The story continues. Our EHR, partnered with Epic predictive AI model among other predictive tools have reduced sepsis mortality by 1000 fewer deaths per year compared to our baseline, as we find and treat sepsis earlier with reconfigured teamwork in addition to improved detection tools. Another tale of the Psycho-80: 80% of a project’s success is about the psycho-socio-political skills of the people and 20% of the success is due to technology. Grateful for smart colleagues and partners. (image, our fearless informatics leaders, analysts and trainers having a well-deserved meal after another EHR implementation day)
As tech accelerates, I wonder what has AI done for me lately? Sure it writes my notes, but does it really help me “grok” this patient? Here is my updated Grok-board design take for EHR’s.
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.
This is the quote of the meeting. From a chance meeting with Dr. Wong.
COSMOS AI preprint is available. My mind is blown and I want to know what this means. And I think I won’t know for awhile until the tech bubbles up to something I can get my head around.
I was chatting with Karen Wong Epic physician in the physician lounge in Voyager. I was bemoaning my trying to understand what COSMOS AI could do. Then she let this epigram loose:
COSMOS AI doesn’t speak English. It speaks Events.
This is perhaps the quote of the conference. Thank you Karen. And now, off to read the ARXIV article and pretend to understand it.
UGM229 Scaling Generative AI Chart Summary Features. Mayo Clinic
Getting from ‘blob’ summary to problem based insights. It got much better: ‘Revolutionary’. Now at 290 users. Surveying for usefulness.
Way to determine the value of this summary? Looking at usage. Else what is the point?
Outcomes
Powerful outcomes. Concise, burden reducing. Accurate. CT observation today: Ok we need this.
Draft hospital course. Compared to human written prior to go live. Now about 500 users. LLM did better than human in every category.
So helpful to see Mayo’s analysis plan: value, maturity, scalability. token limit problem early on. Now able to see many more notes to summarize. Including notes prior to cosignature. Important else missing data. How does this overlap with inpatient insights.
Success!
About 500 pilot users. initially providers but now all clinical staff. Nutrition, PT, RN. Could take 5-10 minutes to generate a summary in morning if many requested at once.
UGM151 Ambient Voice Technology: 1,000 Down, Only 19,000 Users To Go. Advent tell us the road map
Early training model during the pilot. Support with love chat group on teams. For 14 days. Immediate support and success stories. Transitioned to live chat group with all clinical informatics support teams.
Support web page!
But no on-demand training. and a time zone problem for large organization. Now using QR 20 minute video.
Gives the option AFTER the video to sign up for license.
Tracked signal data. Criteria of DAX used in 25% of notes.
Create a training program in Signal. That way Epic can track time zero. Patrick Sweeney from Epic helped set this up. Survey from Microsoft.
23% drop in time in notes.
Typing drop by 20%. Drop copy/paste by 50%. Documentation length goes up.
Drop in documentation time but growth of time in chart review. Docs are taking that time and it goes back to patient care.
At the end of the day. Brain is full. Epic big tent does fun. Spaceship cruise. Join us!
Amanda Brill, Laura Macke, Rachel Rodriguez, Adam Ward, Frances D’Arcy, this blogger.
The author and Kelley Aurand, CMIO extraordinaire at Legacy Health who taught me about ambient. Is this what AI really thinks I look like? AI printers.
End of day introvert face. Thanks to Esther Park Christina Jung and David Bar-Shain for my PACmentor lapel badge for 2025-26. Go PACmentors!
Thanks Epic colleagues for another amazing day of learning.
Another day tomorrow. Anyone coming to my book club talk at 230pm? UGM255. Book Club for piglets. Mystery in the Midwest. Ukulele song. Fair warning.
UGM066 What’s New: A Tailored Upgrade Training Experience. Sure sure lots of great ideas but: a sound-track-backed anthem?!
Hear more about Epic’s new system training tool. Go see the slides and talk recording later. Now, enjoy 30 seconds of Dr. Mabus belting out this anthem.
How do we know that referrals are completed? How does Epic help manage these outpatient consultations?
58% of patients seen at ICHS require translation services.
A big room of FQHC organizations.
The problem of closing the loop for imaging or specialist report. It is a patient safety issue if the referral data ever makes it back to referring. Harder for FQHC since everything goes outside of the clinic walls.
Then there are regulatory expectations.
Must close the loop within 30 days!
And this same referral loop closure is an eCQM MIPS metric. Value based care, anyone? You should also care.
Big challenges for FQHC’s. One FQHC Golden Valley, almost all primary care, sends 14,000 referrals a month. Huge tracking problem. Most of the work is in WQ work queues for going out for authorizations. Then tracking for completed referral. This process is invisible for nurses and provider. Lots of manual work by referral specialist in authorization system to fax or transmit and then to mark things as returned or not.
14,000 per month is unmanageable in a work queue despite all the possible filters. How are others doing this?
Health Choice Network. 19 states. Hosting. 328 locations. 150,000 referrals a month or about 60 referrals per provider per month. Average.
Lots of roles involved in this big task.
Lots of moving parts. Lots of team members. Close the loop status doesn’t automatically close the referral. Designed and implemented an every midnight process to close the referral when status was ‘closed.’ Seems like this should be an automated process for everyone not just some clever person who built this for one organization.
Then build exclusion criteria to help reports be only tasks that have an action. Whoa. This seems really complicated.
Clinicians helped define an owner for closing the loop. Results follow up clinical workflow.
Created new custom reports to track activities. This seems like a ripe process for improvement from Epic Wisconsin. And if done well for FQHC referral loop closure this could benefit all health systems. Closing the loop is hard for everyone, but particularly for FQ’s. And it is so important for patients. Let’s do it!
What does it mean to be a highly effective informatics organization? Metrohealth tells us. physician EXEC 15. What a great roadmap from a senior CHIO in our industry. Nicely summarized. Dr. Kaelber, we salute you.
Evolution of our aims. 3 to 4 to 5 aims.
Learning health system 7 of 12 aims rely on informatics. Translating data into action.
What a nice summary of what informatics does. Where is the value of informatics to departments and operations leaders.
‘Don’t come to us with a solution, come to us with a problem’ —David Kaelber
What are the 7 principles?
Cool farm team.
Assistant directors are not paid.
Must check into this more ourselves.
Remarkable performance. It is impossible in talks like this to absorb all of it. So what one thing will we each takeaway?
