NerdMDs StackBytes #7

🎧 StackByte Episode Summary (Ep #7 – “Confessions of a Former CMIO: I Was Wrong About Integration”)In this episode of StackByte, host Adam Carewe, a former Chief Medical Information Officer, candidly reflects on a major shift in his thinking about health IT. Once a staunch advocate for EHR integration, Adam shares why he now believes the future belongs to tools that are intelligent, not just integrated. He explores how generative AI is enabling standalone solutions that deliver real clinical value, sparking a move from traditional ambient documentation to intelligent clinical companions. Packed with hard-won insights and real-world examples, this episode challenges healthcare leaders to rethink their tech priorities. Dive deeper into the topic in the original Substack post: Confessions of a Former CMIO: I Was Wrong About Integration.

🔹 00:00 – Intro & SetupAdam introduces the theme of the episode—why he now questions the long-held belief that “integration is king” in healthcare tech. He sets up the context for his confession, rooted in his own leadership experience at Kaiser.

“For most of my career I believed it with religious conviction… But here's the confession—I think I was wrong.”

🔹 01:20 – The Old Rule: No Integration, No DealReflecting on his time at Kaiser, Adam recounts how he rejected tools that didn’t directly integrate with Epic, even if they showed promise. Back then, integration equaled usability and adoption.

🔹 03:00 – Enter Generative AI: A Game-ChangerThe rise of generative AI has changed the equation. Tools like OpenEvidence now deliver high clinical value without being embedded in the EHR. He explains how this shift reshapes what's possible in digital health.

“We’ve entered an era where a tool doesn’t need to be hard-wired into the EHR to deliver value.”

🔹 05:25 – The Problem with Integrated ToolsAdam shares his experience trialing ambient note tools that were seamlessly integrated—but underwhelming. Though technically elegant, they flattened clinical reasoning and buried key insights.

🔹 07:15 – The Rise of Intelligent Clinical CompanionsHe introduces the idea of tools that go beyond documentation—tools that listen, guide, generate notes, and offer decision support. At General Medicine, his team has already shifted to using raw transcripts and building intelligence in-house.

“An intelligent clinical companion doesn’t just document, it guides.”

🔹 09:45 – Rethinking the PlaybookAdam warns that many healthcare leaders are stuck in a 2018 mindset, still prioritizing integration above all else. But the grassroots adoption of non-integrated AI tools by clinicians tells a different story—one of unmet needs and innovation.

🔹 11:40 – Final Thoughts & The Real QuestionHe wraps up by encouraging leaders to ask not only does it integrate? but does it deliver outsized value even without integration? The next wave, he argues, will be defined by intelligence, not connectivity.

“The tools that win physician loyalty won’t be the ones that integrate first. They’ll be the ones that act as true intelligent clinical companions.”

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