Scott Webb (Host): Artificial intelligence, or AI, has been in the news a lot lately, and it's even being used in healthcare. Joining me today to discuss how AI is being used within the Elliot Health System and the future of AI in healthcare is Dr. Holly Mintz. She's the Senior Vice President and Chief Medical Officer for EMG Ambulatory Care with the Elliot Health System.

This is Your Wellness Solution, a podcast by Elliot Health System and Southern New Hampshire Health, members of SolutionHealth. I'm Scott Webb. Doctor, thanks so much for being here.

Dr. Holly Mintz: Thank you so much for having me, Scott. I'm thrilled to be here. I'm very excited to be part of your podcast.

Host: Yeah, it's nice to have you here. And I just want the audience to know that we are not being generated by AI, we are real people having a real conversation. So, I got a bunch of questions for you, and I think the most important one, the pressing one in my mind anyway, is how do you see AI improving healthcare in the years to come?

Dr. Holly Mintz: I think that one thing that people are concerned about is whether is AI going to take the place of healthcare professionals. And in my opinion, that will never happen. There's always going to need to be a human component to healthcare delivery. However, where providers and clinical staff are overwhelmed is just the incredible overload of information that's coming our way.

And in addition, the importance of us preserving that patient-caregiver experience. So, you know, in my opinion, the two highlights regarding the technology that's available right now is, first of all, allowing the provider to actually have a meaningful face to face interaction with the patient without them looking at the computer all the time.

And the other big concern is that providers are so overwhelmed with the amount of documentation and information that's coming in that if AI is able to help us manage that, then people will be able to find more joy in their work and also have a better work-life balance.

Host: Yeah, that's perfect. That's music to my ears, doctor. I love these conversations I get to hear about robots, about lasers, about AI. But one of the things I've learned, doctor, and always want to emphasize to listeners and viewers is that, yeah, you may have a robot involved in your surgery, but the robot's not doing the surgery, right? The doctor, you know, the team is performing the surgery with the assistance of the robot. And so, as you're saying with AI, yes, AI has a role, has a place in healthcare, but it's not going to replace good old face-to-face conversations with our providers, right?

Dr. Holly Mintz: Correct. And in fact, it's going to allow for that to happen. I have been in medicine for 28 years. So back in the day, we were writing our notes. And now, we're able to put all of our notes that are readable in the electronic medical record, but there's a lot of work that goes along with that. And so, what it really has detracted from is that ability to actually look patients in the eye and have a meaningful conversation. You know, with the new ambient technology and voice recognition, our providers are able to perform a patient visit without looking at the computer barely at all.

And in addition, once the visit has been completed, the documentation is there. It's there available for the provider, for the patient. And it's actually able to capture everything that happened in the visit, which sometimes is hard if a provider happens to be finishing notes at the end of the day. It's very difficult to remember every single thing that happened in the visit.

So, I truly believe this will improve the quality of our notes of the documentation of what's happening in the visit. And it really allows the provider to focus on the patient and the patient's family, as opposed to looking at a keyboard. Nobody goes to medical school to type on a computer, that I can tell you a hundred percent. 

Host: Yeah. And we could do a separate podcast, doctor, those of a certain age, not you, of course, you're much too young to remember getting prescriptions written by hand by doctors and trying to decipher doctor handwriting. So, good to know that AI is involved there. I want to get a sense of what are some of the current applications of AI within The Elliot or the Elliot Health System.

Dr. Holly Mintz: We were one of the first in our region to adopt what's called the Dragon Ambient Experience, which really allows for that capture of the documentation without a provider needing to type it in. And the technology is able to recognize who is the provider, who is the patient, and who is the patient's potential family member so that it all kind of gets included in the note.

And in addition, you know, extraneous things that may be kind of like conversation are excluded from the note. And so, I think that's definitely been an improvement for our providers. When I hear providers telling me that they're getting home in time to have dinner with their families, because their notes are completed, it is music to my ears because we want people to want to go into medicine. And if there's a work-life balance, people are going to refrain from ending their careers. 

