The Clinical Realist

Virtual nursing gets sold to hospital boards as a staffing patch. Put a camera in the room, put an experienced nurse behind it, and the math on the slide works. Almost nobody in that boardroom asks the question that decides whether it works on the actual unit: what does this do to a shift in week three? Julie Tuel is System Vice President of Nursing Care Transformation and Clinical Digital Care at...

The encounter ends, the patient goes home, and then a bill arrives. Amy Stillman argues that a medical bill is not a payment reminder. Patients frequently do not understand what happened to them, what they owe, or what they are supposed to do next, and the bill lands after the frightening part is already over. Stillman is Chief Product Officer at Cedar, where she has run product, design, research,...

Start with a number. In a registry of about 6,000 patients on GLP-1 medications, roughly 45 percent have taken two or more versions of the drug, most often moving from semaglutide to tirzepatide. The largest published study, about 127,000 adults, puts 12-month switching closer to 20 percent. Nobody can fully verify either figure, because no single system holds the whole record. Shashi Shankar spen...

Anthony Guerra has asked roughly the same question about 600 times. He founded Health System CIO in 2010 and has covered health information technology since 2005, which is 16 years sitting across from the people who sign off on what technology actually enters a hospital: CIOs, CMIOs, and Chief Information Security Officers, across three or four full technology cycles. Most people in health tech ca...

You cannot will your way to better healthcare outcomes. Agency, it turns out, is not a mindset problem: it is a neurological one, a design one, and a systems one. Kris Nessa has spent her career on both sides of the vendor-to-health-system interface, including Cleveland Clinic, Cerner, Dell, and SHI International. She knows exactly which technology promises do not survive contact with a real ICU a...

Somewhere in your organization there is an AI tool in year two of its contract, performing worse than the day you signed. The model did not change. Your patients did. Arvita Tripati calls what accumulates in that gap trust debt, and she has watched it accrue from three different chairs. She spent nearly two decades bringing regulated products to market across digital health, medtech, diagnostics,...

Ask a health system CEO about their women's health strategy and you will hear two things. Labor and delivery. Mammography. Then they wipe their hands, and the checkbox is checked. Priya Bathija spent nine years at the American Hospital Association building maternal and child health policy at national scale. In 2022 she left to found Nyoo Health, where she now advises hospitals and health syst...

Most clinical trial eligibility criteria are written by people who have never run a site. Lisa Sonneborn has run one for 15 years. She built the first stand-alone clinical trial facility in Upstate New York, focused on Alzheimer's and NASH research. Watched sponsor after sponsor send protocols with visit schedules, lab windows, and exclusion lists that were scientifically defensible and opera...

People whose care is scattered across multiple providers, with no single person or system holding the whole picture, have more than double the risk of dying, even after accounting for how sick they already are. Amy Andrade has spent her career on that gap. In this episode of The Clinical Realist, Dr. Sarah Matt talks with Amy Andrade, Co-Founder and Chief Product Officer of Alphiniti and a biomedi...

Most healthtech founders solve a real clinical problem, get piloted in a few systems, and then discover that solving the clinical problem was never the same thing as building a company someone would actually buy. Dr. Roxie Mooney, DBA, has spent her career on that exact gap. In this episode of The Clinical Realist, Dr. Sarah Matt talks with Dr. Roxie Mooney, founder and CEO of Legacy DNA, where sh...

Two years ago, every health system was running an AI pilot. Today, most are still running AI pilots. The technology improved dramatically. The deployment gap between what a board approves and what happens in an exam room stayed the same. In this episode of The Clinical Realist, Dr. Sarah Matt talks with Dr. Robert Pearl about what that gap looks like from inside a system that actually closed it. P...

Patient experience gets treated as a soft metric. Amanda Brummitt, FACHE, has spent 25+ years in health system operations proving it is a margin lever, a retention lever, and the first thing most AI rollouts ignore.\n\nIn this episode of The Clinical Realist, Dr. Sarah Matt sits down with Amanda Brummitt, Principal of Brummitt Group, to unpack why patient experience is strategy, not sentiment, and...

