System of Record - Raw Transcript
Yeah. So anyways, you don’t have to. So, I’ll sort of get to it in the end. Sorry, you don’t have to necessarily comment umh. So this one’s called System of Record and The way I would describe it is as such Uhm So, Let me just think for a secondSo System of Record. System of Record. So, Here it is. Uh in medicine, We have an electronic medical record. Again, historically it’s been a Monolithic Endeavor Where You have, Sort of a one system Rule them all There’s definitely appendages Don’t get me wrong, I think that each Eh. Each there is like, it’s not like it’s definitely monolithic Uh So like the lab might have something and There might be specific software you bolt on for. I don’t know, specific specialties But, overall. It’s been pretty monolithic from the perspective of a primary care doctor. It’s monolithic, uhmm I think last winter I ran Uh. January of this year I was thinking a lot about Command line interfaces and how I thought they would be You know, it’s really what we need. But I think that it was too crude. I don’t think really the command line interface is what we need anymore I think it’s a big Part of what we need? I think we need to move more in that direction But I think it’s less about Less about like that we need an EMR that has a command line interface And it’s more about, More about Separating. Unbundling, right
So right now, The monolithic. Means this Large And it’s all comes bundled, right? You get So the system of record, which I think. Probably the EMR is the Number one place Not only like it’s number one function, right? It’s like this is a system of record. This is like. Where Something happens, It’s recorded here, it’s a ledger Right? It’s a medical ledger Um And so That’s an important job, and I Really don’t think that. We need to change that part of it. But because, historically If you wanted to be a A ledger You also needed to be like the Inputs and outputs section, right? The question is Always how do you get information into the system of record right Then there was more and more information to get in More and more discrete information Checkboxes Total like Uh, you know in End up more and more of our time. Is less about like how to care for the patient And more about How do we get. An accurate system Record
And that was getting it into it Then you have getting it out. Which is like. EMR was also the place we would Get everything out of the system of record. So if you actually chart search Med recon Uh, you have to, like Do all this you want to just like Know when last labs were, right Make sure your health maintenance. All this was again, Just like bundled into the same thing It’s always been like Up to this moment, is that You controlled where the Data was input. You control not even where it is input. You control. The data Layer You had to control the input output layer too That’s. a good business. But I mean trajectories recent article from Oh, I think it was yesterday, so that’s Wednesday September 15 Not how Oracle’s created a plugin. Mod code Well, Oracle owns it. There’d been notes that um Honestly, like, the great thing is selling the plug-in because All that gee- all that graphic user interface Stuff No, sort of like. You don’t even really need that anymore So you’re kind of, like The plug-in, it’s telling something that. It’s gonna. very soon now even You wouldn’t even really need it for. You can just have Chat GPT take your computer and use it. And they can put in, they can put out but, I guess the unexpected, Last, February that it would But still build it, we build a computer like literally But it did It is And so We come to a new Section of The EMR, right? It’s like Where do we go next? Um I think that Historically. Hey buddy, EMR Right. part been almost like a duopoly Lot of little appendages Uh. It would make a lot of money, right? Selling add ons. Your software Um. And they probably had a lot of legal requirements to make it so, like We were allowed to do this or that I think that This point. You’re going to have to double down on unbundling because Kind of like when you had to bring a device to work You’d say like, you know, eventually You’d just say, hey, we’re just gonna start supporting people’s iPhones and iPads because- They’re just bringing them from home, right You know, it’s a positive because maybe you don’t have to buy Uh, you don’t have to buy As much hardware for your Uh. Employees, but it’s Negative, ‘cause now you have a whole new layer Of uh protection against us to incorporate And anyways, I think that Um I think that. It would be smart if the EMRs. Figured out a profitable way Unbundle Right Uh because I think that it’s coming no matter what It’s really like the Input layer no longer needs to be the check boxes, right? Gonna be Sort of like a. I guess More like having a co-pilot on input is what we What we really need. A lot of this sort of input. It’s not really needed to have clicks anymore We need a verification layer. So it’s more like steering, sort of like. The AI is the input and you need someone to have Um be like a verification layer to make sure that what’s going in is in slot. Right? That’s sort of like the biggest concern, but slop is coming. Less and less of a concern over time, it’s something that Companies are really Batting out. And then on the output layer Again, You really like. You can try to make your own product, but This is sort of like a let a thousand flowers bloom situation. You just unlikely to come up With the product that sticks and so Kind of be more of like a realistic about, Hey This is um This is what we got, and this is how we’re going to let you Use this. Like, being the data layer is valuable Not because you can Um, not because you get to do all this third-party stuff. But because you can’t, I mean. Maybe you can migrate your data out. That’s another thing, right? You can probably do it If you want to make it a sticky as possible. Keep your data there. The Ten years, that’s really where it’s at. Like, where am I keeping my data Why am I not migrating? out Most are the new questions, like where would I put it? Right now AI. Point of AI is not to Keep a database in context, right? point is Like, we have database, figure out how to use it Way better than a human can Much faster time frame. Find the- keep telling it what it’s supposed to do I, you know, there probably in the near future. Will build the database capability into the AI So again, you wanna really be thinking about What’s my moat here? What’s my moat? How can I unbundle and keep a moat? I think that’s sort of the new question Uh You know, regulatory capture, certainly Quite a big moat But it’s sort of also like when things get so damn good. Near behind Even that could start to slip. I think. I think that regulatory part will probably slip over time Just given like, you know, how much better life can be for patients And providers Uh- then- currently is and if you’re behind the times Like at some point people will just dump you. Anyway That’s the article. That’s the thought, at least. That’s the journal entry
Later Dictated Addition
The last thing I would note that I want to add to this article is that I’m excited, at least about routine from my own workplace, which is that, which my memory, is in the process of setting up and soon will be deploying a bridge, which I believe is an ambient dictation software. So I’m excited to see how this actually plays out in the real world.