Latest / Becker’s Healthcare Digital Health + Health IT / Dr. J. Scott Smitherman, Associate Vice President and Chief Medical Information Officer at Providence Clinical Network

Transcript

Dr. J. Scott Smitherman, Associate Vice President and Chief Medical Information Officer at Providence Clinical Network · Becker’s Healthcare Digital Health + Health IT

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  This is Laura Duda with the Becker's Healthcare
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  podcast. I'm thrilled today to be joined by
• 0:42
  doctor Scott Smitherman, associate vice president and chief
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  medical information officer at Providence Clinical Network. Doctor
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  Smitherman, it's a pleasure to have you on
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  the podcast today.
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  Good morning.
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  Well, thank you so much for your time.
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  I'm excited for our conversation.
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  Really just, you know, always enjoy hearing from
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  the folks at Providence, and,
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  we'll be looking forward to the hearing more
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  about how you're looking at the future as
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  well. But before we dive in, I'm wondering,
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  could you tell us a little bit about
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  yourself and Providence Clinical Network? What makes it
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  unique?
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  Yes. So my name is Scott Smitherman. I
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  am an internist by training, serve Providence as
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  the CMIO for the Providence Clinical Network, which
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  is basically the employed,
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  physician,
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  network of, of Providence.
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  You know, Providence is
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  a large,
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  healthcare system in the Western US, 1 Hundred
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  And 20 4 Thousand employees, 51 hospitals, a
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  thousand clinics,
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  really a deep history in the area and,
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  you know, specifically called to serve the the
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  poor and the vulnerable,
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  in in the areas we serve.
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  Well, thank you so much, doctor Smitherman, and
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  and really a a fantastic,
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  fantastic
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  population that you do serve and having that
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  mission is so critical for the community.
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  Now I'm wondering, you know, when you look
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  at the last year or so, what accomplishment
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  are you most proud of? Can you tell
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  us a little bit about that and,
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  how you've been, just really doing some great
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  things for your community?
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  Absolutely. Well,
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  very proud here, at, you know, in informatics
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  and IS that, you know, on our on
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  our last survey from from Prescaini of all
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  of our physicians and APCs,
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  you know, we we were able to transform,
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  how, you know, physicians and APCs,
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  regarded,
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  you know, the EMR
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  to,
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  a top quartile performance in on on the
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  question of the EMR enhances the physician
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  and, patient experience. Really, traditionally,
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  a struggle point for a lot of organizations
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  as,
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  you know, the EMR and and and specific
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  vendors' names become sometimes become curse words for
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  various, physicians and APCs,
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  to to really get docs to say that
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  that we're starting to enhance the experience. And
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  I think a big piece of that is
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  the initiatives we've undertaken.
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  We're the largest user
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  of ambient documentation
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  in the world.
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  We partner with Nuance Microsoft on on using
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  DAX and have deployed that at a larger
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  scale than
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  any other health system in The United States.
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  All of our
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  outpatient physicians and APCs have access to it
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  and are, you know, are using it to
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  to a great extent and, you know, they're
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  describing,
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  the use of that technology,
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  like they they've fallen in love for the
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  first time or or, you know, the birth
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  of their child or something like that.
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  Also very proud of some of the other
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  initiatives we're undertaking.
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  We're using
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  AI to help,
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  categorize
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  and,
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  help us
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  process the huge crush of messages coming through
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  the in basket and all that offline work,
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  along with continuing just to invest in the
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  the nuts and bolts of informatics, like ongoing
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  training and, you know, mixture of at the
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  elbow and and virtual support, which has kind
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  of led to that,
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  the turnaround in in, I think, in how
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  our physicians and APCs regard the EMR.
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  That's great to hear. And I love that
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  analogy of physicians and clinicians feeling like,
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  you know, the the how much they love
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  the AI, the ambient technology, and really being
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  able to integrate that into
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  their broader practice of workflows.
