. It made me think a bit that if parents won’t let their kids explore the world alone, maybe there just might be a role for technology.

It will be interesting to see if there is any research published in the next couple of years with respect to these cell phone limitations and bans and whether they do have a positive impact on youth mental health. It’s estimated that mental health is impacting the US economy to the tune of $282 billion annually, so we can’t afford not to study how these interventions play out.

What do you think about the role of government in limiting the use of technology for individuals, whether they’re children or adults? Leave a comment or email me.

Email Dr. Jayne.

EPtalk by Dr. Jayne 8/14/25

Perplexity made an unsolicited offer to buy the Chrome browser from Google for $34.5 billion. Several people I spoke with agree with the Axios statement that it’s a great marketing play, but unlikely to actually be accepted by Google.

I’ve seen friends and colleagues move away from Google in the months since it added its AI overview feature. I’ve been back and forth with it. I had three significant hallucinations in the same day recently, and all were related to simple fact-based searches that shouldn’t have been problematic. Perplexity claims to have financing in place for the deal, but we’ll likely never know who agreed to back it.

JAMA Network Open has become one of my go-to journals for relevant research that addresses hot topics in healthcare information technology, but at a level that is accessible to more frontline clinicians than might be found in a journal that was targeted towards clinical informaticists. An article this week addressed a great question: “Can a patient portal message with either a physician-created video or an infographic with a physician photograph increase end-of-season influenza vaccination rates?” The study was done at UCLA Health with 22,000 patients from 21 practices. Neither approach raised overall vaccination rates, but both methods increased immunization rates for children and the video message option scored slightly higher.

There’s a lot of vaccine hesitancy in the US, and the Health and Human Service secretary’s recent approval of influenza recommendations received little press coverage. Here’s to hoping that messages from trusted physicians can help drive the needle.

Another feature in the same issue looked at whether physicians made more edits to hospital course summary documents that were generated by large language models (LLM) compared to those generated by physicians. The study was small, looking at only 100 inpatient admissions to the general medical service. The authors found that the percentage of LLM-generated summaries that required edits was smaller than the percentage of physician-generated summaries. The studies were evaluated against a quality standard, with the authors concluding that since the LLM-generated documents needed fewer edits, they were of higher quality than those created by physicians.

I found the study design particularly interesting on this one. The hospital course summaries were randomly assigned to one of 10 internal medicine residents. They had three minutes to review each pair of summaries and edit them for quality purposes. The output of those editing steps was then reviewed and scored for quality by an attending hospitalist physician.

The authors controlled for document length by using a “percentage edited” score and also looked at how much the meaning of the original summary was altered. The authors noted that while the LLM-generated summaries required less editing and may have been “comparably or more complete, concise, and cohesive” they also “contained more confabulations.” They noted that the artificial time constraints may have influenced the result. The study overall supports the idea that using LLMs to help complete this task could be of value.

OpenAI has been trumpeting the release of its GPT-5 model, saying it does a better job with medical questions than its predecessor, but users have been clamoring for an option to return to the previous model. The majority of complaints are around system speed and increased errors. Others took issue with the fact that the new model was rolled out without notice, leading CEO Sam Altman to admit that “suddenly deprecating old models that users depended on in their workflows was a mistake.”

Those of us who have been in the healthcare IT trenches for years understand the value of adequate change management and communication strategies, so I was surprised to learn that the company thought it would be no big deal to just hot-swap the models. If they’re looking for a change management sensei, I might know a girl. Another great quote from Altman: “the autoswitcher broke and was out of commission for a chunk of the day, and the result was GPT-5 seemed way dumber.” Something to ponder for all the folks relying on these technologies. Sounds like they may need a testing advisor as well.

One of my favorite colleagues from residency was in town the other day, doing college visits with one of her children. Her family is going through additional challenges in the college hunt as they evaluate the medical and support resources available to help students manage chronic health conditions in their first few months away from their families. My friend is a brilliant physician who has worked in environments from academic to military to rural health, so she has seen it all.

