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