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  I think, you know, AI has been something
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  that, people have been really,
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  to some degree excited about, but then to
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  others,
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  nervous about as well. Is there anything, you
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  know, as you're looking at, the teams broadly
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  of, Providence and the clinical teams in particular,
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  that you've really had to kind of troubleshoot
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  or convince your your teams to use, or
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  have they been pretty excited and open to
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  some of the new technologies and support platforms?
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  Yeah. We were one of the, you know,
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  the earliest users of, Ambient, you know, partnering
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  with, Nuance since 2020, '20 '20 '1.
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  And, you know, it it has taken some
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  time,
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  to to get where we are. You know,
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  there's really been a turnaround in the last
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  year as the as the quality of the
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  products has,
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  improved. You know, we're we're partners with, with
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  Nuance, like I said, but, impressed with what
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  I'm seeing from
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  other vendors as well.
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  And, you know, yes, the issues of AI
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  are,
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  you know, are are significant. We have to
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  make sure, you know, patients understand. You know,
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  AI is is something that is fearful,
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  to some patients,
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  but, you know, when explained by their physician,
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  you know, when I walk in and tell
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  a patient that I'm gonna be using this
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  new technology that, you know, helps, you know,
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  helps record our conversation, helps me write my
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  notes, kind of explain how it
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  frees me up from that burdensome task, and
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  and, you know, have more time to look
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  them in the eye.
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  The patient's almost universally,
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  assent to to its use. So we, of
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  course, you know, tell patients,
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  what we're doing.
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  And, you know, when explained by a physician,
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  you know, they they're they trust the physician,
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  and and they want, you know, they still
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  want that human interaction. I'm not worried about,
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  you know, AI taking my job, but I
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  certainly,
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  want,
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  you know, when I see my own physician,
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  I want them using AI because I want
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  them I want, you know, them to be
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  relieved of the burden of doing things that,
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  you know, the computer can do.
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  But, you know, that doesn't mean that we
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  we we shouldn't approach it,
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  safely.
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  Providence has done a lot of work with
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  our we have, you know, an AI guardrails
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  committee to kind of evaluate new products or
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  evaluate new uses of AI in the products
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  we already own and make sure that they're
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  safe,
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  that there is definitely,
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  you know, vendors out there who are throwing
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  AI at everything, and we we do have
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  to make sure that it's safe.
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  The issues of, you know, the well,
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  described issues of contabulation,
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  etcetera, that
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  that, you know, some of the large language
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  models are,
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  prone to. You know, we just have to
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  make sure that,
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  we're using them safely and and, you know,
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  and that's what we're doing here at Providence,
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  concentrating on areas where
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  AI can reduce physician burden
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  and take off those, you know,
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  those kind of administrative tasks and other tasks
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  like finding information, etcetera,
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  but but leaving the the the clinical decision
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  making to, the trained professionals.
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  That's great to hear. You know? And, definitely,
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  I appreciate that process,
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  because being an early adopter yourself, it's so
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  helpful for those who are just starting on
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  that journey, to really make a difference. Now
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  I'm wondering, where do you see some of
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  the big growth opportunities for you and your
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  teams over the next twelve months or
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  so? Well, as I said, we're really excited
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  to have been one of the,
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  or or to be the biggest user of
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  Ambient, in the world already.
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  And what it can do right now is,
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  you know, borderline magical. The fact that I
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  don't you know, I can leave my clinic
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  literally an hour earlier per day because my
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  notes are already done for me. You know,
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  that by itself is magical, but I think
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  we're
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  just scratching the surface of what's possible there.
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  You know, besides relieving me of the burden
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  of, of writing my notes,
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  we haven't, you know, yet really
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  done the work to integrate, you know, clinical
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  decision support, coding support, information gathering,
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  all things that would have been, you know,
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  basically sci fi just, you know, two years
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  ago, and now it it is going to
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  happen. It's clear that it's gonna happen,
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  as multiple vendors are working on this.