One of her concerns was the sheer number of communications she receives from her child’s care team: “Seriously, I think I got 15 reminders and a survey, I don’t want to have this kind of a relationship. I already replied, so why are we still having this conversation?” She’s worried that when her child is on her own and receiving all those reminders and messages that they will cause anxiety, which is certainly valid.

Props to health organizations who allow patients to customize reminders and communications. I personally just need one reminder three days out and that’s all. My dentist sends a reminder at 10 days, seven days, three days, one day, and then hourly until you arrive. They claim they can’t adjust it. I’m not sure I’m buying that, but I’m not well versed in dental platforms.

Dr. Nick van Terheyden reached out to let me know that the Lown Institute is accepting nominations for its annual Shkreli Awards, named after notorious “pharma bro” Martin Shkreli. The awards are given “to perpetrators of the ten most egregious examples of profiteering and dysfunction in healthcare.” Previous winners have done such things as: selling the body parts of the deceased without notifying the next of kin, defrauding Medicare by submitting claims on behalf of patients who never received services, and bankrupting community hospitals while living a lavish lifestyle.

What’s the most egregious thing you’ve seen lately in healthcare, regardless of whether it’s worthy of a Shkreli award? Leave a comment or email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 8/11/25

I was intrigued by Mr. H’s mention last week of the Mass General Brigham FaceAge AI tool that can estimate age from facial photos. Researchers found that patients with cancer appeared older than their stated age. The older they looked, the lower their odds of survival.

Although physicians have historically used visual assessments to predict potential outcomes, the tool uses face feature extraction to estimate a user’s biological age based on their photo. An article describing the tool was recently published in The Lancet Digital Health if you’re interested in all the details.

This item, as many things that Mr. H mentions, got me thinking. I found a couple of sites that host biological age calculators and completed the relevant surveys to get a couple of results. Some of them were more specific, asking for various lab values. Fortunately, I had results for all of the requested lab values and even some of the exercise performance measures that were included on one of the questionnaires. I also found a tool that is very similar to FaceAge, although not the exact one used in the study, and snapped my selfie.

The survey-based calculators estimated my biological age as anywhere from 4.6 to nine years below my actual age. The facial photo tool thought that I was more than 10 years younger. I suppose my liberal use of sunscreen and hats is paying off, since my facial wrinkles were scored as 2 out of a possible 100 points. I also did well on the “undereye” measure, although I admit that my photo was taken when I was well rested. I’m sure it would not have scored as well had it been taken after a shift in the emergency department.

I don’t look at a lot of high-resolution pictures of my face, and when I received my score report with a full-screen of my face right in front of me, I was somewhat surprised that you can still see some artifacts from years of wearing an N95 mask while seeing patients. I’m guessing that when I look in the mirror my brain somewhat processes that out, so it was a little startling.

I’d be interested to see how I would score on a medical-grade tool such as the one mentioned in the article. Although it was a fun exercise to complete the different surveys and see where I stand, none of the recommendations provided alongside the results of any of the tools were different from what I usually hear during my primary care preventive visits: keep moving, eat as healthy as possible, and watch out for the rogue genes you’re carrying around.

I would be interested to hear others’ experiences with similar tools and whether they have motivated you to do anything different from a lifestyle perspective.

Mr. H also recently mentioned efforts by NASA and Google to develop a proof-of-concept AI-powered “Crew Medical Officer Digital Assistant” (CMO-DA) to support astronauts on long space missions. As a Star Trek devotee, I couldn’t help but think of the Emergency Medical Hologram from “Star Trek: Voyager.”

The project is using Google Cloud’s Vertex AI environment and has been used to run three scenarios: an ankle injury, flank pain, and ear pain. The TechCrunch article noted that “a trio of physicians, one being an astronaut, graded the assistant’s performance across the initial evaluation, history-taking, clinical reasoning, and treatment.” A particular astronaut/physician came to mind when I read that, and if there’s a hologram to be created, I’m sure other space fangirls out there would find him an acceptable model.

The reviewers found the model to have a 74% likelihood of correctness for the flank pain scenario, 80% for ear pain, and 88% for the ankle injury. I’m not sure what the numbers are like for human physicians in aggregate, but I’m fairly certain I’ve had a higher accuracy rate for those conditions since they’re common in the urgent and emergency care space. However, NASA notes that they hope to tune the model to be “situationally aware” for space-specific elements, including microgravity. I would hazard a guess that most physicians, except for those with aerospace certifications, don’t have a lot of knowledge on that or other extraterrestrial factors.

