What three ICU nurses, a kiddie pool, and one dying patient can teach us about the future of healthcare
“Human judgment, empathy, and understanding of individual
patient contexts remain essential.” — Dr.
Imamu “Mu” Tomlinson, emergency physician and CEO of Vituity
Jeannie Guffey was 74.
She had lung cancer.
She was in the Medical ICU at Huntsville Hospital,
surrounded by monitors, IV poles, equipment, alarms, and the machinery of
modern medicine.
She knew her time was short.
She was preparing to go home with hospice.
Then she told her family something she wanted to do before
she left.
She wanted to be baptized.
Simple enough.
Except she was lying in an ICU bed.
There was no convenient church baptismal pool waiting
downstairs.
No standard hospital protocol titled:
“Baptism for a Critically Ill Patient.”
No dropdown menu in the electronic health record.
No software workflow.
No committee meeting.
So three ICU nurses decided to figure it out.
Erin Powers. Kaitlin Swaim. Emily Owens.
They did some research.
Then they bought a kiddie pool from Walgreens with their own
money.
They had it delivered to the hospital.
The family supplied an electric air pump.
The nurses figured out how to fill the pool with warm water
using ventilator tubing.
The ICU team used the room's ceiling lift to lower Jeannie
safely into the water.
Her son, Jody, performed the baptism.
Her family watched.
For a few minutes, that fourth-floor ICU room became
something else.
Not just a place where medicine was being delivered.
A place where a family was saying goodbye.
And that is where this story gets uncomfortable.
Because we spend billions of dollars trying to make
healthcare more efficient.
More digital.
More automated.
More intelligent.
More connected.
More AI-powered.
And yet three nurses still had to buy a kiddie pool
to make a dying patient's final wish possible.
Maybe the problem isn't that healthcare needs more
technology.
Maybe the problem is that healthcare has become very good at
optimizing the wrong things.
The $20 Question Healthcare Doesn't Like to Ask
Here is my contrarian question:
What if the most important metric in healthcare isn't how
much technology we deploy, but how much human attention we return?
We measure revenue.
We measure productivity.
We measure length of stay.
We measure readmissions.
We measure patient satisfaction.
We measure RVUs.
We measure denial rates.
We measure days in A/R.
We measure clicks.
We measure utilization.
We measure throughput.
We measure everything.
Except perhaps the thing patients actually experience:
Did their clinician have enough attention left for them?
That is a harder metric.
And inconveniently, it cuts across every department.
Because the physician who spends an hour fighting a payer
isn't spending that hour with a patient.
The nurse completing another administrative task isn't
standing at the bedside.
The practice manager reconciling three spreadsheets isn't
solving the operational problem that actually matters.
The billing specialist chasing a preventable denial isn't
working on the next claim.
And the patient?
The patient doesn't care which department caused the
problem.
They just experience the friction.
We Have Confused Digitization With Progress
Healthcare has a strange habit.
We take an old manual process.
Put it on a computer.
Call it innovation.
Then add a dashboard.
Then an API.
Then an AI assistant.
Then another dashboard to monitor the first dashboard.
Eventually someone asks why everyone is exhausted.
This is not innovation.
It is digitized bureaucracy.
The computer is faster.
The bureaucracy is still bureaucracy.
The fax becomes a portal.
The portal becomes an inbox.
The inbox becomes a notification.
The notification becomes a task.
The task becomes a queue.
And the queue becomes someone's problem.
Congratulations.
We digitized the headache.
This is especially obvious in revenue cycle management.
A practice can have an EHR.
A billing system.
A clearinghouse.
A payer portal.
A claims scrubber.
A denial-management platform.
A patient-payment system.
A reporting dashboard.
And six browser tabs open on someone's monitor.
Yet the practice can still have bad data.
That should tell us something.
The problem isn't always the absence of software.
Sometimes the problem is the architecture between the
software.
Jeannie Guffey Didn't Need Another App
This is what makes her story so powerful.
Jeannie didn't need another app.
She didn't need an AI chatbot.
She didn't need a predictive analytics dashboard.
She didn't need a patient engagement platform.
She needed three nurses to say:
“Let's find a way.”
And they did.
That phrase may be one of the most important phrases in
healthcare.
Not:
“That's not our workflow.”
