Latest / Becker’s Healthcare Podcast / Samuel O. Jones IV, MD, MPH, FACC - Director, Inpatient EP Services, The Chattanooga Heart Institute, Memorial Hospital

Transcript

Samuel O. Jones IV, MD, MPH, FACC - Director, Inpatient EP Services, The Chattanooga Heart Institute, Memorial Hospital · Becker’s Healthcare Podcast

• 0:00
  This is Laura Dierda with the Becker's Healthcare
• 0:02
  podcast. I'm thrilled today to be joined by
• 0:04
  doctor Samuel Jones, who is the director of
• 0:06
  inpatient EP services at the Chattanooga Heart Institute
• 0:09
  Memorial Hospital. Doctor Jones, it's a pleasure to
• 0:12
  have you on the podcast today. Thank you,
• 0:14
  Laura. Looking forward to it. Absolutely. Now I'm
• 0:16
  excited for our discussion to dig a little
• 0:18
  bit deeper into some of the cool things
• 0:20
  that you're doing at the Heart Institute. I
• 0:22
  think certainly it's such an important time and
• 0:24
  interesting and innovative time for heart care. But
• 0:27
  before we do that, can you introduce yourself
• 0:29
  and tell us just a little bit more
• 0:30
  about your background?
• 0:32
  Yes. I'm Sam Jones. I am a clinical
• 0:34
  electrophysiologist
• 0:35
  here at the Chattanooga Heart Institute with Memorial
• 0:38
  Hospital,
• 0:39
  and I've had a few roles over the
• 0:41
  years. I've been,
• 0:42
  in the service line,
• 0:45
  EP for common spirit health for several years.
• 0:48
  And then I've had various roles within the
• 0:49
  American College of Cardiology
• 0:51
  focusing on some of our registries, quality improvement,
• 0:55
  advocacy, as well as strategy.
• 0:58
  Overall, it really kinda fits into the niche
• 1:00
  and things I'm interested in, including
• 1:03
  how we're going to transform care.
• 1:06
  ASCs are something that we've been looking at
• 1:08
  very carefully that we may talk about more
• 1:09
  today. Certainly, how we're gonna adopt AI is
• 1:12
  something I've been following. And then just overall,
• 1:15
  the future of our specialty.
• 1:17
  Absolutely. You know, and that's a lot a
• 1:19
  lot to cover, but I think we'll dive
• 1:21
  right in here. So what are the top
• 1:23
  three trends that you're focused on right now
• 1:25
  in health health care as well as heart
• 1:26
  care, thinking about ASCs? We just love to
• 1:29
  hear some of the big things that are
• 1:31
  on your mind today.
• 1:32
  I would say the first one that I
• 1:35
  think everyone in medicine is really worried about,
• 1:38
  especially in cardiology, is workforce,
• 1:41
  which really means access for patients.
• 1:43
  Because right now, we have the epitome of
• 1:46
  a supply demand mismatch, meaning that we've got
• 1:49
  a lot of patients who wanna see us.
• 1:51
  We've got patients that are getting older, and
• 1:54
  they're just sicker. We've never seen patients quite
• 1:56
  like this before. They've got more chronic diseases,
• 1:58
  so they take up a lot of time.
• 2:00
  There's a lot of complexity there. And with
• 2:02
  all of this supply,
• 2:04
  with all this demand that we're having of
• 2:06
  these patients coming, how are we gonna actually
• 2:08
  address it? Because
• 2:10
  we may just not have enough clinicians, at
• 2:12
  least in our current model, to take care
• 2:13
  of it. They talk about within cardiology right
• 2:16
  now that we're kinda shifting older.
• 2:20
  We've got a gray tsunami. In other words,
• 2:22
  all the gray hairs may not be around.
• 2:24
  In 2019,
• 2:25
  they said twenty seven percent of cardiologists
• 2:28
  were over the age of 61.
• 2:30
  And so you've got a lot of cardiologists
• 2:32
  that are getting ready to retire, unfortunately.
• 2:35
  Now that would be okay if we had
• 2:37
  the training pipeline to accommodate for that. But
• 2:40
  every year, we don't have enough coming out
• 2:42
  of training
• 2:43
  than we do that are gonna be leaving.
• 2:45
  And the pathway
• 2:46
  to get to being a cardiologist or to
• 2:48
  be and being other subspecialists within cardiology is
• 2:51
  just so long. It takes a while for
• 2:53
  us to even, address that. Right now, they're
• 2:55
  saying that we're probably gonna lose about 547
• 2:59
  cardiologist every year just because those that are
• 3:01
  leaving and those that are coming in. So
• 3:03
  I think that's a big thing that we're
• 3:04
  gonna have to we're gonna have to really
• 3:06
  think about how do we address this problem.
