The exhausting flood of clicks and messages in electronic health records (EHRs). Rising cyberattacks. A patchwork of telemedicine policies. The rising use of artificial intelligence and large-scale regulatory influences like the 21st Century Cures Act.
The waves of health information technology (HIT) trends hitting medicine have led to “up and down” use among Texas physicians, says Austin family physician Jacob Childers, MD.
On the one hand, the medical director for NormanMD – Austin Regional Clinic’s on-demand, virtual urgent care service – regularly sees patients opting for and benefiting from advances in telemedicine, particularly when distance, a lack of appointment times, or cost would otherwise make care inaccessible.
On other hand, some EHRs – all of which are supposed to streamline care – seem to interrupt it with myriad clicks, refill requests, lab results, and direct messages from patients, among other alerts, he says.
These undulations are why the Texas Medical Association is constantly examining the role technology plays across physician practices, as evidenced by its most recent biennial HIT survey. TMA uses the questionnaire to identify emerging issues and assess clinician priorities. The 2025 survey addressed telemedicine, EHRs, data security, interoperability, and for the first time, artificial intelligence.
“We didn’t go to medical school to become experts at using computers,” said Philip Bernard, MD, the new chair of TMA’s Committee on HIT and Augmented Intelligence (AI). “We went to care for patients. It is unfair to ask physicians to spend their whole day on electronic tasks. We clearly have more work to do in that area.”
Although EHR use continues to rise among Texas physicians, the majority of survey respondents agreed the technology has a negative impact on patient care by interfering with physicians’ attentiveness to patients.
Dr. Bernard believes the sheer number of notifications, alerts, and other e-communications within the EHR is to blame – and over half of Texas physicians agree.
Of the 91% of Texas physicians who use an EHR, 58% said too much data within its interfaces often obscures important patient information, like treatment preferences and family health history.
Dr. Bernard recognizes EHRs, when optimized efficiently, can improve the quality and effectiveness of the health care system.
However, he also says the technology’s usability issues, excessive patient documentation requirements, and unnecessary automated messages – like notifications that a patient has visited another clinician in their health system, for example – have increased physicians’ “cognitive load,” leading to more stress associated with physician burnout.
Meanwhile, widespread tech impacts in interoperability like the 21st Century Cures Act have promoted technological innovation in health care – but not without growing pains.
For example, as of Jan. 1, 2024, new regulations stemming from the Cures Act require EHR vendors to provide data to physicians changing systems – but a share of respondents that reported a switch in the past two years were not able to retrieve their data. However, recognizing that the regulation has not yet been in effect for two years, the number of physicians able to access their data could improve as time passes.
TMA took steps this year to address EHR burnout during the association’s annual TexMed conference in May. During the event, TMA’s House of Delegates (HOD) adopted new policy advocating for the acceptance of EHR-generated health care forms, such as school and camp physicals.
With so many Texas physicians using EHRs, all forms should be permitted to be produced electronically, eliminating lengthy manual processes and unnecessary expenses placed upon physician practices, the policy argues.
And in 2024, the HOD adopted a resolution – brought forth from TMA’s Council of Socioeconomics in tandem with the HIT and AI Committee – that seeks pathways for physicians to get paid for time spent on after-hours EHR documentation and inbox management.
TMA also has educational resources available to aid physicians in managing their inbox, from the association’s EHR comparison tool to its telemedicine resources.
“[Physicians] do not have enough time in the day to … complete all the electronic tasks we are given, even if we were literally to go without sleep. There is still work to be done,” Dr. Bernard said.
Austin internist Manish Naik, MD, has found automated solutions to tackle his EHR burden – AI.
He uses AI speech recognition software in his practice to draft patient documentation, like appointment summaries and refill requests. By avoiding typing his notes, he’s able to reduce time spent in an EHR to be with his patients, he says.
AI “saves valuable time, both in and out of the exam room, and that is beginning to have an impact on physicians,” the immediate past chair of TMA’s Committee on HIT and AI said.