Not:
“That's outside the protocol.”
Not:
“The system won't allow it.”
Not:
“Submit a ticket.”
Not:
“Please call billing.”
Not:
“Please contact your insurance company.”
But:
“Let's find a way.”
Now ask yourself:
How much of modern healthcare prevents clinicians from
saying those words?
The Administrative Tax on Medicine
The numbers are uncomfortable.
According to the American Medical Association's latest
prior-authorization survey, physicians complete about 40 prior authorization
requests per week.
The work consumes approximately 13 hours of physician and
staff time each week.
94% of physicians surveyed said prior authorization
contributes to burnout.
95% said it delays access to necessary care.
79% reported that patients abandon treatment because
of authorization challenges.
And 26% reported that prior authorization had
contributed to a serious adverse event, including hospitalization, permanent
impairment, or death.
Those aren't technology statistics.
They're human statistics.
Thirteen hours is not an abstract administrative burden.
It's thirteen hours.
That is time.
Time that could have been spent seeing patients.
Calling a worried family.
Teaching a trainee.
Reviewing a difficult case.
Going home.
Sleeping.
Being with children.
Being a spouse.
Being a human being.
Healthcare keeps treating time as if it were an unlimited
resource.
It isn't.
Here Is the Uncomfortable Part About AI
I'm a physician.
I'm also a healthcare technology entrepreneur.
I believe AI can be extremely useful in healthcare.
But I'm increasingly skeptical of the industry's obsession
with saying:
“AI will solve healthcare.”
No.
AI will solve some problems.
If we are lucky, it will solve the right ones.
Because AI can make a bad workflow faster.
That's not necessarily progress.
Imagine giving a race car to someone driving in the wrong
direction.
Congratulations.
You're now going the wrong way at 200 miles per hour.
The question isn't:
Can AI automate this?
The better question is:
Should this process exist in this form at all?
That distinction is everything.
Expert Insight #1: The Patient Comes Before the Workflow
Emily Owens' comment about Jeannie's baptism contains a
profound lesson:
“This was a last wish that was very important to the patient
and her family, so we had to find a way.”
Notice the order.
Patient.
Family.
Wish.
Then workflow.
Healthcare often reverses that order.
Workflow.
Policy.
Department.
Technology.
Billing.
Then patient.
We need to reverse it.
Start with:
What does the patient need?
Then:
What prevents us from delivering it?
Then:
How do we remove that barrier?
That is patient-centered design.
It is also good business.
Expert Insight #2: Technology Should Protect Human
Judgment
This week's healthcare conversation around AI is
increasingly moving toward a similar conclusion.
Medical AI is becoming more common in documentation,
clinical decision support, information retrieval, and workflow management.
But physicians remain concerned about accuracy, context,
accountability, and what happens when automated systems make mistakes.
Stanford physician-computer scientist Dr. Jonathan Chen,
featured this week by Science Friday, discussed the growing use of AI by
physicians while emphasizing the tension between its usefulness and clinicians'
concerns about its limitations.
The lesson isn't:
Reject AI.
It is:
Don't surrender judgment to it.
A useful system should make the physician smarter.
It should not make the physician less responsible.
Expert Insight #3: Interoperability Is Really About Time
The AMA is working on an initiative to improve electronic
prior authorization by connecting clinical terminology with administrative
coding.
Why does that matter?
Because the clinical system and payer system often speak
different languages.
Someone has to translate.
Usually a person.
The AMA's initiative aims to bridge SNOMED CT clinical
concepts and CPT coding so electronic prior authorization can become more
seamless.
This sounds technical.
It isn't.
It is about time.
Interoperability is a human-time problem disguised as a
software problem.
Every disconnected system creates another translation job.
Every translation job creates another opportunity for error.
Every error creates another phone call.
Every phone call consumes another minute.
Multiply that across thousands of patients.
Now you have an industry.
The Revenue Cycle Has the Same Problem
This is exactly why I think medical billing deserves a
different conversation.
The traditional question is:
“How do we collect more money?”
Important.
But incomplete.
The better question is:
“Why did the information fail to move correctly from the
patient encounter to the payment?”
That changes everything.
A claim is not born as a claim.
It begins as information.
Patient information.
Insurance information.