• 3:09
  The second thing I would say is is
• 3:12
  AI.
• 3:13
  Probably, there's not a a talk that you,
• 3:16
  hear right now that AI isn't part of
• 3:18
  that. But I think AI is not just
• 3:21
  the the image acquisition. This is one of
• 3:23
  the things in cardiology that we have it
• 3:24
  doing so much for us in the imaging
• 3:27
  space. But, really, it's gonna be how can
• 3:28
  we use it in other things? How can
• 3:30
  we use it to address some of these
• 3:32
  workforce issues? And that could be with some
• 3:34
  of our documentation, whether that's with ambient
• 3:36
  AI scribes,
• 3:38
  care navigation.
• 3:40
  I think scheduling is something that can really
• 3:42
  be used for,
• 3:43
  triage. And so there's a lot of administrative
• 3:46
  type functions for AI that we're gonna be
• 3:48
  able to use as well as just clinical
• 3:50
  decision support.
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  And,
• 3:53
  if we do that right, then maybe we
• 3:54
  can
• 3:55
  help with some of the workforce issues just
• 3:59
  by getting everyone to really focus at the
• 4:01
  top of their license as part of the
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  cardiovascular care team. So that's gonna be a
• 4:05
  big thing, but making sure that we're also
• 4:07
  watching AI very carefully.
• 4:10
  And I think the third thing is just
• 4:12
  a transformation that we're seeing across all medicine.
• 4:15
  One time, especially in cardiology, we were tied
• 4:17
  to the hospital, and everything happened within those
• 4:19
  walls of the hospital. But But that's no
• 4:21
  longer gonna be the case, and we're seeing
• 4:23
  sort of a transformation and a translocation
• 4:26
  of care that's gonna go out. We mentioned
• 4:28
  ASCs already, ambulatory surgery centers. We've seen that
• 4:32
  happen in other specialties, whether it's with,
• 4:35
  gastroenterology
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  and orthopedics and all of those same things,
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  those same principles
• 4:41
  for why things are moving out of hospital
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  will happen in cardiology as well. So how
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  do we do that? How do we make
• 4:46
  sure we're doing that in a in a
• 4:49
  safe way? Because it can't just be about
• 4:51
  making sure that we're we're saving money across
• 4:54
  the board, although that is a big part
• 4:55
  of it. But how are we actually expanding
• 4:58
  access
• 4:59
  and the experience for the patient?
• 5:01
  And in that same area of care transformation,
• 5:04
  it's gonna be more use of telehealth.
• 5:06
  It's gonna be using more diagnostic rhythm and
• 5:10
  device care to help us really get to
• 5:12
  patients really where they are rather than have
• 5:14
  them come to us.
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  I love that. I think all of three
• 5:18
  things you talked about are critical, whether it's
• 5:21
  in the workforce transformation and access to care
• 5:23
  for patients, thinking through how
• 5:25
  AI can help address some of those issues,
• 5:27
  but also understanding
• 5:29
  what it the risks are involved and how
• 5:31
  you can smartly integrate that more broadly into
• 5:34
  cardiovascular
• 5:35
  care teams. And then finally, looking at that
• 5:36
  transformation across all medicine going into the outpatient
• 5:36
  setting, I think it's
• 5:45
  cases into that space, it seems like,
• 5:47
  you know, you're not meeting some of the
• 5:49
  goals in terms of quality and value and
• 5:51
  and bending the cost curve in health health
• 5:52
  care and more, and then really working smartly
• 5:54
  with the the teams that you have. And
• 5:56
  so I I think that's a really interesting
• 5:58
  analysis and overview. And, you know, if we
• 6:00
  were to, dig just a little bit into
• 6:02
  the workforce,
• 6:04
  trend you mentioned,
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  How do you see,
• 6:07
  realistically, the impact of losing that five hundred
• 6:09
  to seven hundred cardiologist,
• 6:11
  you know,
• 6:12
  coming through to retirement,
• 6:14
  you know, over the next several years? Like,
• 6:17
  how are you proactively thinking about that, and
• 6:20
  what does the field need to do in
• 6:21
  order to, make sure that, you know, you're
• 6:23
  in a place where people can still get
• 6:25
  the the care that they deserve?