This year’s HIT survey was the first from the association to include questions about the use of AI by physicians. Its results indicate Texas physicians are cautiously optimistic that AI will reduce EHR and administrative burden. Physicians also reported feeling hopeful AI could offer solutions to another burdensome heavy hitter: compiling, submitting, and receiving approval for prior authorization requests.
Thomas J. Kim, MD, a member of TMA’s Council on Science and Public Health, says AI has the potential to reduce burden on physicians by prefilling prior auth forms, extracting pertinent details from physician notes, and providing real-time updates to payer-specific coverage policies.
However, while a majority of Texas physicians believe AI will have a positive impact on health care, the same sample set reported feeling the technology could also have negative effects.
Dr. Naik says physicians’ skepticism about AI is healthy – and understandable, given its unpredictable liability and privacy implications.
“We’re seeing an increasing level of AI adoption, but by no means is every physician using these tools yet,” Dr. Naik said. “When using AI, you have to [ensure] the security of protected health information, the accuracy of the tools, and appropriate use. It can be tricky.”
And ambient scribes, which the HIT survey found to be the most used AI tool among Texas physicians, have their own restrictions, says Cathy Bryant, manager of cyber consulting services for the Texas Medical Liability Trust (TMLT).
She says physicians who use AI scribes to transcribe or summarize patient visits still must read the notation to ensure it is correct – and that it’s often not.
“Not all transcription services are the same, and some are finding their recorded notes have missing or incorrect information,” she said.
Furthermore, health plan use of AI in reviewing prior authorization requests has been found to produce high rates of care denial, in some cases 16 times higher than is typical, according to figures from an October 2024 U.S. Senate committee report.
Dr. Kim believes that for AI technology to overcome physician skepticism, it must demonstratively reduce physicians’ workload without asking clinicians to master yet another complicated system.
“What the survey results reflect is ‘this is what we’ve got, and we’re making the best use of it,’” the consultant to TMA’s HIT and AI Committee said. “There is no single topic that I am so optimistically terrified of or terrifyingly optimistic of.”
Last year, under the direction of then-TMA President G. Ray Callas, MD, the association added AI consultants to its HIT and AI Committee. These members were tasked with evaluating the use and benefits of AI in patient care to make physicians stronger as patient advocates. The AI consultants helped develop AI education and resources that are now available on TMA’s AI webpage.
Their efforts aided the association in its fight to pursue both meaningful AI use and comprehensive prior auth reform as two of TMA’s 10 key issues for the 2025 Texas legislative session.
Dr. Kim warns physicians that while AI has “enormous potential,” the technology is still evolving. His caution reflects TMA policy, which outlines AI should be used as an “augmented” tool set.
Augmented intelligence, whether assistive or fully autonomous, is intended to co-exist with human decision-making and should not be used to replace physician reasoning and knowledge.
“AI holds enormous positive impact,” Dr. Kim said. “But if you don’t create a thoughtful way to use this tool, then you get things like health payers using it to deny prior auth.”
As the use of AI has grown, another HIT staple, telemedicine, has decreased in utilization among Texas physicians since last year.
The survey’s finding matches nationwide telemedicine trends. A monthly virtual care tracker from Fair Health, an independent nonprofit that manages the nation’s largest database of privately billed health insurance claims, found by January 2025, telehealth represented only 3.87% of all claims. In contrast, in September 2020, at the height of the COVID-19 pandemic, that number was as high as 51.8% of claims.
Respondents in TMA’s HIT survey indicated patients’ preference for in-person visits and technological limitations are physicians’ main deterrents from utilizing telemedicine. However, Dr. Kim says the decrease in utilization “cannot be viewed in a vacuum,” and instead points to systemic issues.
During the COVID-19 pandemic, for instance, state and federal authorities relaxed certain telemedicine restrictions and the changes allowed the technology to prove its worth in providing timely access to physician-led care in Texas, Dr. Kim says. However, many of these flexibilities have since expired, will soon expire, or only apply to certain payers, leaving a patchwork of inconsistent or nonexistent payment policies for virtual care provided in Texas.