Clinical information.
Documentation.
Orders.
Procedures.
Diagnoses.
Codes.
Charges.
Modifiers.
Authorizations.
Then all of that gets translated into a financial
transaction.
Every translation is a potential failure point.
So when a claim gets denied, the denial is often the last
symptom of an earlier problem.
The industry frequently attacks the symptom.
Work the denial.
Appeal it.
Resubmit it.
Call the payer.
Repeat.
Repeat.
Repeat.
That is expensive.
And frankly, a little ridiculous.
If your refrigerator leaks every Tuesday, hiring someone to
mop the floor every Wednesday is not a business strategy.
Fix the refrigerator.
The Revenue-Cycle Thesis
Here is my thesis:
Medical billing is not primarily a billing problem.
It is a data-quality and workflow problem.
Billing is where the problem becomes visible.
By then, it is already expensive.
That means the real opportunity is upstream.
Capture better information.
Connect information.
Validate information.
Identify exceptions early.
Prevent avoidable errors.
Then send the cleanest possible transaction downstream.
This is fundamentally different from building a bigger
denial factory.
The Denial Factory
Healthcare has built an enormous industry around correcting
problems after they happen.
Claim denied?
Work it.
Authorization denied?
Appeal it.
Documentation incomplete?
Send it back.
Coding wrong?
Correct it.
Eligibility wrong?
Call.
Information missing?
Search.
Payer changed its rules?
Update the spreadsheet.
Someone somewhere eventually fixes the problem.
But we rarely ask:
Why are humans repeatedly fixing the same class of error?
That is the question founders should obsess over.
The Five-Minute Test
Here's a simple exercise for every clinic owner.
Pick one repetitive administrative task.
Now ask:
Why does a human have to do this?
If the answer is:
“Because that's how we've always done it.”
Congratulations.
You found a candidate for redesign.
If the answer is:
“Because the systems don't talk to each other.”
You found an interoperability problem.
If the answer is:
“Because someone has to check whether the information is
correct.”
You found a validation problem.
If the answer is:
“Because the payer requires it.”
Ask whether the requirement can be automated, standardized,
or integrated.
If the answer is:
“Because it requires judgment.”
Keep the human.
That last answer matters.
Not everything should be automated.
A Better Division of Labor
I believe the future healthcare operating model should look
something like this:
Machines handle repetition.
Eligibility checks.
Data matching.
Pattern recognition.
Sorting.
Classification.
Routine validation.
Work queues.
Status monitoring.
Humans handle judgment.
Clinical decisions.
Exceptions.
Ambiguity.
Sensitive conversations.
Escalations.
Relationships.
Ethical decisions.
Complex patient situations.
That sounds obvious.
Yet much of healthcare does the opposite.
We ask humans to perform repetitive administrative work.
Then we ask machines to summarize the humans.
Maybe we should switch the arrangement.
What Small and Midsize Practices Should Do Tomorrow
You don't need a $20 million transformation program.
Start smaller.
Step 1: Follow one patient
Take one patient from:
Appointment → Visit → Documentation → Coding → Claim →
Payment.
Write down every handoff.
Don't theorize.
Watch what actually happens.
Step 2: Circle every duplicate entry
If someone enters the same information twice, circle it.
Three times?
Circle it twice.
Ten times?
You may have found your next technology project.
Step 3: Find the first failure
Don't start with the denial.
Find where the information first became wrong.
That is the upstream problem.
Step 4: Measure the human cost
Ask:
How many minutes?
How many employees?
How many interruptions?
How many calls?
How many corrections?
How many follow-ups?
How many claims?
How much cash?
Then calculate the cost.
Step 5: Automate only after simplifying
This is important.
Simplify first. Automate second.
Otherwise you may simply automate a bad process.
Five Metrics I Would Watch
Forget the 37-tab dashboard.
Start with five numbers.
1. First-Pass Yield
How much work succeeds without rework?
2. Denial Rate
How much submitted revenue fails?
3. Days in A/R
How long does earned revenue remain trapped?
4. Administrative Hours
How many human hours are spent moving information around?
5. Revenue Leakage
How much legitimate revenue fails to become cash?
And I would add a sixth:
6. Minutes Returned to Clinicians
This is the metric most healthcare dashboards don't show.
