Former Epic Doctor: How to Actually Make Healthcare Work for Physicians

“Let's be honest, the main technology tool that most physicians use is the electronic health record. And physicians generally don't understand what the options are or what the configuration settings are, and they assume that the way it's designed and set up at their hospital or healthcare system is due to the vendor, which sometimes is true, but often is not true, and that it’s set in stone, which is almost never true.”

Dr. Craig Joseph is a physician-informaticist with decades of experience at the intersection of clinical care and health IT. Currently the CMO at Nordic Global, Craig co-wrote the book Designing for Health, spent six years working at Epic, and served as Chief Medical Information Officer for several health systems.

On this episode of How I Doctor, Dr. Graham Walker talks with Craig about what’s actually broken in American healthcare, and why blaming EHRs often misses the point. They discuss the messy realities of health system design, the value of examining minor IT annoyances, the job purview of a CMIO, and the need for physicians to lead innovation in medicine. Craig offers the ultimate insider’s perspective on rethinking healthcare tech and getting the most out of AI.

Here are three highlights from a dynamic episode that makes informatics accessible for all physicians.

The aspect of healthcare where AI will always fall short

“There’s that intuition you miss when you have a machine that's just looking at the facts and doesn't know the person or understand the emotion.”

Doctors and other types of clinicians are handling a lot of tasks that will increasingly be done by AI, which Craig thinks is great. Documentation and ordering medication are two examples. But he doesn’t think AI will take over diagnosis anytime soon. And he thinks AI fundamentally falls short in patient care. In attempting to understand what’s going on with their health, patients don’t just listen to what doctors say; they also rely on doctors’ non-verbal cues. AI can spit out an answer, but it can’t say, “Don’t freak out; I see this issue every day” through a facial expression. Intuition goes a long way in doctor-patient communication, and machines can’t offer that.

Why GROSS (Getting Rid of Stupid Stuff) is so important in healthcare informatics

“We generally think that these little annoyances, little pebbles in your shoe, are not as important as the big things, the rocks that we see that we need to move. So we work on moving the rocks.”

The concept of GROSS came from a health system that allowed employees to submit forms questioning the purpose of tech processes and tasks that seemed, well, stupid. For example, someone might ask why they needed to document a patient’s blood pressure in two places, or why they needed to click a button twice. This forced the health system to address minor EHR issues, which typically get overlooked in favor of bigger projects that seem more important. As Craig notes, small fixes can make a meaningful difference. So, a lot can come from merely asking, “Hey, this thing we’ve all been doing is stupid — do we really need to do it?”

Craig also points out that IT teams usually focus more on adding tools, systems, and features than on removing ones that aren’t worthwhile. Even if removing something is the best way to solve a problem, it’s not where our minds go first. Craig reasons that the desire to build is, to some extent, just human nature.

Documentation is on its way out

“There are lots of privacy concerns. I totally acknowledge that. But there are also lots of privacy concerns with carrying a tool in your pocket that tracks your location and what you do and what and what you think about every day.”

How will tech in healthcare change in the near future? By 2030, Craig predicts doctors won’t be doing any documentation. Instead, they’ll use AI tools to record every interaction. Craig concedes there will be privacy-related objections. But he also suspects that patients will come around, just as most people have come around to using smartphones that pose considerable privacy risks. Once it becomes less novel to have AI scribes present during visits, Craig believes that people will decide the benefits of recorded visits outweigh the downsides.

Connect further with Craig on LinkedIn here.

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Transcript

Craig Joseph:
If you take all the easy, quick, relatively straightforward patients out of my practice and send them somewhere else, well, then you're leaving me patients who are very complicated and then I can only see six, 10 patients a day and there's no way you keep a primary care practice open with that kind of flow. It's really not designed well.
Healthcare is not really designed as a system in the United States. It's just developed and evolved into this thing that we're hoping we can continue to put band aids on.

