Why does practicing medicine feel like fighting a Frankenstein of stacked software? A physician executive with 34 years of practice argues that EHRs, population health tools, remote monitoring, and now AI have all been bolted onto 60-year-old billing infrastructure, and nothing has actually gotten better. Grace Terrell, who runs clinical at IKS Health and has led two large multi-specialty groups, makes the case that connected workflows, not more point solutions, are the only way out.

⏱️ Chapters:
0:00 Introduction
0:28 Why 34 years of new tech made nothing better
2:46 The Frankenstein of stacked legacy systems
3:42 The back pain case that exposes the whole broken chain
6:15 Why hospitals keep buying point solutions anyway
8:51 Prior authorization as Spy vs. Spy
10:51 Stop letting the EHR be the center of everything
11:59 What a connected workflow actually looks like
12:53 The questions every CMIO should ask vendors
15:27 EHRs may be obsolete in five years
17:37 Take home messages

About this episode:
Grace Terrell, a practicing internist and chief medical officer at IKS Health who has run two large multi-specialty medical practices and led a genomics startup, returns to argue that 34 years of layered health care technology has not made anything better for clinicians or patients. She walks through five stages of health care tech, from 60-year-old practice management systems through EHRs, population health, remote monitoring, and AI, and shows how each was bolted onto the previous one without ever rebuilding the underlying workflow. Using a back pain case that turns into a possible spinal abscess, she traces every administrative friction point that puts the patient at risk and the clinician in burnout. She names prior authorization as the clearest place to start, calling the current state a Spy vs. Spy escalation between payers and clinicians that AI could either worsen or finally resolve. She tells CMIOs what questions to ask vendors before signing another contract, argues that systems of action should replace the EHR as the structural center, and shares why her own CIO believes EHRs may be obsolete in five years. The closing message is direct: it is about the patient, and connected technology, not more point solutions, is how clinicians get back to that.

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