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  You know, the idea that I can be
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  having a conversation,
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  an AI agent is listening to that in
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  real time and able to, you know, search
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  the chart in the background. So I'm discussing
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  congestive heart failure
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  that, the last, the patient's last echocardiogram
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  could just, you know, appear on the screen
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  for me without me having to go find
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  it, spending you know, have my nose in
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  the computer looking for that information.
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  The last, article on, you know, how to
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  treat this patient's,
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  particular condition,
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  you know, could appear in the sidebar.
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  And and when I'm done with my note,
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  it could, you know, help me with, coding
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  it, you know, doing the appropriate coding to
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  the to the maximum specificity.
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  All things that, you know, are,
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  easy for for AI agents to to do
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  if we can get all the pieces connected.
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  And that's where I see the future going
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  and and going quite quickly,
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  as as,
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  all of the AI vendors are working with
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  other partners and knowledge bases to to make
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  this happen. So I'm very excited about that.
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  I'm also excited, as I said, of just
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  other technologies we're investing in to relieve physician
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  and APC burden. I mentioned,
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  earlier,
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  we're using,
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  AI to, you know, basically read every incoming,
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  you know, MyChart advice request and help categorize
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  that so that the appropriate people,
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  can answer the questions first. So for instance,
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  say, you know, in in the old days,
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  every message had to go to my medical
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  assistant
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  and to be read and, you know, distributed
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  as, as appropriate.
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  Now the AI can, you know, label a
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  message that's about,
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  referrals, and maybe our referral team could take
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  a look at that first,
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  freeing up the clinical team to focus on,
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  you know, messages that are categorized as, having
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  a symptom.
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  So symptom messages come to us,
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  first and our our MAs, our medical assistants
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  look at those or our nursing teams look
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  at those.
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  We have a lot of great examples of
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  patients,
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  even though we tell people not to, you
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  know, message us with urgent medical concerns,
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  but sometimes they still do.
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  People having either a mental health crisis or
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  a concerning medical condition, and they send us
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  a message.
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  And, we're able to get them in, you
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  know, many cases, same day. Whereas in the
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  old days, you know, first in, first out
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  processing of messages,
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  we wouldn't have gotten to those messages for
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  a couple of days.
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  Instead, those patients are being seen the same
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  day as as, we can. So, I think
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  the future is bright for all of this.
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  There's a lot of work still to be
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  done in this space,
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  and,
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  you know, we're looking forward to the next
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  year.
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  Absolutely. It sound like there's just some really
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  great opportunities there to boost not only the
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  clinical workflow flows but outcomes for patients, which
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  is amazing,
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  to hear. And really cool, as you mentioned
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  too, to have the ability
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  of upcoming potentially,
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  to really have that AI agent, that are
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  working for you as on the clinical side.
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  I know, you know, really cool things we've
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  talked about so far, but there are also
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  challenges. What are some of those challenges that
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  you're anticipating?
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  So, you know, first off,
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  you you know, I work for an organization
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  that has been really future forward at making
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  investments in things like AI to, you know,
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  reduce, position and APC burden.
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  But, you know, you can't get away from
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  the the current health care environment that is
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  tough,
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  particularly for large nonprofits.
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  The,
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  you know, budgets are are tight, or or
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  more than tight.
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  You know, the current, political environment, we don't
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  there's a lot of uncertainty of what, you
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  know, is going to happen and how that
• 12:06
  will affect systems like Providence.
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  You know, the the situation with telehealth is,
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  is is a great example that, you know,
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  we currently only have,
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  telehealth
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  approved through Medicare for the next, several weeks.
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  And while there's, you know, bipartisan support for
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  that, we don't, you know, we don't know.
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  And so we have to kind of both
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  prepare for a world where that doesn't, get
• 12:30
  approved and for a world where it might,
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  or where where something might change. So, you
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  know, the need to focus on things like
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  that,
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  distract from some of the things I've just
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  mentioned about our investments in AI, etcetera.
