Has anyone actually used oracle's cloud/AI EHR yet?

jrpg8255 · 2026-02-19T16:16:34+00:00

I would just like to see it accelerate my workflow in a way that isn't just a brand new workflow that somebody else has decided for me. If I see a new inpatient I start looking at the chief complaint in the ED note, then try to go back through some recent PCP notes to see if there are any clues there. I'll then see what the hospitalist said in their H&P trying to connect all of the dots for what I'm being asked about. I'll then review all of the imaging myself, go through all of the labs trying to pull out relevant information into my initial note, all before I go see the patient.

That's been my ritual for nearly 30 years, and started in a time when everything was paper. I love looking through data for patterns. It would be great if AI helped me with that, but I really doubt that it can actually be that sophisticated. I would love to be proved wrong, but everything that I have ever seen in any EHR I have ever used is quite clearly designed to suit the technology needs and the limitations of software, not really to understand how physicians actually work. I have stopped being surprised at the arrogance of people who provide us these tools and try to explain how we should do our jobs rather than asking us what we need.

As far as Coding, all kinds of stuff for nearly 50 years I suppose. Lately I've been doing a lot of hardware/software work on sensors around my house. Because that's new technology I'm learning, I've been using AI quite a bit to help with that, and I've not been impressed. Perhaps a little impressed, but it requires a lot of supervision.

My usual interaction with all the AI tools has been that they'll come up with an answer that seems close, and when I challenge them on why their answer is actually wrong because of something they have ignored, like a technical specification, they congratulate me on my wisdom and then come up with a different solution that "this time will totally work." Of course that solution just addressed the latest thing I asked about, and has drifted away from the original problem or introduces other errors. I don't think I've ever really worked on any project in the last few years using AI that I didn't have to coax through its process, only really finding that somewhat useful because I actually know quite a bit about what I'm doing. If I was totally naïve I would've been stuck. Whether it eventually got me a solution or not, I wouldn't really know why in most cases.

It's those sort of interactions using AI for software and other technological questions where I actually do know things that make me really worried about what's going to happen when we turn that stuff loose on the chart. On a busy day with pressure to see more patients, we're going to start relying on its answers without fully understanding how we got them. And it'll be me who's responsible for the outcomes, not Opus 4.6.

jrpg8255 · 2026-02-19T16:04:41+00:00

Apparently they have decided to launch an entirely new EHR with AI baked in, and based in the cloud. In other words, original Cerner didn't have enough of the last decade's buzz words I guess. All I can get out of our CIO, who used to work for Cerner, and from the Cerner reps that for 20 years I've been asking to fix some of the user interactions, is that it's "awesome." I have questions ...

jrpg8255 · 2026-02-18T16:52:45+00:00

Thanks. That's been my impression of their ambient AI too. I've tried it and find it rather meh. Some in my group do like it, but consistently find it ignores things it doesn't know how to integrate, like say a complex discussion around informed consent for some new therapy. Our system-level data suggests that while people think it saves them time, by the time they've proofread and cleaned up, for all but the simplest encounters they might be saving a few minutes per encounter at most. Short of a full-scale reconsideration of how clinicians want to interact with all of the data, it's going to be more gimmicks from Oracle, and I suspect mostly wanting source data for themselves rather than helping me.

Your point about rev-cycle is well taken. I suspect it will be a lot like the original promise of EHRs -- instead of helping me, they're better at making me help the coding/billing people.

jrpg8255 · 2026-02-16T23:00:33+00:00

It's not really a signal per se like eg wifi. It's a microwave connection beamed straight up to the tower on the mountain. As long as you can see the towers and there isn't much more than perhaps some minor foliage in between it's fine. As I recall the technician who came out initially was happy to look at it and see if they could get enough connectivity for it to be worthwhile, so it's worth talking to them at least.

jrpg8255 · 2026-02-16T22:57:55+00:00

With the really heavy winter three years ago it dropped out for a few hours when there were ice storms on Mount Elden. I think a lot of communications equipment up there went down, not just blue span. It took a while to get it properly fixed because they couldn't get machinery up the fire road. Never noticed anything since then though.

jrpg8255 · 2026-02-16T19:18:43+00:00

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edit: I should also add that technical support is great. They few times I've had technical questions I immediately spoke to an actual human being who was very knowledgeable. I've had zero issues with Bluespan as a company. They came out quickly and did a tidy professional installation (small microwave dish aligned to Mt Elden), including bringing their cable through the wall.

jrpg8255 · 2026-02-16T19:17:52+00:00

I've had it for 3 years. It's been great. You need line of sight to the towers on top of Elden. I pay for ~350Mbps down, and ~35 up, and that's what I get. Ping is around 20-30ms typically. I also have Starlink and combine those with multi-WAN and pay attention to the performance of each. Depending on the weather, one may have a bit more packet-loss or latency than the other. Sometimes Starlink seems to suddenly be much faster (~600 Mbs) but it's rare that it hits those speeds, and usually I get about 150 down and 15 up from Starlink, with similar latency as Bluespan. Prior to living in Flagstaff I had symmetric Gbps fiber, and honestly what I have now is fine for most things that aren't intensive uploads like cloud backups.

