Digitization of the US Healthcare System and Early Insights from the AI Era

Minutes

On September 25, 2026, Members of the Society and guests joined the speaker for a reception and dinner at 5:45 PM in the Members’ Dining Room at the Cosmos Club. Thereafter they joined other attendees in the Powell Auditorium for the lecture proceedings. In the Powell Auditorium of the Cosmos Club in Washington, D.C., President Larry Millstein called the lecture portion of the 2,541st meeting of the Society to order at 8:03 p.m. ET. He began by welcoming attendees, thanking sponsors for their support, announcing new members, and inviting guests to join the society. Scott Mathews then read the minutes of the previous meeting which included the lecture by Jonathan Arenberg, titled “Heroic Engineering of the James Webb Space Telescope: Lessons Learned for Future Flagship Missions”. The minutes were approved pending a minor correction.

President Millstein then introduced the speaker for the evening, Julia Adler-Milstein, of the University of California, San Francisco. Her lecture was titled "Digitization of the US Health Care System and Early Insights from the AI Era."

The speaker began by noting that the digitization of the US healthcare system has been one of the few sustained areas of deep bipartisan consensus. She explained that prior to national policy interventions, clinical documentation and workflow management relied heavily on paper medical records. In the pre-2009 era, a handful of pioneering health systems, such as Vanderbilt University and the Department of Veterans Affairs, demonstrated that computerized recordkeeping could improve patient safety, notably in terms of prescription and medication errors. However, national adoption remained negligible due to substantial capital acquisition costs, long-term maintenance burdens, and significant clinician resistance.

The speaker reviewed the enactment of the Health Information Technology for Economic and Clinical Health Act (HITECH) of 2009, passed under the American Recovery and Reinvestment Act as an economic stimulus initiative. The federal government committed approximately $30 billion in incentives tied directly to Medicare and Medicaid reimbursements. To prevent organizations from purchasing systems that remained unused, the legislation established the "Meaningful Use" framework, which mandated that systems demonstrate actively used capabilities. The speaker characterized the HITECH Act as an unqualified success in driving adoption, while noting that excluded facilities, such as nursing homes, behavioral health centers, and dental practices, lagged far behind. She also conceded that the HITECH Act showed no clear system-wide reduction in cost or increase in productivity.

The speaker turned to health data interoperability, describing it as the persistent Achilles' heel of health information technology. Because patient care is geographically fragmented, interoperability represents an inherently national challenge rather than a local one. She detailed the obstacles impeding data exchange, including: conflicting state-level patient privacy statutes, inconsistent semantic data standards, and fundamental economic disincentives. She said that hospitals bear capital costs to share data with regional competitors without capturing financial returns. She presented findings from her own work, indicating that hospitals that shared a large number of patients reported little or no electronic interoperability with their local competitors.

Adler-Milstein then discussed some more recent successes with interoperability, specifically with respect to the “Care Everywhere” platform from Epic Systems Corporation. She discussed how reorganizing the user interface and allowing easier access to the list of available outside records caused the number of views per week to nearly double almost overnight. Despite these successes, she said, many clinicians still rely on fax machines for exchanging health records.

The speaker then examined the expansion of telemedicine during the COVID-19 pandemic. Prior to 2020, regulatory restrictions, medical licensure, facility credentialing, and lower reimbursement rates restricted telehealth to negligible volumes. The onset of the public health emergency led to the rapid waiver of these barriers, enabling an overnight transition to remote care. Post-pandemic utilization has diverged across clinical domains, with procedural specialties predominantly returning to face-to-face visits while psychiatric care maintains high telemedicine rates.

The speaker addressed the use of artificial intelligence in healthcare. She observed that while many AI healthcare models have been developed, rigorous evaluation filters them down to a small number deemed safe for clinical deployment. AI scribes represent the first widely deployed AI tool, capturing doctor-patient dialogue to generate notes, reducing workload while preserving a human clinician in the loop. The speaker highlighted recent comparative studies in which unassisted physicians achieved approximately 74% diagnostic accuracy, physicians assisted by LLMs achieved 76%, and autonomous LLMs operating alone achieved 92% diagnostic accuracy. Looking forward, she anticipated expanded use of administrative chatbots handling more mundane tasks such as scheduling appointments and medication refills. The speaker ended her talk by saying that, in the near term, she does not see AI becoming your complete health care experience, but it is clear that AI will be performing some of what doctors currently do.

The lecture was followed by a question and answer session.

A member asked why the combination of human plus AI was not as accurate as AI alone. The speaker responded that the study could not parse individual causes, but suggested that clinician skepticism, suboptimal prompting, and a perceived loss of autonomy on the part of the clinician were important factors.

A guest asked how health systems manage AI hallucinations and the prescribing of dangerous medications, prior to model maturation. The speaker replied “the human-in-the-loop is the solution”. She stressed evaluation against real-world standards rather than perfection, acknowledging that human errors occur in healthcare all the time.
A guest asked why the Health Insurance Portability and Accountability Act (HIPAA) was not cited as the primary obstacle to interoperability. The speaker responded that HIPAA explicitly authorizes data sharing among covered entities for treatment, payment, and healthcare operations, serving as a framework for protected sharing rather than an operational impediment.

After the question and answer period, President Millstein thanked the speaker and presented her with a PSW Rosette, a signed copy of the announcement of her talk, and a signed copy of Volume 17 of the PSW Bulletin. He then announced upcoming lectures and adjourned the 2,541st meeting of the Society at 9:58 p.m. Eastern Time.

Temperature in Washington, D.C.: 18.3 °C
Weather: Partly Cloudy

Dinner Attendance: 34
Lecture Attendance (In-Person): 67
Livestream Attendance: 36
For a Total of 103 viewers
Views of the video in the first two weeks: 614

Respectfully submitted, Scott Mathews, Recording Secretary