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  There's a continued crisis
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  in physician and APC burnout,
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  in doctors
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  reducing their FTE
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  or leaving practice entirely.
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  It's been one of the, you know, most
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  rewarding aspects of working on things like Ambient.
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  You know, to hear physicians tell me, you
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  know, hey. I was I was thinking about
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  reducing my FTE,
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  you know, going down from a a full
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  time to a point eight or a point
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  five because I just couldn't keep up. I
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  could never get home to dinner.
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  You know, and now with this technology, I
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  don't need to do that. I can stay
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  in practice. I can maintain access,
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  to
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  a primary care,
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  you know, physician in my community
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  because I don't need to reduce my my
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  time in clinic because this technology is taking
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  the burden of that nonclinical time off of
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  me.
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  You know? And then these things are gonna
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  require all require a change in culture, which
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  is certainly tough.
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  You know, a lot of,
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  implementation
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  of AI isn't just gonna be a matter
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  of, can we throw a technology out there
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  to to solve our problems?
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  We really have to,
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  partner with our operational leaders and and physicians
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  and and clinics to to make these things
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  work. I mentioned our,
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  our technology,
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  that we call Prevaria that, which just stands
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  for automated real time in basket assistant.
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  It does a wonderful job of helping categorize
• 14:06
  messages and suggest workflows. But if you just,
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  you know, then shove the all of those
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  messages to the same overworked MA who's trying
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  to answer,
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  messages in between rooming patients for their physician,
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  it doesn't it's not gonna help. It's only
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  gonna help if we kind of partner with
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  operations
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  and and think through how we process these
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  messages as a big system
• 14:28
  and and take work off of that overworked
• 14:30
  MA and by by, you know, changing how
• 14:33
  we do things. And, you know, Providence is
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  a is a large, extremely complex organization. We,
• 14:38
  you know, we have everything from large clinics
• 14:40
  in places like LA, Seattle, and Providence to,
• 14:43
  you know, single doctor practices who who've worked
• 14:46
  with the same medical assistant for years and
• 14:49
  and don't want, us to make changes. And
• 14:51
  we have to,
• 14:52
  we have to work through the situation in
• 14:54
  both of those kind of environments.
• 14:56
  That makes sense. You know, and it seems
• 14:58
  like a really powerful,
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  message in terms of, you know, how you're
• 15:02
  able to keep clinicians on longer because of
• 15:04
  the technology or,
• 15:06
  really improve their quality of life. But as
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  you mentioned, you know, having to go through
• 15:11
  that change management
• 15:12
  isn't always easy,
• 15:14
  from the people perspective.
• 15:16
  Is there anything that you found over time
• 15:18
  that's worked well,
• 15:19
  to help people through that change or especially
• 15:23
  times like today when there's a rapid change
• 15:25
  happening and uncertainty in the field? How do
• 15:27
  you really prepare your teams to continue to
• 15:30
  provide great patient care, but also, move them
• 15:33
  forward on that adoption cycle?
• 15:36
  Yeah. We we really have to,
• 15:38
  you know, do the hard work of meeting
• 15:40
  with clinicians where they are and, you know,
• 15:43
  explaining how the technology is gonna be beneficial
• 15:45
  to them. Even things like,
• 15:48
  Ambient, which,
• 15:50
  you know, many doctors regard as magical. If
• 15:53
  it if I just send the doctor an
• 15:55
  email about it, they're not gonna sign up.
• 15:58
  You know, I I lead the informatics teams
• 16:00
  here at the Providence Clinical Network that, you
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  know, can, you know, get out teams of
• 16:04
  both physicians and and other informaticists who can
• 16:06
  get out to the clinics, elbow to elbow,
• 16:09
  and and, you know, kind of explain the
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  the benefit.
