I am worried. Just because our whiz-bang technologies can do lots of stuff, I ask: should it? I previously wrote about my Grok-board idea in 2024. In one short year, we have seen ambient notes, chart summarizers and agents take off.
Here, I still aspire to use an EHR that helps me “grok” the patient. Grok comes originally from Robert Heinlein’s “Stranger in a Strange Land” sci-fi novel from 1961, wow more than 60 years ago. He coined the term “Grok” meaning to “instantly empathize and understand.”
In my 2025 version, the left column of the EHR remains intact, with links to many useful parts of an existing EHR patient chart.
What does it mean?
- Blue Column 1: The Patient story board. Links to patient details: demographics, allergies, primary care doc, care gaps, selected chart items.
- Green Column 2: This Human: the patient telling us what is important to them, what are their joys and pressures.
- Orange Column 3: Homunculus visual problem list and an AI summary of the current status of diseases with any available metrics.
- Pink Column 4: Insights. Active and suggested AI agents, artificial intelligence entities that can obtain data, and then act on predetermined criteria to achieve a general goal, assess the patient’s top risks and suggested next steps.
- Blue Column 5: Today: pre-visit questionnaires, solicited patient questions, the last progress note you wrote, and an AI Greek Chorus of somewhat adversarial advisors with suggestions for me.
An ideal Grok-board
should be humane and emphasize the patient’s identity and goals, so a physician can connect human-to-human and communicate more effectively. It should also increase the signal-to-noise of the information presented. It should make it quick to grok and then act. It should prioritize the most important next actions, then make doing the right thing easy
Thanks to Gregory Makoul for his groundbreaking work on connecting patient values to physician thinking. Let’s continue to debate the psychology of which displays gives the quickest, most useful view of the patient. Let’s arm-wrestle, not over sorting of the problem list, but over which display leads to better care of the patient with less cognitive burden and more joy for physicians, the clinical team, and the patient.
Taking it further
Let’s design a video gamer’s chair that helps you use all your senses. What if your left forearm vibrates to warn you of a medication allergy when you’re writing a prescription? What if your right calf feels warm if there is kidney impairment or left calf feels warm if there is liver impairment affecting your next decision. What if your lower back vibrates if you’re about to close a chart with unaddressed care gaps. What if we had smell-o-vision to detect the fruity breath of a patient in keto-acidosis?
CMIO’s take? We are underusing our senses and our pattern-matching skills. Let’s build a way for our physicians and teams to grok the patient and then make it easy to do the right thing. We must intentionally build our humanity into this future.