Graham Walker:
Welcome to How I Doctor, where we're bringing joy back to medicine.
Today, I'm talking with a physician who sits right at the crossroads between medicine and technology. He's a pediatrician. He's a chief medical information officer. He worked at Epic. He's a floor wax and a dessert topping.
Dr. Craig Joseph is one of the wryest people I've gotten to know over the past few years, but beyond his hilarious snark, deep down, he's secretly extremely passionate about healthcare, getting medicine and the technology piece right.
Craig has written a fantastic book called Designing for Health that explains the values that healthcare and technology have to use to be successful for patients and for healthcare professionals too.
I'm super excited to talk with Craig today because he's worn so many hats over his career that he can often translate something that's confusing from one perspective but makes a ton of sense from the other. And he does it with humor.
Craig Joseph, welcome to the show.

CJ:
I am so excited. I don't know who you're talking about, but I am here and I am ready to answer your questions.

GW:
Craig, like I said in the intro, you've had so many roles. What do you think physicians misunderstand about informatics?

CJ:
Let's be honest. The main technology tool that most physicians use is the electronic health record and physicians generally don't understand what the options are, what the configuration, kind of settings are, and they assume that the way it's designed and set up at their hospital or healthcare system is due to the vendor, which sometimes is true, but often is not true and is set in stone, which is almost never true. And so they often are upset about things, appropriately so, but blaming the wrong party.

GW:
I think that's totally true. I will put on my clinical informaticist hat on today as well, Craig. You've seen one Epic install at one hospital, you've seen one Epic install because Epic is so infinitely configurable. I think that's both often their strength and their weakness.

CJ:
Absolutely.
I've said to physicians that... You've mentioned I'm a little sarcastic and I sometimes get away with stuff, but I've asked physicians when they've come to me with certain valid complaints.
If they enjoy practicing medicine in the United States and with the implication being like, "Hey, I've seen the same software outside the United States," and that concern is not shared by the physicians there, and so... "Hey, we have this 'healthcare system' and the software's there to try to support that."
Absolutely, the vendors make mistakes. Absolutely, the hospitals that implement those solutions make mistakes but sometimes it's just like, "Yeah, it's a crazy system and we're trying to do the best we can with a really bad system and the technology is going to support that really bad system."

From Pediatrics to Epic: Why Dr. Craig Joseph Left Clinical Practice

GW:
Craig, how long did you practice medicine before you decided to transition to working at Epic?

CJ:
I did primary care pediatrics for almost nine years in the Metro Detroit area before moving to the dark side.
I did my undergraduate at University of Miami in Florida. During orientation my freshman year, all the pre-meds sat in a room and the dean of admissions at the University of Miami Medical School came and gave a talk and someone asked her what they should major in. Boy, that room got quiet real fast.
I remember almost word for word what she said. "You can major in anything, but most of you will major in biology or chemistry, and if you're interested in those two things, that's great. But if you want to stand out on my desk, you should have a non-traditional major such as poetry or art, and you'll have to take the MCAT and you'll have to show us that you can work hard. But boy, we're looking for well-rounded students."
At that point, I was pretty nerdy, and so I said, "Well, computer science, it is because I'll be able to get good grades."
That literally was my only decision-maker that I thought this was the major that would help me get into medical school, and I think it did.
Boy, I did get attention from people who were like, "You are a computer science major and you're going to medical school." Nowadays, psh. Yeah, that's pretty, pretty normal.

GW:
It's actually quite common. Yeah.

CJ:
Yeah.

GW:
Craig, I think that's something that you hit on very early for a physician to decide, "Hey, I'm going to go work at a EHR company." Twenty years ago, that was not a common pathway at all.

CJ:
I think that I was burned out before it was cool to be burned out.
This was again, Metro Detroit, and back in the day, almost everyone just opened up their own practice or joined another small group. We weren't working for these large organizations, and so there were times where I couldn't pay myself because we hadn't gotten... We had just paid for a bunch of immunizations, we were waiting on... And so it's really stressful.
I didn't like all the hiring and firing of nurses and MAs and all of that and the office politics. I was really pretty stressed out and looking for some way that I could still leverage my clinical experience and be involved in healthcare but be adjacent.
I'll tell you. When I announced that I was leaving the Detroit area and moving to Madison to go work for some electronic health record company that no one had ever heard of, or at least my colleagues had never heard of, we were fully on paper in the hospitals-

GW:
Yeah. Of course.