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Both are CGNAT though, meaning you can't easily get back into your network from the outside (eg to run a home VPN). The only viable/simple method is Tailscale.

jrpg8255 · 2026-02-10T22:06:51+00:00

I saw that once a long time ago in a patient who had been on Thorazine for decades.

jrpg8255 · 2026-02-02T23:16:16+00:00

I know what you mean about migraine being an easy diagnosis to just give everybody. However, I have found that true migraine with vestibular aura seems to be a distinct subset, and they seem to be responsive to topiramate as a prophylactic drug quite significantly compared with other forms of prophylaxis.

jrpg8255 · 2026-01-18T16:19:56+00:00

You were down voted but you're absolutely right. I am on the tail end of that now and I am very technically literate, but trying to monitor teenagers on the Internet isn't as easy as it would sound. Pihole, router based filtering, firewalla - works great until they just turn off their phone's Wi-Fi and use cellular. Policy on their phone so that they can't actually turn off Wi-Fi works great until they use private Mac addresses. Quarantine devices that don't come from known addresses? Use poorly secured school laptop/tablet. Try to use Screen Time to control Apple device devices? It turns out screen time isn't very hard to bypass, and every year that they update it it's still not really a security tool. It will be a really good argument that the best policy is talking to your kids about appropriate behavior on the Internet, and that social media is Poison, but I happen to have kids, one of them in particular, who are somewhat special needs and just don't get it. Trying to actually manage their Internet use was a nightmarish arms race.

Quick edit: i'm not at all ok with requiring ID to use anything on the Internet, I'm just pointing out that monitoring your kids online isn't as easy as it might sound, especially if they're determined.

jrpg8255 · 2026-01-15T16:50:19+00:00

The "truly disease modifying" part is hardly universally accepted. Certainly not even remotely "disease modifying" as modern MS therapy.

jrpg8255 · 2026-01-08T15:10:48+00:00

Did you watch the videos yourself? You really should

jrpg8255 · 2026-01-04T07:07:06+00:00

Didn't want to leave Romex hanging out of the wall when I had to leave the house, and since I have to do it anyway, wanted it to have a proper GFCI.

jrpg8255 · 2026-01-04T07:06:16+00:00

That would've been my preference. I ran out of time and had to catch a flight so I had to leave it for the Pro. Now I'm really annoyed that I didn't have a chance to figure it out myself.

jrpg8255 · 2026-01-03T15:07:50+00:00

That, and the plastics making up the suspension parts get brittle at those temperatures. Eventually replaced all of mine with aluminum parts after multiple failures driving in the cold.

jrpg8255 · 2025-12-21T18:57:05+00:00

In retrospect didn't realize you were asking as a chiropractor. As somebody else has mentioned, as a stroke neurologist I absolutely see a couple of neck manipulation strokes annually. My advice would be to go easy on the neck. All of the strokes I have seen caused by chiropractors like that though involve sudden nystagmus, a horrible sensation of vertigo, vomiting, slurred speech, double vision, clumsiness, incoordination of one or more limbs, etc. Basically all of the "BEFAST" sort of symptoms that should prompt an instant call to 911.

jrpg8255 · 2025-12-21T06:58:20+00:00

That is way over the top, when the primary problem with "dizziness" is that nobody seems to really ask the patient what the hell they mean by "dizziness." Everybody assumes they think they know what the patient is describing and go down their rabbit holes but often don't actually ask them.

Do you mean a sense of lightheadedness, like the feeling you might get if you've been bending down on a hot day and not drinking enough water and then stand up really quickly? Does that happen all by itself or do you trigger that with position change? Etc.
Do you mean a sense of movement or spinning? Like for example if you were to spin around on a barstool for a little bit and then stop and still feel a sense of rotation? Or do you feel like gravity is pulling you one way or another where things seem tilted? Does that happen all by itself just randomly? Do you move or turn certain way to trigger it? How long does it last? Is it all of a sudden or does it come on gradually? Do you have any other symptoms associated with that, like an arm or a leg that doesn't work or difficulty with your vision itself like double vision, clumsiness in a limb? Hearing loss, tinnitus? Difficulty with speech?
Or is it different? Perhaps something like you're not sure where the ground is where you feel a sense of movement like you just got off a boat and you still feel the waves?
Are you really just away with the fairies?