The article links out to a NASA slide deck. Since I do love a good NASA presentation I had to check it out. I was excited to see that there is a set of “NASA Trustworthy AI Principles” that address some key factors that are sometimes lacking in the systems I encounter. The principles address accountable management of AI systems, privacy, safety, and the importance of having humans in the loop to “monitor and guide machine learning processes.” They note that “AI system risk tradeoffs must be considered when determining benefit of use.” I see a lot of organizations choosing AI solutions just for the sake of “doing AI” and not really considering the impacts of those systems, so that one in particular resonated with me.

Another principle that resonated with this former bioethics student was that of beneficence, specifically that trustworthy AI should be inclusive, advance equity, and protect privacy while minimizing biases and supporting “the wellbeing of the environment and persons present and future.” Prevention of bias and discrimination, prevention of covert manipulation, and scientific rigor are also addressed in the principles as is the idea that there must be transparency in “design, development, deployment, and functioning, especially regarding personal data use.” I wish there were more organizations out there willing to adopt a set of AI principles like this, but given the commercial nature of most AI efforts, I can understand why these ideals might be pushed to the side.

In addition to the CMO-DA project, three other projects are in the works: a Clinical Finding Form (CliFF), Mission Control Central (MCC) Flight Surgeon Emergency Procedures, and a collaboration with UpToDate. I love a catchy acronym and “CliFF” certainly fits the bill.

I recently finished the novel ”Atmosphere” by Taylor Jenkins Reid . If you are curious about the emergency procedures that a mission control flight surgeon might need to have at their fingertips, the book does not disappoint.

The deck goes on to discuss the evolution of Large Language Models, retrieval-augmented generation, and prompt engineering within the context of the greater NASA project. The deck specifically notes that any solution must be on-premise, which is particularly true when you experience the communications blackouts that are inherent in space travel.

There are more details in the deck about the specific AI approach and the scenarios. I particularly enjoyed learning about “abdominal palpation in microgravity” and the need to make sure that the patient is secured to the examination table to prevent floating away. I also learned that “due to the microgravity environment, the patient’s abdominal contents may shift,” which got me wondering exactly how many organs were subject to shifting since many of them are fairly well-anchored by blood vessels and other not-so-stretchy structures.

The deck listed the three physician personas who scored the scenarios. Based on physician specialty, it’s likely that my favorite astronaut wasn’t one of them, but I was happy to see that an obstetrician / gynecologist was included.

Apparently there was a live demonstration of the CMO-DA at the meeting for which the presentation deck was created, so if anyone has connections at NASA, I know of at least one clinical informaticist that would love to see it. I’ll definitely be setting up some online alerts for some of these topics and following closely as the tools evolve.

Did you ever dream of being an astronaut, and what ultimately sidelined you from that career? Leave a comment or email me.

Email Dr. Jayne.

EPtalk by Dr. Jayne 8/7/25

One of the hot topics around the virtual physician lounge this week was the opening of the Alice L. Walton School of Medicine in Bentonville, Arkansas. The school is named after its founder, who is an heir to the Walmart fortune.

The initial class of 48 students will be trained in a curriculum that is based on preventive care and a whole-health philosophy. The school is located on Walton family property and borders the Crystal Bridges Museum of American Art, which should provide an excellent diversion when students need time away from studying. Apparently the curriculum also includes a course that incorporates art appreciation as a way of encouraging observational skills and empathy.

Students are expected to perform community service as a way of better understanding those in their care. Other ways the curriculum differs from the standard include a focus on nutrition education, including cooking classes with teach-back sessions to patients, and time spent gardening and working on a teaching farm.

Tuition for the first five graduating classes will be covered by Mrs. Walton, who hopes that graduates will consider practicing in underserved areas. There are certainly some opportunities for service in Arkansas, which has some of the poorest health outcomes in the US.