CJ:
... in our offices. I got almost the exact reaction from everyone, "What are you doing?"

GW:
"Are you okay?"

CJ:
Yeah. Yeah. "Should we do an intervention?"
But soon thereafter, they said to me, "Oh. I wish I could do that." And to which I said, "I think you can." Most of them are like, "No. No. I couldn't do it." Because it's risky.
This is going to sound really bad, but I'm going to say it anyway.
Many people who go to law school have no intention of becoming lawyers. They're looking for the information that they learn how to negotiate, how to think like a lawyer-

GW:
Think about, yeah, yeah.

CJ:
And by any stretch of the imagination. I'm not promoting people going to medical school and then not having practice experience because, boy, the eight, nine years that I was practicing full-time with one other physician, I learned so much.

GW:
Oh, yeah.

CJ:
And to this day, I don't know how I could do the job I have if I had simply done medical school. Even if I had done a residency and just walked out after doing a residency.
Even as a resident or fellow, there's always someone above you who's ultimately responsible until it's your license and you are going to make that life or death decision. Until that. It's hard to really understand the practice of medicine.
I've had some people say, "Oh, people have sought out my advice and I might just do a three-year residency and be done." I'm like, "Okay, that's something. But if you're looking to lead physicians or if you're looking to convince physicians that you have good ideas without having that significant practice experience, it's really complicated because we can smell you. We can smell you."

GW:
I agree.
I've heard somebody say that the two biggest leaps in knowledge or competence or ability or learning happen from beginning and end of intern year and then that first year or maybe two years as an attending. Those are actually the biggest leaps in your confidence in your ability because you learn so much about the practice of medicine.
What was it like actually working at Epic? What did you do there?

Behind the Scenes at Epic: Building the Foundation System

CJ:
I got hired to work on something that was called Judy's project. Judy being the CEO and founder. She had been tasked by CEOs of her clients to make the implementations of our electronic health record faster, cheaper, better.
They were all CEOs said to her basically as I understand it before my time but basically said, "Hey, we pay you a lot of money. You tell us it's important to have our clinicians and operations folks and all kinds of folks answer questions that your staff ask us. We give you the best answers that we can. They're often wrong, and it's a waste. And wouldn't it be better if you just told us how to do it and asked us fewer questions that we couldn't answer?"
Because, again, if you asked me as a doctor, "How do I want it?" Well, I want it the way I've been doing it for the last 20 years, which is often at that time on paper.
We ultimately created what is now called the foundation system. So instead of just getting blueprints and the parts to build a house, you actually got a house that was pretty much built before you even signed for it, and you got to make some minor changes. That was the main thing that I got to be involved with, which was really a lot of-

GW:
That's huge. Yeah.

CJ:
It was a lot of fun.
We had to overcome a lot of questions from our peers because forever Epic said, "We're not a content company. We're a software development company. We don't give you order sets, we don't give you documentation," which is right. That's a good answer except that people really needed those things as a starting point or a foundation as it's now called.
Getting that starting point saying, "Well, this is not perfect, but there's a lot of customers of Epic just like you who are using these tools today very successfully. So maybe you need to tweak them, but you probably don't need to reinvent them."

GW:
One of the things that our mutual friend, Matt Sakumoto, often calls out is just like you said, we recreated paper workflows in the HER and that actually is part of the problem.
It's taken us so long to digitize all the paper in healthcare for a lot of reasons, including HIPAA and privacy and workflows and everything like that, that we actually haven't taken the next phase of technology, which is you actually make new workflows that use the EHR or use a digital standard as opposed to just pretending to take an old paper chart and turn it into a digital paper chart.
How accurate do you think that is?