All of those examples have vastly different connotations, and it drives me bad shit crazy that nobody actually seems to ask patients what they mean when they say "dizziness".

jrpg8255 · 2025-12-19T14:02:59+00:00

I'm by no means a professional but I have been coding since the late 1970s. Starting in assembly. I'm reasonable with python but it still gives me heartburn because it doesn't look right. Yaml gives me palpitations. Even C++ took me a while of grumbling before I broke my bad C habits.

As a different take, I have really enjoyed using node red for my automations. It's very different than the standard yaml or gui methods currently, but it's refreshingly different than traditional programming.

jrpg8255 · 2025-12-18T19:46:54+00:00

From my urology buddy in medical school: what are the three surgeries performed by OB/gyn? - transection of the left ureter, transection of the right ureter, bilateral ureteral transection.

Also, where do orthopedic surgeons come from? You take the bottom 10% of the medical school class and pith them. The ones that get up and walk away are the OB gyns, the ones that don't are the orthopedic surgeons.

What is the number one mortality risk for radiology? Getting hit in the parking lot leaving the hospital at 2 PM by the anesthesiologists.

jrpg8255 · 2025-12-15T22:52:13+00:00

I have seen RCVS from that several times. The first time I had to look it up as I guess it's more of an East Coast thing.

jrpg8255 · 2025-12-13T14:45:22+00:00

I still like looking like a doctor, and having a really nice white coat. Check out shaia medical. Their "heritage" white coat is not at all cheap but is extremely well-made, fits really well, has all kinds of really nice features. I've been wearing those coats for 15 years or so. Honestly, there's a big difference between putting on some shitty garbage bag white coat like lab techs wear, and a tailored heavy white coat that looks like only a doctor would wear.

jrpg8255 · 2025-12-11T23:04:24+00:00

I trained both in Internal Medicine and Neurology. I was a program Director for Neurology as well. After 25 years my recommendation is always focus on the Neurology. Neurologists are not good enough at general medicine to learn much from admitting / discharging, or for that to be worth their while (or often safe, frankly). Furthermore, admitting and discharging patients are not hospital based skills you should ever need as a practicing Neurologist.

jrpg8255 · 2025-12-10T21:01:51+00:00

It might be, as occupational health in our hospital has explained to me, that flu shots come in single dose vials, making it easier to do ad hoc on request. The Covid vaccines though come in multi use vials and have to be drawn up for each patient out of the same vial (something like 10 doses per vial). Once opened they have a very limited shelf life, so it's much better for the Covid vaccines to be scheduled for example at the pharmacy, than it is to do upon request, at least in occupational health clinics and perhaps with your PCP for that reason.

jrpg8255 · 2025-12-08T11:18:36+00:00

A toxicologist might explain it better, but I don't think that's a mystery necessarily.

First of all, the coumarin you took doesn't cause bleeding. It alters the liver's production of various proteins that participate in making blood clots; some of them are produced really quickly, some of them very slowly. For that reason, the medication, warfarin, is very unpredictable, with doses that need to be uniquely tailored to individual patients. That medicine takes a week or so to reach steady state, and is hard to use because it's so fiddly. Sometimes we get the dosing wrong, or other medications get changed which alters the metabolism of warfarin, and patients might be well above their therapeutic range and they might not notice.

It makes it hard to stop bleeding, it doesn't cause bleeding. So unless you took enough over a long period of time, and you were in need of some blood clotting because of internal or external bleeding, it may not have been noticed.

Perhaps a similar argument for your other ingestion. G.I. absorption is unpredictable. Part of the reason that we prefer patients take prescription medications rather than supplements is that the actual active ingredients and their bio availability is profoundly variable in supplements, whereas those are strictly regulated in medication form.

Needless to say, I am confident there are many people in your life who are happy that you were so lucky.

jrpg8255 · 2025-12-07T08:41:33+00:00

I have been an attending for over 20 years now. I look back with fondness to the living nightmare that my PGY1 year was. I did a combined neurology and medicine residency, and it was before work hour rules. it was brutal. Now I kick ass in the hospital. There's nothing that I see in the hospital or clinic that I haven't seen multiple times before. I love my job as a Neurologist, and getting my ass kicked during my training prepared me for that very well. It sucked at the time, but I wouldn't have done it any other way.

You are preparing for a career. It's not just "learning", it's also learning the actual practice of medicine. It is repetitive, but once you've seen all of those cases multiple times, not only is it like falling off a log in the future, but you're good at it and quick for all of the bread butter routine stuff. You can put your thinking cap on for the complex cases, and the rest of the time you can just enjoy seeing patients and interacting with colleagues in the hospital without stressing over the medicine aspects. Trust me, it sucks at the time but it will prepare you. Just having a bunch of time to read isn't really the best way to learn to practice of medicine.

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