iiinova — where your digital self keeps evolving

Agree completely, I think in many ways APP oversight debates are most relevant here (though a lot of nuance when it comes to hand off).

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yes agreed completely!!! I'm working on it :D If you wanna move to DM I can let you know some of the stuff we're working on (BIDMC is the home of MIMIC, and we continue to be up to some cool stuff!)

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These are all very exciting ideas, but the evidence isn't there yet and there's a lot of foundational work to be done (both computationally, and as you point out, in clinical workflows and HCI)

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... but that work is in its infancy. Similar exciting work around early decompensation but that's even earlier.

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This is a great question! I do not think that GenAI CDS like OpenEvidence meaningfully changes anything (other than maybe a little more efficiency, which TBH is why it has caught on so much). There's been some interesting work with sequential e triggers (rules-based, then LLM) ...

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In the next year, we're going to see more experiments like the Utah Rx refill one with Doctronic. How quickly this scales is largely going to be driven by how adventurous state regulators are going to be (and how good the data is).

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Scaling in the short term is through the Lotus Health HITL model (which has LOTS of limits); human "overseer" as liability sponge. K Health is an example of a safe version of this that's already been deployed in health systems (AI as telehealth urgent care screen) including here in Boston.

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... and what regulatory systems might look like. HHS/FDA is working on new regulatory pathways. But healthcare moves (often appropriately) slow, and I can't meaningfully predict beyond a year or two.

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I think we're likely to get an overlap of dyadic and triadic care -- digital health DTC (like Hims/Hers or Cerebral) predate gen AI, but will likely start scaling more with the tech (a la Lotus). One of the unanswered questions is how GOOD DTC dyadic care will get in the short term ...

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My perspective is colored by my research of course (clinical trial will be releasing soon). IMO what is meaningfully different about genAI from previous CDS tools is the ability to act at least somewhat autonomously (Babylon was the first at scale, and prev NLP DDSS like Isabel were getting close)

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messaging-custom-newsletters.nytimes.com

The only hope for our field is triadic care, where AI is deployed in such a way that maintains -- or even enhances -- human relationships. Otherwise, "AI doctor" startups will continue to chip away and further fragment our already struggling primary care.

Opinion Today: It’s OK if your medical advice comes from A.I.

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messaging-custom-newsletters.nytimes.com

New guest essay in the @nytimes.com -- patients (and doctors) need to be open with each other about our AI use. It's here, it's useful (with drawbacks). If we put our heads in the sand, we get the dyadic "AI doctor" that cuts human relationships out of medicine

Opinion Today: It’s OK if your medical advice comes from A.I.

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Reposted by Adam Rodman

Mike Johansen @mikejohansenmd.medsky.social · 10/02/2026

In ranking the problems with medicine in the 🇺🇸; i wouldn't rank this in the top 10k. www.acpjournals.org/doi/10.7326/...

acpjournals.org

ACP Journals

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Reposted by Adam Rodman

F. Perry Wilson, MD @fperrywilson.bsky.social · 03/02/2026

In med school I bought a $15 noise machine to drown out the sirens and helicopters of Washington Heights. It worked. Or at least I thought it did. A new study suggests it may have been making things worse. 🧵 (1/13)

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Reposted by Adam Rodman

Charlotte Blease PhD @crblease.bsky.social · 30/01/2026

My latest Substack on AI Use and Depression, discussing the latest findings in a worrying JAMA Open study. open.substack.com/pub/bleaseon...

open.substack.com

AI Use and Depression

An Interesting Signal But Not Yet a Verdict

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Reposted by Adam Rodman

Bob Wachter @bobwachter.bsky.social · 20/01/2026

On tonight's All Things Considered on NPR, I discuss patients' use of AI for health. While there are risks, many patients benefit. Overall, I favor tools that guide patients through their symptoms (with iterative Q's & A's) rather than general tools like GPT or Gemini. www.npr.org/transcripts/...

npr.org

The benefits of AI in health care outweigh potential hazards, many experts say

ChatGPT Health is OpenAI's foray into medicine, and so far, it gets high marks from both a cancer patient and a leading doctor. But there are worries it could be misused.

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Adam Rodman @adamrodmanmd.bsky.social · 16/01/2026

Incredibly proud of my colleagues Peter Brodeur, Liam McCoy, and Ethan Goh for all the amazing work they put into the inaugural State of AI Report. I'll try to get my thoughts into some sort of thread -- though it's VERY hard to keep up these days! www.arise-ai.org/report

arise-ai.org

State of Clinical AI Report 2026 - ARISE Network

The State of AI Report is the most widely read and trusted analysis of key developments in clinical AI.