Paper to Digital: Why Healthcare Tech Still Feels Broken

CJ:
It's terribly accurate.
Most of us don't sit and question why. It's just that's the way it has been.
Thinking about turning on a car with a button. Right now, that's not that kind of crazy, but the first time I saw a car that you turned on with a button freaked me out.
When I was at Epic, I went to an implementation once and I got called down to blood bank because I was told there was going to be a fight, and I'm like, "Well, I don't do that. You're thinking of someone else."
But blood bank didn't want to give out blood because they didn't have this form that needed to be signed by the physician. I have the physician. So I'm looking... The blood bank says, "We have to have this form. We always have this form. We can't ever give out blood without this form, and it only can be done by a physician." And then I looked at the physicians and they said, "We don't know what they're talking about. We've never signed these forms. This is not information here that we have to give and we've never signed this."
It turned out it was a unit clerk that was signing these forms.

GW:
Oh, wow.

CJ:
Yeah. For years. For years and years and years. Somehow, it got missed during the implementation process and no one asked.
The point is that, boy, the place was running fine with this paper that was totally unnecessary and no one really thought about it until we had to about, "Okay, well, what information does the physician actually need to give? Because clearly the unit clerk was providing this information. They didn't go to medical school. They're very smart, know how hospitals run. They were collecting information from the chart and writing it down and it was basic information."
In the same way, "Well, the physician has to write the note, all aspects of the note, and collect all that information," when you're like, "That actually never really happened on paper."
In paper, when I was practicing, oftentimes, my medical assistant, forget about nurse, my medical assistant would collect the history and sometimes, it was so complete.
I had a medical assistant who was taking care of kids long before me and she would attach often a parent handout. I would walk in, I'm like, "Well, Cheryl thinks that your kid has croup, and I know this because Cheryl has attached the croup handout to your child's paper chart." I looked at them...
Again, I practiced mostly in a two-doctor practice so I knew most of the parents pretty well. I said, "Now, Cheryl's only right about 98% of the time, so I will recheck everything that she's done and re-ask you the information to confirm it. But let's go with it's probably croup."
We had developed protocols. We didn't call them protocols. We just said, "Hey, if a mom calls and says that the amoxicillin was left out all night, the liquid amoxicillin that needs to be refrigerated, I don't want to hear about that. All right. What I want you to do is call in a prescription..." Long before e-prescribing, "Call in the prescription and then let me know about it after it happened. I will sign off on it just so I'm aware of it, but don't ask me if it's okay. It's amoxicillin. It's 100% okay."

GW:
I've blessed it. Yeah.

CJ:
Yeah. Never want to hear about it until...
Again, I signed it at the end of the day and I was aware of it and we certainly wouldn't do that if you called and said, "I think my kid has an ear infection. Can you call in..." Absolutely not. But if they look in the chart and I prescribed 10 days of amoxicillin and we're on day three and she left it out accidentally overnight, it's a very low risk to calling in another seven-day supply.

The Role of a CMIO: Translating Between Doctors and IT

GW:
Craig, let me just ask you a little bit about being a chief medical information officer. I think a lot of physicians, especially if you don't work in informatics or you don't work with other leaders at the hospital, it's not a chief medical officer.

CJ:
Nope.

GW:
It's not a chief information officer.

CJ:
Nope.

GW:
Maybe just start, what is a CMIO and what did you do all day?

CJ:
Typically, the CMIO... Or now CHIO is another offshoot of that.
Typically, we're talking about physicians, and I always said, I have one foot in the clinical world and I have one foot in the IT world, and typically, CMIOs would report to the chief medical officer or to the chief information officer. That's typically how you would do it.
And so my job was to again call balls and strikes and to say, "Hey, IT, I know we don't want to personalize this and spend a lot of time for this thing because we just want the cardiologist to do the ordering the same way that the PCPs and the pulmonologists do it but, boy, they have valid reasons to change this because they don't work like the others. This is where the juice will be worth the squeeze to make this fix."
But sometimes I need to look at the gastroenterologist and say, "Hey, pediatric gastroenterologist, what you do is not all that different than what the adult gastroenterologists do. It's different, of course, but you've similar tools. You treat similar diseases. I'm never saying that children are little adults but, boy, a lot of the basic tools that you're using in the EHR should be fine for what you're doing."
I often have to remind my IT friends that I can technically write an order... Again, I like to push the boundaries. I can write an order, I always have been able to, to ask the nurse, to tell the nurse, to order the nurse to hang the patient outside the window by the wrist. I can write that order. You have got to allow me to write that order.
Now, I fully expect the nurse will not do that and will question me, which is totally appropriate, this is a team-based sport, and that's fine. But I need to have the security to be able to do those kinds of things because every now and then, maybe that order's not ever realistic, but there are times where I want to order more of a medication than we typically would.
Again, my job is to convince the pharmacist that what I'm doing is safe and in the best interest of the patient, but I can't allow technology to get in the way.
Oftentimes, we think of technology in a black and white world and we all know we live in a gray world. At least in healthcare. I think probably everywhere.