It should.
Why “Minutes Returned” May Be the Best ROI Metric in
Healthcare
Imagine your technology saves a physician 30 minutes a day.
That's 2.5 hours a week.
More than 100 hours a year.
Now imagine that physician uses those hours to:
See patients.
Call families.
Teach.
Review charts.
Take a breath.
Leave the office earlier.
That is ROI.
Not just financial ROI.
Human ROI.
We need to start measuring it.
A Funny Thing About Healthcare
We have spent years trying to calculate the value of a
physician's time.
RVUs.
Collections.
Visits per day.
Revenue per physician.
Productivity.
But we rarely calculate the value of a physician not
doing administrative work.
That's strange.
If a surgeon spent an afternoon repairing the office
plumbing, we'd recognize the absurdity.
But if a physician spends an afternoon fighting an insurance
portal?
Somehow that's called healthcare.
It isn't.
It is a systems failure.
What Jeannie Guffey's Nurses Did Right
Let's return to Jeannie.
Erin Powers.
Kaitlin Swaim.
Emily Owens.
They didn't have perfect information.
They didn't have a perfect workflow.
They didn't have a perfect solution.
They had a patient.
They had a problem.
They had limited time.
And they improvised.
That's healthcare at its best.
The important lesson isn't that every nurse should
personally buy a kiddie pool.
Quite the opposite.
Healthcare organizations should build systems where
clinicians don't have to become heroes just to do the right thing.
That's the real lesson.
Heroic work is inspiring.
But it is not scalable.
The Dangerous Myth of Heroic Healthcare
Healthcare loves stories about extraordinary clinicians.
The nurse who stays late.
The doctor who makes the impossible diagnosis.
The surgeon who works through the night.
The staff member who personally calls every patient.
We celebrate them.
We should.
But then we should ask:
Why did the system require heroism?
A heroic workaround can hide a broken process.
If one nurse staying late saves a patient, that's
compassion.
If every nurse must stay late because the system is broken,
that's an operational problem.
There is a difference.
Best Practice Isn't Always Best
Here's another uncomfortable opinion.
“Best practice” can become an excuse for not thinking.
A process can be standardized and still be terrible.
A workflow can be compliant and still be inefficient.
A dashboard can be accurate and still be useless.
A billing company can process millions of claims and still
create unnecessary friction.
A software platform can have 400 features and still solve
the wrong problem.
The real question isn't:
“Is this industry standard?”
It is:
“Does this work?”
Pitfalls Healthcare Leaders Should Avoid
Pitfall 1: Buying software before understanding the
workflow
Technology cannot diagnose a problem you haven't defined.
Pitfall 2: Measuring activity instead of outcomes
Claims processed aren't cash collected.
Denials worked aren't denials prevented.
Clicks reduced aren't necessarily time saved.
Pitfall 3: Automating everything
Some decisions require humans.
Pitfall 4: Ignoring staff
The people who actually perform the workflow know where it
breaks.
Listen to them.
Pitfall 5: Treating billing as a back-office problem
Billing affects cash flow.
Cash flow affects staffing.
Staffing affects access.
Access affects patients.
Everything connects.
Pitfall 6: Creating another silo
If your new tool creates another login, another dashboard,
another inbox, and another reconciliation process, ask whether you actually
solved anything.
Pitfall 7: Assuming AI equals intelligence
AI can be powerful.
It can also confidently be wrong.
Healthcare needs auditable intelligence, not magic.
Legal and Compliance Reality
Automation does not eliminate responsibility.
A practice remains responsible for the accuracy of its
claims and appropriate handling of patient information.
Any technology touching protected health information should
be evaluated for:
Privacy
Security
HIPAA obligations
Business associate arrangements
Auditability
Access controls
Data retention
Vendor responsibilities
Coding accuracy
Payer requirements
Human oversight
The key principle:
Automate the work. Don't automate away accountability.
For specific compliance, legal, coding, or reimbursement
questions, practices should consult qualified professionals.
Ethical Question: Who Gets the Time?
This may be the most important question in healthcare
automation.
Suppose technology saves 10 hours a week.
Who gets those 10 hours?
The corporation?
The payer?
The practice?
The physician?
The patient?
The staff?
There isn't one universal answer.