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Adam Rodman @adamrodmanmd.bsky.social · 13/01/2026

My energy level the second week in January. (it's for a talk in two days, I know that's not today!)

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Adam Rodman @adamrodmanmd.bsky.social · 09/01/2026

If you are at MGH tomorrow and want to see me try a mystery case, please come to the noon clinicopathological case conference! The CPCs are, IMO, the most important case series since the Hippocratic Epidemics, and it's the honor of a lifetime to flail through one publicly!

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Reposted by Adam Rodman

Bryan Carmody @jbcarmody.bsky.social · 30/10/2025

OpenEvidence has revenue of $50 million. But investors value it at $6.1 BILLION. So… a couple of questions for the “AI won’t replace doctors!” crowd: What do you think OE’s long-term monetization pathway looks like? And what do investors expect to happen that could justify this valuation?

Screenshot of OpenEvidence investment prospectus, noting revenue of $50,000,000 with valuation of $6,100,000,000.

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As I'm writing this, I realize I'm probably not making anyone feel better😀 TL;DR: I largely agree with your premise, but it's going to take longer, and have much more slow and incremental change (and then fast and epistemic change) than the tech bros think

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... since most of the proposed regulatory systems rely on tech that doesn't really exist yet.

There's also the regulatory angle. I think that SaMD absolutists are delusional (and probably not talking to anyone in the government), but companies are going to need some sort of regulatory structure in order to make investments in this space. That's a problem (right now) too...

... but I see no signs that OE is doing that, and I don't think that's happening in the short term (which, I mean, is like 5 years)

I think it's much more likely that OE wants to become the indispensable tool for doctors, and leverage the massive amount of data that they collect on us. I also think that means that eventually, an OE API might become part of an evidence retrieval agent for a semi-autonomous HITL->HOTL system...

But that's the *easy* part. Building out workflows, developing and testing oversight systems, and then deploying and iterating -- that is a MUCH larger challenge. If OE wants to do that, they've made no signs in their hiring, or any acquisitions.

... for many tasks at least. OE has built an industry standard for an incredibly important part of that (knowledge retrieval), and their moat is now their content agreements, as well as the RL from all of their users.

Maybe I can make you feel better (in the short run at least). Replacing doctors (or rather creating agentic workflows that allow for moving from HITL to HOTL) is both an immense technological and oversight system challenge (though I believe that it's fully doable).

All of these studies have limitations of course -- but the evidence suggests that LLMs can absolutely collect information in meaningful ways directly from patients at least within certain confines (especially telehealth-style urgent care).

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Similarly, the K health studies again show LLMs (though the K-health system uses multiple types of tech) are capable of collecting patient histories (in urgent care)

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LLMs work well at eliciting information (from patient actors, compared to a blinded human, via a chat interface). The study the OP is referring to is CRAFT-MD, which uses MedQA questions and two LLMs role-playing a human and a patient. Clinical trial data coming soon.

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I don't think being anti-AI is the solution -- just to be thoughtful about it. EG, me and my resident made a neurological diagnosis (we are not neurologists) by using GPT-5 to help guide us on the bedside neurological exam. Lord knows I'm not usually breaking out Hoffman's sign

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Kind words from @medcrisis.bsky.social (and definitely not a techbro -- still use my wood carved stethoscope!). Thread expounds more on my quote in the article: "if we don't figure this out, we're screwed."

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So maybe 15 years from now none of this will matter (though I'm skeptical) -- but in the meantime, I think I stand by what I told Dhruv in that story, if we (meaning educators) don't figure out how to train the next gen in this environment, we're all screwed.

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(plus, it's not like there's going to be an "AI doctor" -- there will have to be brand new workflows, safety systems, and regulatory environments)

in the near future (reward systems favor classification, though of course we all know that for many important diagnoses we never get anything close to a definitive answer). But management reasoning at a physician level is probably beyond that these systems can reasonably do

This probably WOULDN'T matter too much if this current generation of tech would uniformly outperform doctors. But it won't. I'm actually much more optimistic than @ericstrong.bsky.social that diagnostic reasoning will largely be done better than LLMs for a variety of diagnoses (not just esoterica)

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We don't have a LOT of evidence yet about what overreliance on the tools does to our diagnostic (and management) reasoning abilities, but there's plenty of reason from other domains (and our psychological understanding of learning) that it degrades them.

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