GW:
I think Craig, one of the things that we frequently get into trouble with is when we lump physicians all together and then just say, "Well, this is physician work," or something like that and physicians, "Our specialties couldn't be more different." What a cardiologist does, a pathologist, a pediatrician, a GI doctor, an emergency physician, they all do different stuff all day long in the EHR like how an ER doctor thinks about ordering versus a primary care doctor could not be more different.

CJ:
Yeah. And we made so many mistakes when we started both developing the software and implementing the software and configuring it to not take that into account.
Another thing that we did all the time was we said to ourselves with our IT hats on, "Well, it's easy to ask the doctor this. Let's just make sure the doctor answers this question."
My standard example of that is the patient pregnant when you're ordering an x-ray. Is the patient pregnant? Well, that's something interesting to know. We need to know it before we order that. But again, one of the things that I've developed is a series of questions and to help me think about these things.
One thing I think about whenever we get to some point like that is, "Well, did you need to go to medical school to answer that question? Because if you needed to go to medical school to answer the question, then it's a valid statement to say, 'Well, we want the doctor to answer that.'"

Design Flaws in Healthcare: Stop Asking Doctors to Do Everything

GW:
"This human needs to do this." Yeah.

CJ:
This human.
But to answer that question, we don't need to go to medical school.
One of the things that I always tell my staff would be like, "Hey, if you didn't need to go to medical school, don't ask the question of the doctor." What pharmacy does the patient want the prescription sent to? Again, don't need to go to medical school to answer that. Why are physicians involved in answering that?
I think it makes sense to double check it to go over it.

GW:
Sure.

CJ:
We all know about allergies. You get asked 85 times.

GW:
Well, Craig, we are having a nice segue into your book, which I have to say I literally agree with, I think, everything in the book because you are so spot on with your recommendations and stuff. I want to read a little passage and get your opinion. This is, I think, in the first couple chapters.
"While retail and tech-led providers can compete on convenience and price, sometimes, nothing short of a visit to a traditional health provider will do.
As an OB-GYN will tell you, every delivery is routine until it isn't.
One of the things that sets traditional healthcare apart is the depth and breadth of knowledge that makes it possible to deal with non-routine problems."
It's a long-winded way of saying healthcare is complicated and traditional healthcare, doctors, nurses, not digital health are quite adaptable to handling anything that gets thrown our way.

CJ:
First of all, whoever wrote that, I agree with that.
I don't think it's long-winded. I know you said that, but I think the author did a great job with that phrase.
This is this part of the problem of where the healthcare is going in our attempt to say, "Oh, well, if it's just a rash, you can go over here and we can handle that with either this retail clinic or something or an app or whatever," and most of the time, that's right.
However, it falls apart under two situations. One is when that's a very dangerous rash.
I took care of a patient with meningococcemia and they came to the emergency room because they have-

GW:
It certainly can cause a rash.

CJ:
It did.

GW:
Yeah.

CJ:
It did cause a rash. It was a bruising kind of rash actually, Dr. Walker, and that's a very dangerous... That's a fatal disease often.

GW:
That's a bacteria that gets in your brain and causes meningitis, but it actually can also cause a rash on the skin because, I think, it's actually causing vascular necrosis is what we're seeing.