But we should at least ask.
Because if automation simply means:
“Great. Now you can see three more patients.”
We may have missed the point.
Maybe the physician needed those minutes to think.
Maybe the nurse needed them to recover.
Maybe the patient needed them for a conversation.
Efficiency without humanity can become another form of
exhaustion.
What OnnX Is Trying to Change
This is the philosophy behind my work with OnnX.
OnnX is an AI-powered medical billing SaaS built around a
simple idea:
Small and midsize practices should not need unnecessary
layers of middlemen and administrative friction to get paid for the care they
already delivered.
The objective isn't “AI for AI's sake.”
The objective is better information flow.
Better workflow.
Earlier detection.
Less avoidable rework.
More transparency.
More control.
And ultimately:
More time returned to the people doing the actual work of
healthcare.
That's the north star.
But Let's Be Honest About What Technology Cannot Do
Technology cannot make every payer policy reasonable.
It cannot eliminate every denial.
It cannot replace clinical judgment.
It cannot fix every broken incentive in American healthcare.
It cannot make difficult patients easy.
It cannot eliminate every administrative requirement.
And it certainly cannot make healthcare human by itself.
Technology is a tool.
The system around the tool matters more.
The incentives matter.
The workflow matters.
The people matter.
The culture matters.
The Future Isn't “AI Replaces Doctors”
That headline gets clicks.
I think it misses the point.
The more interesting future is:
AI removes work that doctors shouldn't have been doing.
That's a much better story.
A physician should be thinking about the patient.
Not whether an insurance number was copied correctly three
screens ago.
A nurse should be thinking about the bedside.
Not which portal contains the authorization status.
A practice manager should be thinking about the health of
the practice.
Not manually reconciling three spreadsheets.
A billing specialist should be solving complex exceptions.
Not repeatedly correcting predictable errors.
That's where intelligent automation becomes useful.
Recent News: The Same Story Keeps Appearing
The healthcare news cycle this week has been remarkably
consistent.
The technology gets smarter.
The administrative problem remains.
A recent Science Friday discussion featured Stanford
physician-computer scientist Jonathan Chen, examining how doctors are
using AI for documentation, diagnosis-related tasks, and staying current while
wrestling with accuracy and trust.
The AMA continues to report serious physician concern about
prior authorization.
And a recent physician commentary described the broader
payment and administrative environment as a structural problem for independent
practices.
The lesson?
The industry doesn't simply need smarter tools.
It needs better systems.
Three Questions for Every Healthcare Founder
Before building another healthcare product, ask:
Question 1
What human task are we eliminating?
If the answer is unclear, keep digging.
Question 2
What decision becomes easier?
Automation without better decisions is just faster activity.
Question 3
What happens to the time we save?
That is where the human value lives.
Three Questions for Every Physician
Ask yourself:
What administrative task makes me think, “Why am I doing
this?”
That's your first target.
Then:
What information do I repeatedly have to hunt for?
That's your data problem.
Finally:
What would I do with five extra hours a week?
That's your ROI.
Three Questions for Every Practice Owner
Where is revenue leaking?
Where is staff time disappearing?
Where does information break between clinical care and
payment?
Don't solve all three at once.
Pick one.
Fix it.
Measure it.
Then move.
The 30-Day Challenge
If I were running a small medical practice, here's what I
would do.
Days 1–7
Track every administrative interruption.
No judgment.
Just count them.
Days 8–14
Group them.
Billing.
Eligibility.
Prior authorization.
Documentation.
Payer communication.
Patient billing.
Days 15–21
Identify the largest source of wasted time.
Find the root cause.
Days 22–30
Automate, eliminate, or redesign one process.
Then measure the difference.
Not six months later.
Now.
Myth Busters
Myth: More automation always means better healthcare.
False.
Bad automation can create faster bad decisions.
Myth: Denials are simply a billing department problem.
False.
Many denials originate upstream in registration,
eligibility, documentation, coding, authorization, or data exchange.
Myth: Bigger RCM vendors automatically perform better.
False.
Scale doesn't guarantee alignment with a practice's
workflow.
Myth: AI should replace human review.
False.
AI should make human review more focused and useful.
Myth: Technology saves time automatically.
False.
Only workflow redesign converts technology into actual time
savings.