The lure of free tuition is strong, but students are taking a bit of a gamble attending a school that does not yet have a track record for residency placements or a broad alumni network. Still, the school received over 2,000 applications for the class. Best wishes to these new students, and I look forward to seeing how the curriculum is implemented as the inaugural class progresses.

Another hot topic was a recent JAMA op-ed piece that is titled “When Patients Arrive With Answers.” It covers the evolution from patients arriving with newspaper clippings to bringing in printed results of internet searches and now arriving with AI-generated materials to discuss with their physicians.

One of my colleagues focused on a line in the piece about tools like ChatGPT: “Their confidence implies confidence.” This led to a discussion hallucinations that we have encountered using AI solutions, even in situations where simple fact-based questions are being posed. The author notes that they are now “explaining concepts like overdiagnosis, false positives, or other risks of unnecessary testing.” 

That comment resonated with my colleagues. One noted that she feels that AI is worsening the burnout problem in her primary care practice. She must regularly defend her recommendations against AI-generated suggestions, as well as misinformation that is being provided by TikTok influencers. The author recognizes this, and notes that explaining evidence-based recommendations in contrast with patient requests isn’t a new phenomenon and encourages physicians to “meet them with patience and curiosity.” Given the tight schedules that most physicians face, I’m not sure that’s realistic.

Keeping with the theme of AI, I enjoyed this JAMA Editor’s Note on “Can AI Improve the Cost-Effectiveness of 3D Total-Body Photography?” As someone who has had entirely too many skin biopsies, this immediately caught my attention.

The authors specifically address the idea of photography for patients who are at high risk for melanoma, citing a recent randomized clinical trial published in JAMA Dermatology. The study found that although the intervention resulted in more biopsies, it didn’t increase the number of melanomas that were identified.

Another study that was also published in JAMA Dermatology looked specifically at whether 3D total-body photography is cost-effective. It found that it wasn’t, but posed the idea that with AI enhancements, it could become more financially feasible. For patients who need regular monitoring, however, I guess we’ll just have to stick with “usual care.”

I used a non-medical AI tool this week to help address a question that a family friend posed. When you’re a primary care physician, everyone assumes you know about all facets of medicine. I’m constantly getting questions about radiology reports or lab results because people “don’t want to bother the doctor.” I still find it strange that they’d rather expose their protected health information to someone they don’t know well, who is merely the daughter of a friend, but that’s often how it goes.

I was curious what the patient would have seen had they decided to just use Google or any of the AI tools out there. In this case, both Google and Copilot did a great job explaining “what does pleural based opacity” mean, giving answers that were similar to my own.

The primary difference between the human answer and the AI generated one was in the follow up. Where I said that the patient should follow up with the ordering physician to understand what the term means in context of their clinical picture, both sources recommended further investigation, which most patients would interpret as needing additional testing.

I wasn’t as patient with another person who reached out for medical advice. Someone who I hadn’t seen since high school decided it was a great time to message me via Facebook and ask about various medications versus injections versus surgery for back pain. I have to admit that I took the easy way out by saying “so many factors play into the choice of treatments and it really depends on the patient,” which was as empathetic as I could get at the time.

A few days later, I plugged it into Google to see what it would provide. It did an exhaustive review of the different options and closed with this: “Important note: The choice of treatment depends on the specific nature and severity of the herniated disc, as well as individual patient factors and preferences. It’s crucial to consult with a doctor or pain specialist to determine the most appropriate course of action for your situation.” At least in this situation, I agree 100% with the Google. 

Are you a clinician who has to field medical questions from people who are not your patients? Have you considered outsourcing your advice to AI, especially if it’s outside of your typical scope of practice? Leave a comment or email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 8/4/25

I recently had the opportunity to spend some time with a computer engineering student who was looking to learn about healthcare information technology. Specifically, he was curious about the role that clinicians play in the field.

We had some great conversations and the experience was very enjoyable, in large part because few of the discussions centered on AI. He has a particular interest in cybersecurity, so our initial conversations had some fairly deep coverage of the topic. He was interested in learning more about how hospitals and health systems handle the backup and recovery process, particularly when a security incident might have occurred. Based on a couple of his comments, I think I surprised him by being able to provide a deeper discussion of the topic than he expected to hear from a physician. 