Dr. Marschall Runge, MD, PhD, Dean of the University of Michigan Medical School and CEO of Michigan Medicine, sits across the table from health tech founders every day. In this episode, he shares the institutional reality that most health tech companies never see: what it actually takes for an academic medical center to say yes. Not the demo. Not the pilot. The governance questions, the budget str...

The AI tool you bought last quarter, the one bundled into your EHR upgrade, the one your hospital piloted on your unit. Was it cleared by the FDA as a medical device? Most physicians do not know the answer. The vendor's pitch deck almost certainly did not lead with it. And the answer matters, because once an algorithm crosses into FDA medical device territory, the rules that govern what it ca...

Medical school teaches you pathophysiology, pharmacology, and clinical reasoning. It does not teach you how the money actually works. In this episode, Dr. Sarah Matt breaks down the economic structures that govern every clinical decision, every technology purchase, and every AI pilot that dies in a committee room: who pays, who decides, who uses, and why those three people are almost never the sam...

Recorded live at Cornell Ithaca. This is the extended cut of Dr. Sarah Matt's keynote on the central design flaw in modern healthcare: a system optimized for an "average" patient who does not exist. When you build clinical workflows, EHR defaults, drug dosing tables, and AI training sets around a statistical mean, every patient outside that mean pays the cost in workarounds, missed...

Most clinical AI governance frameworks tell you how to evaluate tools before you deploy them. Nobody talks about how to exit a tool that is not working. In this episode, Dr. Sarah Matt walks through the anatomy of sunk cost bias in health system AI: how it starts (month four or five, mixed performance data, a vendor who keeps resetting the clock), how experienced vendor account teams use it to ext...

Most health systems that deployed clinical AI in Q1 are now six to eight weeks post-launch and starting to see the governance gap. Dr. Sarah Matt explains what the gap looks like in production, why retrofitting governance is more expensive than building it before go-live, and the four-step rapid governance build for organizations that are already live and need to catch up. — Resources & Links:...

Your pilot worked. You got approval to scale. Six weeks into full implementation, something is wrong: not catastrophically wrong, just wrong enough to make you wonder whether "it worked in the pilot" meant anything at all. In this episode, Dr. Sarah Matt breaks down the pilot trap: the gap between proving a tool works under controlled conditions and proving an organization is ready to ru...

Most health systems that fail at clinical AI adoption are not failing because the tool is bad. They are failing because they diagnosed the problem wrong before they ever touched a vendor pitch. In this episode, Dr. Sarah Matt breaks down the core misdiagnosis that derails AI implementation: health systems treat AI failure as a technology problem when the actual issue is a question problem. The org...

You ran the pilot. The AI worked. The clinicians loved it. The outcomes were solid. Then you tried to roll it out system-wide and it fell apart. This is the 90% problem, and it is not a technology problem. It is an adoption problem. In this episode, Dr. Sarah Matt breaks down why pilot success is the wrong measure for scaling readiness, the four structural gaps that separate a winning pilot from a...

Health system boards are approving eight-figure AI investments without a governance framework that tells them what they are actually approving. They are receiving technology presentations. What they need are risk assessments. In this episode, Dr. Sarah Matt breaks down what boards are actually approving when they approve AI investments, three misconceptions shaping board-level AI decisions, six qu...

A physician executive signed a clinical validation form. Eleven months later, she was the one accountable in peer review after an AI-assisted recommendation contributed to a delayed diagnosis. She had not read the indemnification clause. Almost no physician does. In this episode, Dr. Sarah Matt breaks down the four contract clauses that matter most to physicians in AI procurement, the five questio...

When an AI tool causes a patient harm, who gets called into the review meeting? In almost every health system, the answer is the physician. The same physician who was brought into the procurement conversation as a validator after the vendor had already completed four executive demos, built the business case, and received board approval. That is not a governance design. That is liability assignment...

Health systems are signing AI contracts they cannot govern. That is the real problem. Not the technology. In this episode, Dr. Sarah Matt, physician executive and healthcare strategy advisor, breaks down the three governance layers where AI deployment fails in health systems — and why organizations that conflate technology procurement with organizational readiness are setting themselves up for exp...