• 6:28
  Yeah. This is gonna be a big thing
• 6:30
  that cardiology has to address, and I think
• 6:32
  it's gonna be a multi pronged approach because
• 6:35
  you might just look at it and say,
• 6:36
  let's just train more. Let's just open up
• 6:38
  a lot of spots. Well, that's not really
• 6:40
  how it works, and that's not how how
• 6:41
  GME works. While there are some things that
• 6:43
  we can probably do, as I mentioned, because
• 6:46
  the pathway to become a cardiologist is so
• 6:48
  long for training, that that's gonna take a
• 6:50
  long time if we can even do that
• 6:52
  at all. So there may be some things
• 6:54
  within education. Are there ways in which we
• 6:55
  can shorten some of that training? Can we
• 6:57
  remove some of the barriers so that we
• 6:59
  can do that? So that's one thing. But
• 7:02
  I think it's important to know it's not
• 7:03
  just about the physician. It's about the entire
• 7:06
  care team. And I think in cardiology, we're
• 7:09
  really blessed more more than any other specialty
• 7:11
  that we have really embraced that idea
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  of how do we use everyone working at
• 7:16
  the top of their license. And this is
• 7:18
  gonna be critical because without that, we really
• 7:20
  have no hope for it. Even within that
• 7:22
  cardiovascular
• 7:23
  care team, though, we need to redesign some
• 7:26
  things, and we need to make sure that
• 7:27
  we understand what are the care pathways
• 7:30
  that we can utilize to really become more
• 7:32
  efficient in the care that we're given. How
• 7:34
  can we use the technology
• 7:36
  that's coming on board so that that's helping
• 7:39
  patients as well? How can we get to
• 7:41
  more virtual diagnosis with patients with telehealth
• 7:45
  and some of the other things that are
• 7:46
  becoming available with technology? So it's gonna have
• 7:50
  to be a multi pronged approach,
• 7:52
  definitely looking at the training pathway itself for
• 7:55
  cardiologists,
• 7:56
  using the cardiovascular care team to the top
• 7:58
  of the license,
• 7:59
  instituting the technology and AI in other ways
• 8:01
  that we haven't done before.
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  I love that. That makes a lot of
• 8:06
  sense. You know, it is really helpful to
• 8:07
  understand the big picture problem and then some
• 8:09
  of the things that you're doing in in
• 8:11
  in the field is doing in order to
• 8:13
  prepare for the future. Now
• 8:15
  speaking of,
• 8:17
  just kind of some of those activities, what
• 8:19
  are you most excited about right now? What's
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  really,
• 8:22
  exciting for you as you think about what
• 8:23
  we're able to do today in in the
• 8:25
  cardiovascular
• 8:26
  space and what's ahead?
• 8:28
  Yeah. I think there's a lot to be
• 8:29
  excited about, and you don't always get that
• 8:31
  message from people, but it really is.
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  Right now, we're living in a phenomenal time,
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  and there's,
• 8:38
  while there's the the burden is great, I
• 8:41
  think that the opportunities then just are gonna
• 8:44
  keep showing themselves more and more. Part of
• 8:46
  that's just innovation,
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  and what we're seeing across the care pathways,
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  how we're able to do things in cardiology
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  with our procedures
• 8:54
  quicker,
• 8:55
  safer, and not always requiring the, the same
• 8:58
  need to be in the hospital and ship
• 9:00
  those out. So that innovation itself is gonna
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  be phenomenal.
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  I think the entire artificial intelligence, though, is
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  gonna showcase things that we haven't even dreamed
• 9:09
  of about how that's going to do. Now
• 9:10
  we're gonna have to monitor that carefully. So
• 9:12
  while I'm excited about it, I have to
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  admit that I'm also a little bit concerned
• 9:17
  to make sure that we understand what that
• 9:19
  AI is gonna do for us.
• 9:21
  And then just looking at
• 9:23
  the efficiency
• 9:25
  and the experience that we're delivering to patients.
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  I think this is something that people are
• 9:29
  starting to realize.
• 9:31
  We have to do this better for patients,
• 9:34
  And we're gonna find that with some of
• 9:36
  the translocation of care outside the hospital, this
• 9:38
  has become a premium on making sure we're
• 9:40
  providing that service to patients. In the end,
• 9:42
  patients can definitely be served better with all
• 9:45
  of those things. So the main thing I'm
• 9:47
  excited about is just the innovation, whether that's
• 9:49
  not just from the technology, but just from
• 9:51
  the overall care delivery of pathways. How do
• 9:54
  we institute our cardiovascular care team? How do
• 9:56
  we institute telehealth to really transform this into
• 9:59
  something that's gonna be a better system for
• 10:01
  patients?