This patchwork of policies, as well as the sometimes-expensive cost of integrating telemedicine software and infrastructure into a practice, have created financial uncertainties for physicians providing telemedicine services, says Dr. Kim.
“It’s important that people understand that this is a race that’s been run for decades, and Texas continues to be, in my opinion, a leader in this space,” he said. “But these unreliable [policies] create a climate of uncertainty. Nobody knows what’s going to happen in a few months, which forces us to hesitate, rather than to continue to step forward. It has had a chilling effect on telemedicine.”
TMA continues to advocate for meaningful and permanent policy changes in Medicare that would allow Medicare patients to be seen virtually from the patient’s home, and for physicians to be paid fairly for providing virtual care.
Additionally, TMA’s telemedicine webpage offers members multiple resources, including a vendor evaluation worksheet similar to its AI vendor evaluation tool.
“It makes perfect sense to me that [some] physicians are rolling back their use of telemedicine,” Dr. Kim said. “But I don’t think, in any way, that is a meaningful commentary on the intrinsic virtue of [telemedicine and] telehealth, but instead a business decision driven by uncertainty.”
As health care has continued to integrate electronic tools, new threats have begun to drive the uncertainty that accompanies new technologies: viruses, malware, and hackers that target physicians and their patients.
“Health care continues to be a favorite target for this kind of attacker, and the urgent need for access to data in emergency situations only adds to the pressure health care organizations feel when their systems are all unavailable and they must resort to more old-school processes,” according to the report.
TMA itself was targeted this year by scammers pretending to be affiliated with the association, a TMA-authorized vendor, or a county medical society. These cyberattacks utilized fake invoices disguised as genuine communications to trick recipients into providing sensitive information, such as bank details, credit card numbers, personal identity data, and passwords.
Ms. Bryant says the upward trend in cyberattacks – what she calls a “digital paradox,” when compared with decreasing trends in telemedicine – often comes in the form of malicious attachments, including documents, zip files, executable applications, and suspicious email links that can bring users directly to websites that are used to place malware on a system.
Similarly, phishing email scams can give hackers access to internal business systems that could reveal confidential information like credit card numbers, personal identity data, and passwords. Often these emails appear to come from real companies or trusted individuals.
Other recent scams targeting physicians include calls, texts, emails, and even faxes from criminals pretending to be the U.S. Drug Enforcement Administration, FBI personnel, or Texas Medical Board employees, according to Shannon Vogel, TMA’s associate vice president of HIT. These messages usually demand money to reinstate a license or threaten enforcement unless the physician or practice pays a fine.
Ms. Vogel told Texas Medicine that physicians should report such fraud directly to the Federal Trade Commission. She also warns phishing scams, especially those utilizing AI platforms like ChatGPT, are becoming “more difficult to catch,” and suggests examining the tone of the email to check if it matches how the sender usually speaks.
Physicians also can obtain cyber liability coverage, which typically includes network security and privacy-related exposures such as lost or stolen laptops or theft of patient data.
With TMLT, for instance, if a policyholder reports a ransomware attack, staff assign an attorney familiar with cybersecurity to handle the case and to determine whether the practice needs a forensic examination to assess the threat, Ms. Bryant told Texas Medicine.
As a part of ongoing efforts to stay abreast of the latest information about health care cybersecurity, TMA technology staff attended a nationwide cybersecurity coalition meeting in April that touched on virtual challenges impacting medicine, routine staff training, best practices surrounding AI, and more.
The conference’s host, the Health Sector Coordinating Council Joint Cybersecurity Working Group, is an industry-led advisory council of more than 450 health care organizations, including the American Medical Association.
The takeaway: Many of the event’s key points on cybersecurity and AI reflected longstanding TMA policy and guidance.
“The event reiterated what TMA has been saying for a long time,” Ms. Vogel said. “Train your staff, practice cyber hygiene, and conduct a security risk analysis.”