Last December I started writing something more comprehensive, and long enough to sell. If I price each copy at $100,000 apiece and sell 25 of them, I can start thinking about retirement.
Despite the (completely realistic) financial incentive, I dropped the project and didn’t pick it back up again until this month. I’m not ready to announce it yet, but the very fact that I’m talking about it may give me the impetus to finish it.
I just uploaded the latest draft to Google Gemini, both to write a 100 word promotional blurb (which I may or may not use or adapt), and to write two book reviews: one positive, one negative.
Again without giving away too much about the book, here are two excerpts from the negative review.
“Author John E. Bredehoft spends significant time on self-promotion and anecdotal stories, such as his hypothetical attempt to access Donald Trump’s medical records, which may distract readers seeking deep technical data.”
Here’s the second:
“While the writing is accessible, those looking for a dense, scholarly analysis of biometric algorithms might find the conversational tone and frequent “investigative lead” reminders a bit repetitive.”
I’ve discussed the electronic health record (EHR) before, and plan to do so again. But before I dive into EHRs and “the A word,” I want to take a look at WHY we have EHRs.
When dinosaurs roamed the earth
In the old days, even within the lifetimes of some of us, there were no ELECTRONIC health records. There were PAPER health records, stored in large file cabinets. If you were lucky, the health records were typed; heaven help you if they were in a doctor’s famously illegible handwriting.
When a relative’s doctor retired in the 20th century, the relative requested their health records and received a huge pile of paper dating back to who knows when. In that form, it was about as useful as the huge file cabinets in which the U.S. Federal Bureau of Investigation used to store its millions of fingerprint cards. And unfortunately, paper health records didn’t have the health equivalent of a “Henry system” to find individual records quickly.
The two purposes of an electronic health record
So now that we have electronic health records, why do we have them?
To make life easier for the doctor? Of course not.
To make life easier for the patient? Definitely not.
Electronic health records have evolved to serve two OTHER parties.
First, electronic health records serve the billers
I can’t speak to countries other than my own, but in the United States the health “system” is a mishmash of multiple parties. For example, when I had a colonoscopy a few years ago, the following entities were somehow involved:
The doctor who performed the colonoscopy.
The facility where the doctor performed the colonoscopy.
The anaesthesiologist who assisted with the colonoscopy.
My insurance company.
My former company (via COBRA) who provided me with the insurance.
And probably a half dozen other entities that I missed who somehow got a cut.
So this one procedure created one, or perhaps multiple, electronic health records (perhaps even with pictures) describing every chargeable thing that could be itemized during my time in the facility. All with the proper billing codes (Current Procedural Terminology or CPT codes) and the like, so that every entity can pay what they’re supposed to pay. And if a particular thing wasn’t covered by insurance, then I had to pay it.
Google Gemini.
The most important thing is to get the billing codes right…never mind how hard it is to ENTER all the billing codes.
“By integrating EHR and billing software, healthcare providers can automate various aspects of the billing workflow, resulting in increased efficiency, reduced manual work, and other tangible benefits.”
Second, electronic health records serve the lawyers and regulators
But it’s not only the billers who need information.
To practice medicine in the State of California, you have to perform a colonoscopy in accordance with medically approved procedures. And you have to document that you did so.
If I had died on the operating table during my colonoscopy, then a number of private and government entities would have a keen interest in what was performed during the colonoscopy. And the electronic health record would be one of the main sources of information about what happened, and perhaps what went wrong. And who was responsible. The doctor? The facility? The anaesthesiologist? Someone else?
“The “EHR mandate” refers to the federal requirement for eligible healthcare providers to adopt and use certified EHR technology. Primarily affecting providers who accept Medicare, participation in MIPS and the Promoting Interoperability program requires CEHRT to avoid negative payment adjustments, which effectively necessitates EHR use.”
The result
So now the medical field has these wonderful EHRs that comply with billing requirements and legal requirements.
“For instance, emergency medicine physicians at one health system must click 14 times to order Tylenol—that’s a lot. Yet, those at another health system using the same EHR must click 61 times!”