• 10:02
  I love that. And that's certainly an inspiring
• 10:04
  message when you think about how you can
• 10:06
  do things that you've never thought of before,
• 10:09
  and truly
• 10:10
  make that experience and the patient journey,
• 10:13
  much better. And two, some of the outcomes
• 10:15
  and quality of care, I can imagine, are
• 10:18
  ways that you can improve some of that
• 10:20
  those things with AI too. Is there anything
• 10:22
  you're doing at the Heart Institute right now
• 10:24
  that, you've been just overcome by some of
• 10:27
  the results or have been really excited by
• 10:29
  some of the results?
• 10:31
  Well, we do,
• 10:33
  have a lot in the imaging space that's
• 10:35
  going on, and I think that this is
• 10:36
  something where we're seeing by
• 10:39
  leveraging
• 10:40
  some of the technologies that's come out, we're
• 10:42
  able to get the right patient to the
• 10:44
  right place at the right time. And and
• 10:46
  what I mean by that is really in
• 10:48
  the world of interventional cardiology.
• 10:50
  You know, before, we would have a lot
• 10:51
  of patients that would come to the cath
• 10:53
  lab and get a diagnostic catheterization,
• 10:55
  and it turns out they did not need
• 10:57
  a stent. We didn't know that until they
• 10:59
  had a heart catheterization.
• 11:01
  But because of some of our CT workforce
• 11:03
  issue, we've been able to actually have patients
• 11:06
  get a noninvasive test.
• 11:08
  And what's what we found with this is
• 11:10
  that by doing this in a in a
• 11:12
  very designated way, we have a champion who
• 11:15
  watches carefully how we're doing with all these,
• 11:16
  are we putting the right patients into the
• 11:18
  CT scanner? How are we adjusting our flows?
• 11:22
  And with all of that, we're actually having
• 11:24
  less patients
• 11:25
  go to the heart catheterization laboratory.
• 11:27
  But that's okay because a greater percentage of
• 11:30
  them actually get an intervention. They get a
• 11:32
  stent. And so I think that's where we
• 11:35
  need to go overall as a field. We're
• 11:37
  trying to find out how do we get
• 11:39
  the patient the right procedure at the right
• 11:42
  time. And by leveraging that technology,
• 11:44
  we're absolutely doing that. And so I think
• 11:46
  that's gonna be one of many things that
• 11:48
  we find that we can we can continue
• 11:50
  to do.
• 11:52
  Overall, like a lot of people, we're also
• 11:54
  looking at how do we get more continuous
• 11:56
  care going on, what do we do with
• 11:58
  hypertension management,
• 11:59
  lipid management, rhythm management,
• 12:02
  all of those things that patients now have
• 12:04
  access to at their home. We're not having
• 12:06
  to wait for them to come in. We
• 12:08
  actually can get some of that data sent
• 12:10
  for us so that they're getting a more
• 12:12
  continuous pathway of of care delivery.
• 12:15
  That's helpful to understand, and thank you so
• 12:17
  much for, digging deeper into that example. Before
• 12:19
  we wrap up our conversation,
• 12:21
  are you thinking about growth over the next
• 12:23
  twelve months or so?
• 12:24
  I think for everyone, it's it's a big,
• 12:27
  issue.
• 12:28
  Growth, though, can't just be about how many
• 12:30
  more procedures are we doing, all that, but,
• 12:32
  again, smarter pathways. And I've I've mentioned that
• 12:34
  a few times, but I really think that
• 12:36
  that's critical because
• 12:38
  the new center of excellence
• 12:40
  can't just be, what it used to be.
• 12:42
  I think it's gonna have to be efficiency
• 12:43
  of care to really make sure we're getting
• 12:46
  the right thing for for the patient at
• 12:47
  the right time.
• 12:49
  So that comes down to access,
• 12:52
  shifting care where it belongs at all times,
• 12:54
  and making sure it always stays patient
• 12:57
  centered. We're gonna continue
• 12:59
  to use a lot of the new technology
• 13:01
  and AI to do it, but we have
• 13:03
  to make sure that when we do that,
• 13:05
  we're still keeping the clinician front and center
• 13:08
  with all of those things, that we're not
• 13:10
  outsourcing this to,
• 13:12
  artificial intelligence that is making the decisions for
• 13:16
  us. You have to know who is responsible,
• 13:18
  and we can't be dependent upon it. We
• 13:20
  still have to drive that. And I think
• 13:21
  that's what's gonna be really critical for us
• 13:23
  as part of our growth strategy.
• 13:26
  I love that. Doctor Jones, thank you so
• 13:28
  much for joining us on the podcast today.
• 13:29
  This has been a really fantastic conversation. I've
• 13:32
  learned a lot, and I look forward to
• 13:33
  connecting with you again soon. Sounds great, Laura.
• 13:36
  Thank you for the time.