CJ:
Yeah, it's not good. And that's a rash.
Well, it's just a rash. Okay. It's going to show that it's not just a rash in a couple hours, but once we see some of those side effects, it's unlikely we're going to be able to save you.
The other aspect is money.
When I was a primary care physician, the way I was able to keep my office open was that oftentimes the easy patients, I say easy after four years of medical school, three years of residency, and years and years of attending practice, they were easy for me, I don't think they're easy for other people, but I could diagnose them rather quickly that I was able to do that because I could see a bunch of those patients and when we're in fee for service, that's how you make money.
But then I had the teenager who was having thoughts of suicide, who would come to my office as an appointment and given 10 minutes because the mom made an appointment and said, "He's depressed," which, again, I had 10 minutes if it was just a depression and that just... There's no way for us to predict that. I have to attend to that patient.
Boy, if you take all the easy, quick, relatively straightforward patients out of my practice, again, especially fee for service and send them somewhere else, well, then you're leaving me patients who are very complicated and then I can only see six, 10 patients a day and there's no way you keep a primary care practice open with that kind of flow.
It's really not designed well.
Healthcare is not really designed as a system in the United States. It's just developed and evolved into this thing that we're hoping we can continue to put band aids on.

GW:
I always viewed that as unfair that the traditional healthcare system has to be able to be ready and able to handle anything, all the diversity of human beings and the combinations of past medical history and problems and stuff like that.
But the Amazon clinics of the world get to just pull off the easy stuff that's been screened and... A lot of what they're prescribing is like over-the-counter medicines for heartburn or for jock itch or something like that.
That also almost feels unfair to me that the traditional healthcare system doesn't get to just say, "Nope. Oh, you have something that's more complicated. I get to tell you, go somewhere else." And then my other reaction was like, "Well, can AI address the depth and breadth? Can AI make it so you know that it's not just depression, they're suicidal, or it's not just eczema, it's meningococcemia or something like that?"

CJ:
I think we're far from AI taking over for physicians. There's lots of opportunity for artificial intelligence in healthcare today because a lot of what we do, clinicians, not just doctors, but nurses and everyone else is really we don't need to do.
Documentation, often ordering, it's much easier for me to approve orders than for me to type in the orders, those kinds of things, I think it's great.
In terms of diagnosing, we're probably a bit of a ways from that. There's so much intuition and pattern recognition that we do, some of which is bad, most of which is good. So sometimes, we anchor on certain things and we have trouble getting away from that.
I think that just as a patient myself, I dread interacting with these clinics where it takes months and months to get to a physician because sometimes, I just want to ask a quick question or I just want that reassurance from someone who's seen this.
I've never seen this before. I'm the patient. It's the first time for me. Are you scared, doc? Because if you're scared, I'm scared. But if you look at me, you're like, "Ugh, I do this everyday. This is nothing," then my fear and anxiety level goes way, way, way down. I can't gauge that from an AI telling me because an AI is 100% certain every time.
I had some parents who wanted to impress me. They're like, "Oh my God. This is the worst diaper rash you've ever seen." Listen, you don't want that because if this is literally the worst diaper rash I've ever seen, I'm going to have to send you to the emergency department for admission, and we don't want that.
When I look at it, I'm like, "This might be the worst diaper rash you've ever seen,"

GW:
"Or I've seen today."

CJ:
"But this is not even the worst diaper rash I've seen today."
There's that human connection that you miss when you don't have primary care or a regular doctor.
And also, yeah, there's that intuition that you miss when you have a machine that's just looking at the facts and doesn't know the person or understand the emotion.

“Get Rid Of Stupid Stuff”: Fixing Frustrating Healthcare Workflows

GW:
You talk a lot about this concept of gross, which is one of my favorite concepts in all of informatics and design and everything, so it stands for Get Rid Of Stupid Stuff. I think it came from Hawaii Pacific-

CJ:
It did.

GW:
... Medical Center.
Just for listeners, I'll explain.
The idea is there's a lot of cruft or junk or stupid stuff in healthcare that we all do, and this idea was I think this health system allowed their employees, their nurses, doctors, pharmacists to submit a form that said, "Why do we do this? Why do I have to document the blood pressure in two places? Or why do I have to click this button twice?" All of this wasted time and effort.
My question for you is why is it so hard for health systems to get rid of stupid stuff?

CJ:
The quick answer is because we generally think, in IT mostly, that these little things, little annoyances, little pebbles in your shoe are not as important as the big things, the rocks that we see that we need to move and so we work on moving the rocks.
I'll give you this example.
When, I think, I don't know, I was the CMIO somewhere and I was talking to some doctor and I said, "Hey, are you happy with that big module that we implemented?"