It was a good opportunity to explain the field of clinical informatics and how many types of roles we fill. I’m unusual in how much experience I’ve had with infrastructure, architecture, and the nuts and bolts of interoperability. I’ve been fortunate to work with some great engineering and development teams throughout my career, picking up some interesting and unique knowledge along the way. I never thought I’d be able to have conversations about Citrix load balancing or be able to explain the role of transaction log shipping as part of a disaster recovery solution, but you never know where your career is going to take you.

In large part, I learned about those things not because I necessarily wanted to, but because I had to. The first EHR project I was involved in did not go well. A lot of IT folks were techsplaining, which didn’t help me solve the problems that were interfering with my ability to deliver high-quality care.

Although I think that many of them were just talking in their everyday language — similar to how physicians talk among themselves, without trying to leave me out of the conversation — I experienced more than one situation where an IT staff member was treating me in a way that was equivalent to patting me on the head and saying, “Don’t worry about this, little lady.”

After one of those encounters, I decided that I would need to hold my own, so I started doing a lot of reading. I figured if I could learn biochemistry and the complexities of the human nervous system I could certainly learn some of this new language and how all the technology was supposed to be working compared to how it was actually performing in the field.

Thinking about how information access has changed, learning about those domains would be a lot easier now than back in the days when only 5% of physicians were using electronic health records. You couldn’t just pop into your web browser and find articles about implementing systems in hospitals, because we were just getting started. Meaningful Use wasn’t yet a thing, and those of us that were trying to bring up systems were doing it because we thought we could revolutionize patient care, not because someone was making us do it.

Hospitals had electronic laboratory and monitoring systems and of course billing, but computerized order entry wasn’t even on the radar of physicians. Heck, we couldn’t even print patient labels from the computer system at one of my hospitals. They were still using Addressograph cards to add patient information to the paper used for writing daily progress notes.

We went down the internet rabbit hole as I was trying to explain that piece of equipment to my student. I wish I had a picture of the look on his face when I explained how a similar technology was once used to process credit cards at businesses. Apparently you can buy a vintage credit card imprinter machine via various online resale sites, for those of you who miss the very specific noise made when the charge card was pressed under the carbon paper.

That led to a good conversation around the idea that 40 years ago, we had no frame of reference for the technologies that we would be using today. No one would have guessed that we could simply tap our credit cards on a machine to pay, let alone load that credit card information into a palm-sized phone and use it to pay as well. I can’t even imagine how things will work in 40 years, and I hope that when he’s later in his career, he will have the experience of being able to share stories of how things used to be with someone who is just starting out.

We also had some interesting conversations about healthcare in general, and particularly around healthcare finance and how the revenue cycle works. In my opinion, it’s one of the messier aspects of the US healthcare system, and opportunities exist to make it better.

We had a good conversation around how claim adjudication works and why it’s rare in our area to see an organization that is doing real-time claims adjudication. Some of the practices that I go to don’t even collect your co-pay during the office visit, so I can’t imagine what a big shock it would be to use a system like that.

I also ended up teaching him how to read an Explanation of Benefits statement, which I think was an eye-opener, especially for someone who doesn’t have a lot of patient-side experience in his relatively brief adulthood.

I enjoyed learning about some of the non-healthcare work that the engineering student has done as he works towards his degree. Also, the supplemental activities that are available to students that didn’t exist when I was in school. His school has competitive rocketry, drone, and Mars rover teams where students can apply what they’re learning as early as the first semester. We had to wait until our junior year to really have experiential learning opportunities and they certainly weren’t as cool as any of those.

Although I tried to bring healthcare and healthcare technology to life, I’m not sure it’s going to be as cool as some of the other career options that will undoubtedly be available to him, especially if he’s leaning towards cybersecurity and cryptography. He’ll be back next week, and I plan to cover topics including robotics, prosthetics, and human-computer interaction. I might still be able to convince him that healthcare can be cool.

What do you think are the coolest technologies we’re using in healthcare, beyond AI? Leave a comment or email me.

Email Dr. Jayne.