• Faces of AMIA

    Philip A. Smith, MD

    My interest has always been what we can do to leverage and improve safety with electronic systems ...

Philip A. Smith, MD

Current Affiliation: President, MedMorph LLC, Odessa, Fla.
BS, Case Western Reserve University, Cleveland
MS, Wright State University, Dayton, Ohio
MD, Wright State University School of Medicine, Dayton, Ohio
Board Certified in Family Medicine and Clinical Informatics

Biography and photograph when elected: 

How do I describe my work to those outside the field …

I combine my informatics and medical experience to solve problems and do projects that other people usually pass on or failed on. I really love to take on challenges that most people can’t solve.

Years of experience:

I started my clinical experience in healthcare back in 1978 as a PA student doing clinical. My first informatics experience was in 1985. It was solving a problem in our residency that you could end up in family practice being on specialty rotations but literally never get the full participation because of conflicts with your family practice clinic responsibilities. So I worked with a computer scientist and we designed a program that would do what we call Rotation-based Scheduling. It would look at all the residents and all the specialty clinics that they were responsible for in their family practice clinic responsibility, and to reconcile those to maximize those their specialty clinic exposure on each monthly rotation, while allowing them to fulfill the responsibility of their four half-days in family practice clinic. This made their educational experience more relevant. Prior to that, your family practice clinic took precedent and, you could literally be on a rotation like dermatology and never experience a dermatology clinic. If the dermatology clinic time corresponded to your family practice time, you could literally go through a whole dermatology rotation and never set foot in the dermatology clinic. We used Lotus 1 2 3 and wrote custom macros to create a database that would reconcile the residents’ family practice clinic responsibilities with their specialty responsibilities for that month and come up with a unique schedule for all of their clinics for a full year so they would maximize their exposure to specialties while still meeting their family practice requirement.

And then, in 1993, I was the first physician in Tampa Bay, Fla., to have an electronic medical record. I saw the value of the EMR right away. I was always interested in the value of using computers to solve problems that were beyond someone’s ability to figure them out, so computer logic always made sense to me. The reason I adopted an electronic medical record in 1993 was because I understood that just on drug-drug interactions, I could not manage the 40,000 published drug-drug interactions, so I wanted my prescriptions to be done and do the checking. This was at a time when my colleagues said they didn’t need any assistance doing that – they could figure it out.

Now today you’d probably have half a million drug-drug interactions, and there are still people who figure out that they track all that in their head. I think we’ve lost that because today we worry more about alert fatigue than how to build effective alerts that actually give a high value. While CMIO at Adventist Health System, we measured that our EMR gave us 122 alerts per 100 medication orders to start.  However, with some customization, we reduced medication alerts down to 7 alerts per 100 medication orders, 6 of which changed the prescribing behavior of the doctor. That is how we need to take the capability of the computer and to fine tune it down to a level where we are adding maximum value with the least amount of intrusions.

In my career, I have automated over 60 hospitals; I’ve spent over 12 years as a Chief Medical Information officer; I’ve had four years of experience as Chief Medical Officer, and I’ve had six years of consulting experience, so I’ve been able to do all these different things and bring them together, in addition to my medical practice experience of medicine as a family physician. So, this has given me a wide knowledge base of healthcare operations, informatics, the practice of medicine, and my real passion is projects that allow physicians to function more efficiently and get benefit from electronic systems rather than have them being a yoke around their neck.

Why Informatics?

We implemented EMR in 1993 and I cut two to three hours a day off of my day by the efficiencies I gained, while my associate added two to three hours a day. So I began to understand in the real world, that it’s not the technology but rather the ability to effectively adopt the technology to improve efficiency. There wasn’t anyone who was really helping people early on to figure out the difference between installing technology and adopting technology.

So my interest has always been what we can do to leverage and improve safety with electronic systems. We must provide efficiency and effectiveness with technology so that we’re improving workflow rather than slowing. Many EMRs are still not deployed optimally and we need systems that are designed more like computer games, rather than electronic versions of paper charts.  We haven’t gotten there yet, but we’re making tremendous progress.

What are your ambitions? At the end of your career, what do you hope to have accomplished?

I am at the end of my career! I’m 59 years old now, and I’ve accomplished more than I ever thought was possible in a lifetime, and now I’m really focused on niche areas where my multidisciplinary experiences can really add value. I’m working with some software vendors, a medical device manufacturer and a start-up on some great innovations for healthcare.  I’m very passionate about what we can do to improve care of the patients with technology.

Who or what are your “key sources” in the informatics field?

My best source of knowledge in the informatics field has been going into places where there were prior failures, and turning those around. I think my biggest source of information has been the fact that I have a tremendous experience with a large number of clinical informatics settings and I pull that together to learn from other people’s failures as well as some of my own.

The other thing – in 1993, I decided to embark on a personal improvement program of reading one nonfiction book a week for 20 years. I read over 1,000 books during that time. This has given me a tremendously broad approach to ideas and concepts which I bring to bear, by reading biographies and business books, psychology books, and sales books and marketing books, technology books. This has allowed me to bring a bigger number of solutions, much like an engineer does, so I’m not just relying on healthcare or healthcare IT, but am bringing in things that worked in other industries.

Articles that spotlight my research interest …

I authored a book that was published 3 years ago: Making Computerized Provider Order Entry Work. Springer.  London, 2013. It is geared towards understanding change leadership for successful implementation and adoption of computerized provider order entry, which is really the bigger picture of automating physician work flow.  I have had numerous healthcare executives tell me that it made a huge difference in their efforts.

Hobbies/Interests outside AMIA ...

I love to teach. I’ve done some faculty teaching in an informatics course for a couple years. Now I am focused on small group teaching through my church. I have a small group that meets every other week where I lead Bible studies.

AMIA is important to me because ...

It provides an environment of networking with professionals in my field. What I like about AMIA is that it is a good mix of the researchers, developers and informaticians. I started to attend both the iHealth and Annual Symposium last year and  am very excited about the ability to hear from the scientists as well as from the implementers. It takes all of us working together to create value and it is such fun to be able to meet colleagues and vendors, to exchange ideas and maintain friendships. Yesterday I got a phone call from a colleague who reached out on the list serve who had a problem she needed to solve. I gave her some ideas that I had done successfully in the past, which were things that she hadn’t thought about. To be able to share ideas with colleagues -- it’s a great association to be part of.

I am involved with AMIA ...

Chair of the Maintenance of Certification (MOC) Committee for AMIA

It may surprise people to know ...

I was a big comic book fan in the 1960s and my secret ambition in life was to be a superhero. I’d like to be Flash. He was a normal human and had chemicals spilled on him, and then was struck by lightening at the same time, which gave him the ability to control the molecular vibrations of his body, which allows him to do two things – to run faster than anyone else and to travel through time. If I could go back and experience historical people and to be able to do things faster those would be two things I would really aspire to. Dream big!