Myth: Patient-centered care is only clinical.
False.
Every administrative interaction can affect access, trust,
cost, and continuity.
The Question Nobody Puts on the Dashboard
Here is the metric I want healthcare leaders to consider
adding:
Human Attention Returned.
How many hours did we give back?
Not hours that disappeared into another task.
Hours that actually became:
More patient conversations.
More clinical thinking.
More family communication.
More teaching.
More rest.
More presence.
Because that's what technology is supposed to buy us.
Not more software.
More humanity.
Final Thoughts: Jeannie Guffey Didn't Need the Future of
Healthcare
She needed three nurses.
Erin Powers.
Kaitlin Swaim.
Emily Owens.
She needed a kiddie pool.
She needed her son, Jody, to baptize her.
She needed her family.
And she needed a healthcare team willing to say:
“We have to find a way.”
That story should make us proud.
It should also make us uncomfortable.
Because we shouldn't build a healthcare system that depends
on extraordinary people overcoming ordinary administrative obstacles.
We should build systems that remove those obstacles.
We shouldn't ask:
How can we make doctors more productive?
We should sometimes ask:
How can we stop wasting their time?
We shouldn't ask:
How much AI can we put into healthcare?
We should ask:
How much unnecessary work can we take out of healthcare?
And we shouldn't define innovation simply as doing more with
less.
Maybe innovation is:
Doing less unnecessary work so humans can do more
meaningful work.
That is a different vision of healthcare.
And I think it is the better one.
Get Involved: Your Turn
Here is my question for physicians, practice owners, nurses,
healthcare executives, and founders:
If you could permanently eliminate one administrative
task from your practice tomorrow, what would it be?
Don't give me the polished answer.
Give me the annoying one.
The task that makes you sigh.
The task you have explained to five different people.
The task that exists because “that's how the system works.”
Tell me in the comments.
I want to know what healthcare professionals are actually
fighting every day.
If this article made you rethink the relationship between technology,
administrative burden, medical billing, and patient care, share it with
another physician or practice owner.
And if you believe healthcare technology should create more
room for human care rather than simply more room for software, join the
conversation, raise your voice, and help shape what comes next.
The future of healthcare should not be measured by how
many clicks we automate.
It should be measured by how much human attention we
return.
Let's build systems that give clinicians more time to do
what only humans can do.
References
1. Huntsville Hospital Health System — the original
account of Jeannie Guffey's final wish and the three Medical ICU nurses who
helped make her baptism possible.
Read
the Huntsville Hospital account
2. American Medical Association — 2026 physician survey
documenting the continuing burden of prior authorization, including time
consumption, delays, denials, and burnout.
Read
the AMA report
3. Science Friday — August 28 discussion with Stanford
physician-computer scientist Jonathan Chen on physicians' growing use of AI and
their concerns about the technology.
Listen to the
Science Friday discussion
Continue the Conversation
Healthcare changes quickly.
The harder question is whether we are changing it in the
right direction.
I share practical perspectives on healthcare operations,
medical billing, physician experience, healthcare technology, AI, and the
business of medicine.
Explore the ideas, challenge them, and bring your own
experience into the conversation.
Listen
to the podcast on Spotify
Knowledge drives progress. But knowledge becomes useful
only when we turn it into better decisions, better systems, and better care.
About the Author
Dr. Daniel Cham is a physician and medical consultant
working at the intersection of medical technology, healthcare management,
medical billing, and practice operations.
His work focuses on practical ways healthcare professionals
can reduce administrative friction, improve operational performance, and use
technology without losing sight of the human experience of medicine.
Connect with Dr.
Cham on LinkedIn
Disclaimer / Note
This article is intended for general educational and
informational purposes. It should not be interpreted as medical, legal,
coding, compliance, reimbursement, financial, or professional advice.
Healthcare organizations should seek guidance from appropriately qualified
professionals regarding their individual clinical, operational, contractual,
regulatory, privacy, and legal circumstances.
One Last Thought
The best healthcare technology may not be the technology
patients notice.
It may be the technology that quietly removes the work
standing between a clinician and a patient.
Jeannie Guffey's story gives us a surprisingly simple test:
Did we create more room for people?
If the answer is yes, we're probably building something
worthwhile.
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