• 16:12
  You know, we can coordinate having, you know,
• 16:15
  doctors tell other doctors about it.
• 16:17
  What's really helped us take off,
• 16:20
  you know, recently
• 16:22
  is that as as we've reached the scale
• 16:24
  we have with Ambient,
• 16:26
  physicians are able to see that, you know,
• 16:28
  older
• 16:29
  physician in their own community using it. People
• 16:31
  that they thought would have been holdouts start
• 16:33
  to use it. And when when they hear
• 16:35
  from that guy,
• 16:36
  they're willing to give it a try. Whereas,
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  if they just hear from the, you know,
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  the doctor nerds like myself who say this
• 16:42
  technology is cool, you know, they're they're they
• 16:44
  they're more likely to tune it out. But,
• 16:47
  you know, really putting in that time to
• 16:49
  get to individual clinic meetings, you know, primary
• 16:52
  care section meetings, etcetera, and explain how the
• 16:55
  technologies
• 16:56
  are going to benefit them.
• 16:59
  And when when you do that, you put
• 17:01
  in that kind of work,
• 17:02
  we're able to to make gains.
• 17:05
  Got it. That's helpful to hear and understand,
• 17:07
  really what that process looks like for you.
• 17:10
  Now I'm curious before we wrap up here,
• 17:12
  what's the number one thing that you're doing
• 17:14
  right now to
• 17:16
  make sure that Providence Clinical Network is set
• 17:18
  up for long term success?
• 17:21
  So, you know, we mentioned the headwinds and
• 17:23
  it it's going to be difficult to,
• 17:26
  you know, to to
• 17:28
  make the appropriate investments in this tough budget
• 17:31
  environment, but Providence knows that it must.
• 17:35
  You know, our new, CEO, Eric Wexler,
• 17:37
  is is has set up what he's, calling
• 17:40
  the office of transformation.
• 17:42
  And that's really you know, its prime goal
• 17:45
  is concentrating on technologies that reduce
• 17:48
  physician and APC burden,
• 17:50
  things like documentation
• 17:52
  and, you know, offline messaging, etcetera.
• 17:56
  We're making those investments,
• 17:58
  so that we can responsibly use AI to
• 18:01
  reduce burden in our organization because,
• 18:04
  you know, we have to. These are this
• 18:05
  is the future. It's what everybody's going to
• 18:08
  be doing.
• 18:09
  And, you know, and even though it's tough
• 18:11
  to make those investments,
• 18:13
  the it's essential for the future. You can't
• 18:16
  just keep doing things the old way,
• 18:18
  and and because there's just not enough of
• 18:20
  us, there's not enough physicians, there's not enough
• 18:22
  support staff to to to meet the burden.
• 18:25
  We need these technologies and we're
• 18:28
  focusing on appropriate investments,
• 18:30
  safe investments that allows physicians to be physicians,
• 18:34
  because, you know, patients don't wanna be treated
• 18:37
  by an AI, but
• 18:38
  at least I, as a patient, absolutely wanna
• 18:41
  be treated by a physician,
• 18:42
  who has, you know, AI as their as
• 18:45
  their, you know, as their sidekick, their copilot
• 18:47
  to help them,
• 18:49
  you know, make clinical decisions because there's there's
• 18:51
  too much medical information out there.
• 18:53
  You know, we we have a saying here
• 18:55
  at Providence that, you know, our promise is
• 18:57
  to to
• 18:59
  answer the call of every patient to know
• 19:01
  me, care for me, ease my way. And
• 19:03
  I think AI absolutely helps us do all
• 19:06
  of those things and and do it safely.
• 19:09
  I love that. Doctor Smitherman, thank you so
• 19:11
  much for joining us on the podcast today.
• 19:13
  This has been a very inspiring and fun
• 19:15
  conversation, and I look forward to connecting with
• 19:16
  you again soon.
• 19:18
  Absolutely. Thank you very much.