And that’s just for Tylenol. I’m sure it’s a lot worse for the camera that looked at my colon.
It could have been worse, because many Americans are not healthy.
“[O]ur patients have increasingly complex health needs. More than 40% of American adults have at least two chronic conditions, one-third take at least three medications, and one-fifth suffer from mental illness.”
Put these and other things together, and EHRs have become (as I said before) “a pain in a particular body part.”
Google Gemini.
So that’s the problem with EHRs. Later I’ll look at the solutions, including:
Don’t get violent at a Transportation Security Administration (TSA) checkpoint. If you do, you may not fly anywhere…or drive or walk anywhere either.
Here’s the story of a man named Idress Vinay Solomon who was preparing to board a Southwest Airlines flight from Dallas’ Love Field to Oakland on March 10. Somehow Mr. Solomon missed the memo that you need a REAL ID or equivalent to board a plane. Something that has been discussed for decades, since passage of the Real ID Act of 2005.
But as readers of the Bredemarket blog know, despite years of declarations that you must have a REAL ID to fly, you don’t need one. The TSA launched ConfirmID this year, an alternate identity confirmation service for those who don’t have approved identity documentation. You pay $45, and TSA confirms your identity via other methods.
“[T]he Oakland resident allegedly started reacting aggressively and attacked the officers present. During this incident, he punched a [Dallas Police Department] officer multiple times, resulting in the officer suffering an “orbital blowout fracture” in his left eye.”
“A blowout fracture is the most common type of orbital fracture. This fracture is a break along the floor or thin inner wall of your eye socket. Getting hit in the eye with something like a fist or a baseball most often causes blowout fractures.”
The Cleveland Clinic does not indicate whether iris identification is affected by blunt force trauma.
But let’s return to “Love” Field.
The police officer was hospitalized, and Solomon remains in custody. If convicted, he could face up to 20 years in federal prison, as confirmed by the Department of Justice.
“Violent conduct perpetrated against TSA and law enforcement officers will never be tolerated in the Northern District of Texas,” said U.S. Attorney Ryan Raybould. “We will prosecute such offenses to the fullest extent to seek justice for the victims here and to deter others from resorting to aggressive attacks against officers responsible for ensuring the public’s safety while traveling.”
I don’t have access to Forbes, so I’m relying on this LinkedIn message from Certuma:
“We raised $10M in seed funding led by 8VC to build the first FDA-approved AI doctor.”
The way that sentence is worded, it sounds like the goal is to have the FDA approve a doctor who can…well, doctor. Like my fictional Dr. Jones. (See the 2013 version in tymshft.)
““I don’t mind answering the question,” replied the friendly voice, “and I hope you don’t take my response the wrong way, but I’m not really a person as you understand the term. I’m actually an application within the software package that runs the medical center. But my programmers want me to tell you that they’re really happy to serve you, and that Stanford sucks.” The voice paused for a moment. “I’m sorry, Edith. You have to forgive the programmers – they’re Berkeley grads.””
But Certuma’s website tells a more cautionary story in which the “AI doctor” is NOT in control.
“Certified clinical decisions at machine speed. Physician-verified and fully auditable.”
And the workflow indicates that this “doctor” is more like an intern, or even a student.
“Certuma routes every in-scope plan through physician verification. That workflow is the point: fast turnaround without removing accountability….
“Red flags, contraindications, interaction checks, scope limits, and uncertainty thresholds run through the deterministic verification layer. If something is emergent or out of scope, the system escalates instead of guessing.
“Clinicians see structured intake, highlighted risks, and a draft plan with supporting evidence. They approve, edit, or escalate; changes are captured with reason codes and a durable audit trail.”
Now there is clearly some benefit in having the bots grind out the plan, provided that the bots don’t hallucinate. There are potential time savings, and a real doctor reviews the final results.
But an “AI doctor” who can doctor independently is NOT on the horizon.
As you know, I’m tired of the simplistic “we use AI” marketing messaging. One reason is because when prospects hear “we use AI,” they may respond with “Oh, that technology that hallucinates.” This is NOT a good selling point.