The other really important application is the ability to pull out pieces of information. So, I'll give you an example. This fall, we will be going live with artificial intelligence to help us capture all of the incidental lung nodules that are found on CT scans. So, let's just say a patient goes to the ER and has, you know, some kind of a chest x-ray and something is seen, and it's kind of what we call an incidental finding. It needs to be followed up on though, because lung nodules that are incidental findings can become cancerous. And so, it's really up right now to the primary care provider to ensure that that patient has the follow-up.

What AI is going to allow us to do is find all of the reports of lung films that have incidental findings to create a registry so that not only will the primary care provider be able to refer the patient for follow-up, but we can ensure that everybody who comes through our system is entered into a registry and we can follow up on that nodule and ensure the patient's getting the care that they need in an effort to prevent lung cancer. Lung cancer found early is very treatable. Lung cancer found late is not. And so this will improve our ability to ensure that we're identifying all of those incidental lung findings and ensuring that all of those patients are offered the appropriate follow-up.

Host: Yeah, it's good. On my last visit with my primary care physician, you were saying that it records the important things, but not the maybe, you know, extraneous conversation. So, she bluntly told me that I need to lose some weight. So hopefully, that would not have made it into my final record. And you're mentioning there about lung nodules and how critical and how important that would be for early detection. Let's talk about some of the other patient outcomes because I know at the Elliot Health System, the mission really is patient-centered care.

Dr. Holly Mintz: Right. We are looking at all kinds of opportunities to utilize AI to help manage chronic disease. We know that chronic disease is on the rise in our country. You know, things like hypertension, diabetes, and there is the ability for us to reach out to patients, utilizing AI and help to ensure that they're taking their medications to see if they have any questions, potentially even listing, you know, what their blood pressures are and when they need to call their provider with an elevated blood pressure. Sometimes people don't know, and sometimes people forget, you know, if they forget to take their medicine, they forget to take their blood pressure reading.

And so, we're looking to really utilize AI to help us support patients in the management of chronic disease, which is really exciting. There are also applications where, for instance, people need a screening colonoscopy. We can utilize AI to help walk that patient through the process that they need to go through before a colonoscopy because it can be very overwhelming. So, we're looking at ways to utilize AI to support the patient, the outcomes, and the clinicians in providing the care.

Host: Yeah, it's amazing. And you mentioned earlier about providers actually getting home for dinner with their families, right? What a novel concept, right? You know, at the end of a busy day. So, let's talk about from the other perspective, the provider experience at the Elliot Health System, and how AI is getting them home for dinner, getting them to their kids' games, pickleball matches, or whatever it is.

Dr. Holly Mintz: Right. Well, and for someone who has two children and I have, you know, very much experienced the challenge of the work-life balance. And what we're finding now with technology, and especially since COVID, a lot of patients are looking to have their questions answered via a message as opposed to a visit or a phone call. And providers are spending what we call pajama time at home. So after, for instance, they go to the soccer game and if they get there and the kids go to bed, they spend time on the computer. And so, we're really interested in finding tools that will help to decrease that pajama time. If somebody is working 20 hours a day, they are going to get burned out.

And I will share that I have providers who are relatively new in the field, who have only been practicing maybe five years, and they come to me and they tell me that they're burned out because of the overwhelming documentation and information overload. And again, for me, who's been in the field for 28 years, it makes me very sad to think you go through four years of medical school, three to four years of residency training, and then within three or four years, you're burned out. So, there are applications that we hope to utilize very soon, just to really help organize that information. So that, for instance, if I'm managing your hypertension, instead of me needing to search through the chart before I see you and spend, you know, however much time that takes, that we actually will be able to pull up the three recent areas of documentation that pertain to that problem. So instead of me wasting my time going through the chart, trying to find all these, you know, pieces of information that I really need to help manage, they actually will be kind of found for me. And again, it's not that the AI is interpreting that information. It's just pulling it out so that I'm not spending my time searching for it. 

I think that there will be a lot of opportunities to help providers in their preparation for patient visits. Patients want you to know what's going on with all of their issues when you walk into the room. And so, if we're able to cut down that pre-visit planning time to minutes as opposed to hours, you know, so the providers do not have to get to the office at 5:00 in the morning to prepare for their patients. That is a win-win for everybody. You know, what keeps me up at night is that people aren't going to want to go into healthcare because it can be very overwhelming. And so, any tool that we can adapt that will help support that is honestly, you know, a gift and music to my ears.