GW:
"Yeah, we just implemented the big new module."

CJ:
It was a big deal. It cost a million dollars. It took us six months.
The guy looks at me, he goes, "Yeah, yeah. But let me tell you what I really appreciate. That documentation template, that smart text that I use all the time, the second paragraph, the third line had two periods after that sentence, and I use it all the time."

GW:
It was in all caps and you made it capital case.

CJ:
"And I had to go in and take out that second period that you guys never would take out and you did it and that really changed my life."
These little things are often just overlooked. They're not overlooked by the clinicians or the people using the tool, but they're overlooked by the team because they seem less important.
Also, people, again, don't realize that these things can be changed often. Obviously, if there's a typo somewhere, they know someone can fix that but they don't know how much effort is involved in doing it.
But not only that, sometimes, it's, "Hey, this is really stupid. I don't think we should do this. Can we stop doing this?" Actually, no. That's a state law that we need that or there's a regulation and let me cite it for you. So instead of me just telling you, "Here it is. Here's a link to it."
I think it's human nature to some extent to want to add things to build as opposed to remove things even though sometimes-

GW:
To destroy.

CJ:
Well, it seems that we're going in the wrong direction if we're removing something. Even if we're solving the problem that we're setting out to solve faster, cheaper, better, we're going to try to add something. Removing seems to go in the wrong direction.
Sometimes, removing things, even the small little things that are just irritating the people, it seems like it's less important than adding that big new module.

The Future of Healthcare Documentation: Audio, AI, and Automation

GW:
Dr. Craig Joseph, I have one last question for you. I'm going to ask you to take a big swing here. Let's say it's 2030. What do you think has changed with health technology?

CJ:
I think that we're not going to be doing documentation anymore. This is my prediction. It'll likely be wrong, but I'm still going for it anyway. We're just going to record everything.
We'll record all of our interactions and everyone will know that it's being recorded. Then boy, my documentation is much easier if I've recorded the interaction probably on audio only, probably not on video, and again, not all the time, but when I'm trying to create documentation or a record, and I'll have multiple AIs that can simply generate a response. So meaning it'll create a note for me, which is important for future self Craig, but it'll also create a note for a quality assessment person who's going to be checking it, or a note for a compliance person or a lawyer-

GW:
It's like a one to many...

CJ:
Yeah.

GW:
Yeah.

CJ:
Because that's-

GW:
And it's in the format that the quality people need and that the doctor needs and that the patient wants and... Yeah.

CJ:
If there's a question, and there will always be questions, like, "Well, did this accurately represent what happened?" Hey, we've got the recording.
Storage is cheap. I would envision that recording that we made with everyone's approval is going to be there forever, and we can always look back on it and say, "Oh, yeah, that's exactly... That is what you said and that is what that person said."
There's lots of privacy concerns. I totally acknowledge that. But there are also lots of privacy concerns with carrying a tool in your pocket that tracks your location and what you do and what you see and what you think about every day, and most of us think that's okay. We think the benefits outweigh the disadvantages of giving up our privacy with our phones.
I would argue, I would think five years from now that people are going to be like, "Yeah, that's just how it is."

GW:
Wow.

CJ:
I think physicians are going to be like, "Yeah, well if you don't want that, I'm going to have to do a lot more work. So either A, you might have to go somewhere else, or B, I'm not sure I can charge you the same amount that I charge other people because it's going to slow me down and not going to be as efficient."
I would predict that most of us are going to make the same decisions we made about our phones, which benefits way outweigh disadvantages.
So documentation.
Orders, I think, will all be queued up. Not signed. Not signed, but queued up so the physician can say, "I'm going to start you on amoxicillin, and we're going to order that CBC and I want to see you back in six months," and that will all just go to a screen and I'll be like, "Yes, yes, yes. Done."

GW:
Well, Craig, it's been a pleasure. Thank you so much for joining me today. Always great to talk with you.

CJ:
It's been great. Thanks for having me.

GW:
Thanks for joining me today.
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