But what if your tool, whether it is artificial intelligence or a thousand Third World workers, could actually IDENTIFY errors?
I knew that the set of medical billing codes—Current Procedural Terminology, or CPT—is critically important for health providers, insurance plans, and everyone else in the medical-industrial complex.
I didn’t know that the set of codes changes. Every year.
“The open and rigorous process maintained by the independent CPT Editorial Panel with broad input from the health care community, government, and industry produced 418 total changes reflected in CPT 2026 code set, including 84 deletions and 46 revisions in addition to the 288 new codes.
“Key updates included in the CPT 2026 code set are new codes for digital health services like remote patient monitoring, medical services involving hearing devices and augmented intelligence (AI), and a comprehensive update of codes for leg revascularization.”
Hope the billing coders are ready…although these days the coders may be AI. Again, hope the billing coders are ready.
As I’ve noted before, healthcare is a pioneering user of artificial intelligence, although (hopefully) under robust controls to maintain accuracy and preserve HIPAA-level privacy.
“We are living through a generational shift, one where AI doesn’t just augment how organizations work but fundamentally transforms them from the inside out,” said Mohamad Makhzoumi, Co-CEO of NEA, who will join Qualified Health’s Board of Directors in conjunction with the financing. “From NEA’s nearly five decades of company-building experience, we believe the organizations shaping the next era of healthcare innovation will be those helping health systems reimagine every administrative and clinical workflow from the ground up, and Qualified Health is exactly that company. We are thrilled to lead this financing and to partner with Justin and team to accelerate healthcare’s AI transformation and shape the future of healthcare enterprises across the country.”
“Health systems today are operating under extraordinary pressure, from rising labor costs to tightening reimbursement, while managing increasing complexity in patient care,” said Jared Kesselheim, MD, Managing Partner at Transformation Capital. “What stood out to us about Qualified Health is that the team approaches this work as medical care specialists, with a deep understanding of the realities health systems face every day. That perspective allows them to identify where AI can create meaningful clinical and operational impact. We’re excited to partner with Justin and the Qualified Health team as they help leading health systems navigate this next phase of healthcare.”
I was working with these sectors back when I was at MorphoTrak.
“There are 16 critical infrastructure sectors whose assets, systems, and networks, whether physical or virtual, are considered so vital to the United States that their incapacitation or destruction would have a debilitating effect on security, national economic security, national public health or safety, or any combination thereof. Presidential Policy Directive 21 (PPD-21): Critical Infrastructure Security and Resilience advances a national policy to strengthen and maintain secure, functioning, and resilient critical infrastructure. This directive supersedes Homeland Security Presidential Directive 7.”
Another topic raised by Nadaa Taiyab during today’s SoCal Tech Forum meeting was ambient clinical intelligence. See her comments on how AI benefits diametrically opposing healthcare entities here.
There are three ways that a health professional can create records during, and/or after, a patient visit.
Typing. The professional has their hands on the keyboard during the meeting, which doesn’t make a good impression on the patient.
Structured dictation. The professional can actually look at the patient, but the dictation is unnatural. As Bredebot characterizes it: “where you have to speak specific commands like ‘Period’ or ‘New Paragraph.’”
“Ambient clinical intelligence, or ACI, is advanced, AI-powered voice recognizing technology that quietly listens in on clinical encounters and aids the medical documentation process by automating medical transcription and note taking. This all-encompassing technology has the ability to totally transform the lives of clinicians, and thus healthcare on every level.”
Like any generative AI model, ambient clinical intelligence has to provide my four standard benefits: accuracy, ease of use, security, and speed.
Accuracy is critically important in any health application, since inaccurate coding could literally affect life or death.
Ease of use is of course the whole point of ambient clinical intelligence, since it replaces harder-to-use methods.
Security and privacy are necessary when dealing with personal health information (PHI).
Speed is essential also. As Taiyab noted elsewhere in her talk, the work is increasing and the workforce not increasing as rapidly.
But if the medical professional and patient benefit from the accuracy, ease of use, security, and speed of ambient clinical intelligence, we all win.
Bredemarket 