Host: Yeah, one thing we learned, doctor, of course, during COVID and since then is that there is a shortage of healthcare providers and we need more of them, more of everybody, nurses, doctors, everybody. And as you say, no one goes into healthcare, no one goes to medical school to do paperwork. They go in to help patients, to save lives, to improve the quality of life for their patients, all of that stuff, of course. So, it sounds amazing to me, music to my ears as well. 

One thing I think we all have concerns with, doctor, is about privacy, security, access, and who has access to our data, right? So, maybe you can talk about how the Elliot Health System is ensuring, you know, that we don't need to worry about our data being accessible to just anybody.

Dr. Holly Mintz: Yeah. So, that is something that certainly has been voiced by both clinicians and patients alike. We always ask patients to give us their permission to utilize this technology. But the technology, it's not recorded, it's not transcribed, it lives in like a cloud and then, you know, disappears. So, we're not capturing any of the information on any kind of cell phone or private device. It all is entered into our medical record, our electronic medical record, which is very secure. So, that's something that we always ask as we are meeting with more and more vendors who are interested in helping us with products, is we always discuss, you know, safety and security, which is again, why I would never defer to any type of AI that's just going to make a diagnosis. That's not safe, right? Anything that isn't really secure within our medical record system, isn't something that we would even consider.

Host: And then, in other words, doctor, the doc, you know, if we meet with a provider, they don't leave the room and then make a TikTok when they walk out about all the things that we discussed, right?

Dr. Holly Mintz: Yeah. And that all goes along with our oath, right? I mean, we are very careful about who we tell what to. I think sometimes family members get frustrated when we can't share information because we don't have that authorization. But I do believe that the more and more the technology evolves, the more we'll be able to streamline it so that we don't have to use extraneous devices. And it will probably just be built in, you know, to the device that we're using. Right now, we use an application that's on our phone. But again, none of that lives on the phone. None of that is saved on the phone. And, you know, providers want privacy for patients just as much as patients want that.

Host: Yeah, of course. Well, this has been good stuff today. As I said, I get excited. We start talking AI and robots and lasers and, you know, I sit up a little bit in my chair. I just want to give you a chance, you know, it feels like the future is already here. So, asking you about the future, I don't know, it feels like we're already talking about that, but what are the future plans for expanding AI use within the Elliot Health System?

Dr. Holly Mintz: So, I have learned a lot over the past few years. You know, as I said, we were the first in our region to push forward with the Dragon Ambient Experience. And we are fortunately in a position where we are going to be piloting a lot of different programs, for instance, even flow sheet documentation inpatient for the nurses. So, they're not, you know, staying two hours after their shift to document. 

I think from what I've learned that AI is behind in healthcare. I think everybody uses it much more than we do. And there are so many potential applications. In an ideal world, I think we would go back to that, you know, very unique provider-patient interaction or nurse-patient interaction where we're not having to type. That's what I hope. I hope that eventually, we'll be able to capture everything that's happening through the ambient listening and that the information retrieval will be improved so that people aren't spending time-- you know, kind of like when you Google something, you want something quickly, right? And I'm talking about being a Doctor Google. But you want to have the information at your fingertips. And I think that technology is out there. I do believe that we are just behind in healthcare. 

And I will share that I love working for an organization that is innovative and interested in looking at these potential opportunities that will really improve our caregiver and patient satisfaction. And that's what we're all about. We want to have high-quality interactions. We want to deliver high-quality care. I believe that this technology will help us continue to improve in those areas.

Host: Well, doctor, if I wasn't a believer before we got on the line here today, I definitely am now. You're speaking my language. I'm sure lots of folks watching and listening are nodding their head saying, "Yes, AI in healthcare, that sounds awesome." So, I just want to thank you for your time, your expertise, your passion. Thank you so much.

Dr. Holly Mintz: It's truly my pleasure. Thank you so much for inviting me to speak.

Host: Yeah, it's a pleasure. For more information, go to elliothospital.org. If you enjoyed this podcast, please be sure to tell a friend and share it on social media. This is Your Wellness Solution, a podcast by Elliot Health System and Southern New Hampshire Health, members of SolutionHealth. I'm Scott Webb. Stay well. We'll talk again next time.