Dr. Yaa Kumah-Crystal shares her pioneering work integrating voice assistant technology and AI into healthcare systems at Vanderbilt University Medical Center. This discussion explores practical applications of voice interfaces in clinical documentation, the evolution of hybrid care models, and responsible AI implementation strategies that enhance both provider experience and patient outcomes. Drawing from her dual expertise as a practicing endocrinologist and biomedical informaticist, Dr. Kumah-Crystal offers actionable insights for healthcare leaders navigating technological transformation.
• Voice-first EHR design reduces documentation burden while maintaining clinical accuracy
• Essential governance frameworks ensure responsible AI deployment in clinical settings
• Successful hybrid care models balance telehealth and in-person care for optimal outcomes
• Practical evaluation methods help prioritize technologies that genuinely improve workflows
Yaa Kumah-Crystal, MD, MPH, MS, HealthIT Clinical Director Associate Professor Biomedical Informatics Associate Professor Pediatric Endocrinology Vanderbilt University
Megan Antonelli, CEO, HealthIMPACT Live
Welcome 0:01 Welcome to Digital Health talks. Each week we meet with healthcare leaders making an immeasurable difference in equity, access and quality. Hear about what tech is worth investing in and what isn't. As we focus on the innovations that deliver. Join Megan Antonelli, Janae sharp and Shahid Shah for a weekly no BS, deep dive on what's really making an impact in healthcare.
Megan Antonelli 0:29 Welcome to Digital Health talks. This is Megan Antonelli, and I'm here with my co host, Janae sharp. We have a special episode today where we are going to talk about the incredible week we had at hims 25 and that is going to be followed by an interview I did with Dr ya Kuma crystal, Associate Professor and bio medical informatics and pediatric endocrinology at Vanderbilt Medical Center. We talked a lot about the AI implementations they're doing at Vanderbilt. So stay tuned. But first, Hi, Janae,
Janae Sharp 1:06 hello. I'm thrilled to be here. It took me a little bit to come off mute. I think everyone is back. I thought it was really nice to see the energy of people coming together at HIMSS, and we asked a lot of people what what they thought and what their feedback was. So there
Megan Antonelli 1:24 were a lot, there were there was so much, and there were so much more than five good things. But we're going to try, in a very, very speed, round way, to get to the five good things, the five best things that happened in Vegas last week. But it was a big show, and there were a lot of people. And, you know, we got in on Sunday, and it was already happening and happening, and the pre conferences on Monday were amazing. I think, you know, we, we got a chance to, of course, see our friends, Carol Flagg and Roberta at healthcare now radio, and they had, you know, the sort of the anchor on the podcast row, and they did interviews for three days, so there's gonna be content coming out on all of that for some time, which is awesome. And the folks in the press room, you know, thank you so much to Albie Sachs and Morgan Searles from HIMS, who really did, they're the best. They're really great. Yeah, it was really well organized. We got so much prep and just, you know, really helped be able to navigate such a huge, huge show. So, you know, the first thing I did on on Monday, really, was head over to that AMS hymns, physician executive forum. There were a lot of our health impact friends speaking there. Rashatha kicked it off, talking about innovating with purpose. So, you know, purpose driven, purpose events. I like the topic. And we talked
Janae Sharp 2:47 about, yeah, so maybe one of the our first good thing would then, would be these little education session sessions. Not everybody gets to go to them, but some of these special, special things, like the executive forum was amdus education. Those really make the conference have great content. And that's something we heard from Laura Marquez that him's content is fantastic, like they're actually learning things. It's not just showy and glitzy. There's actual educational content that's valuable for experts and learning from your peers. So maybe I don't know if it's the session with that, you know, absolutely
Megan Antonelli 3:25 no. I mean, I think it is, you know, it speaks to that. And I think amdas As an organization, you know, their focus on that collaboration, you know, with physicians and technology. They've been around for a long time, but they of course, announced a new partnership with hims that they are, they're going to be aligned. And there's me, you know, sort of improved or increased access between that education between them. And I know I heard how speak about just the number of certified CE sessions that were available. So I think hims is really, you know, sort of taken that double down on education, certification, and folks that are looking for that are able to get it. But then also just the specificity of topics. You know, there were a number of sessions on, you know, physician well being I think the one we
Janae Sharp 4:16 had, we attended one of them, and it was great just to see the research that's coming out about it, the different maturity models that people are developing and how some of that work is expanding into workplace well being and nurses are being involved. Different parts of the healthcare system is having access to care. And the thing that I like the most about some of those different developments and sessions was that they're co creating solutions with the people they'll be impacted by that, whether that be nurses and physicians, they're involving everyone, and that's going to make a difference in the success of your of of your health care workforce.
Megan Antonelli 4:59 Yeah. Was Joanne defeats talk, which was really around kind of the VR applications within that. She's with Weill Cornell Medical College. And we love VR, right? We're
Janae Sharp 5:09 always, I'm always on board. I'm fascinated with VR. It seems like we're finally getting there little bit after veterans and a little bit after some first responders. People are like, Hey, we can use this. So I love that
Megan Antonelli 5:23 the applications of it really, she really showed a lot of good work that they're doing. And then Manny berenji, also, you know, UC Irvine talked about one of our favorite topics. So we talked with Kamal Bajaj and other folks at health impact around around AI and sustainability, you know, sort of the the double, double side of that, in terms of AI often adding to resources and and technology, you know, sort of energy and the overlooked cost of that. But she talked about, you know, how they're really trying to to improve upon that there at UC Irvine. So some, some great sessions in that pre conference. And you know, I think to your point that whole, you know, the amount of sessions that were going on were just right. It was, we wanted to be in two places at once.
Janae Sharp 6:14 You know, what else I thought was, one of my good things is the quality of discussions about AI, and like you said, we went to the pavilion. I also had the pleasure of going around with Cade Pavillon from Intermountain, and we were looking for specific patient engagement and consumer engagement, for a better experience and better identity management across different different diseases, and just being able to go to the hospital and they don't lose track of who you are through AI these technology, the promise of technology that we're telling people is actually delivering better outcomes or delivering fewer claims denials, delivering better opportunities for people at work and lowering the workload. You know, if you can take an hour of work out of someone's day, that's fantastic. Yeah, there was,
Megan Antonelli 7:16 I mean, there was so much, I mean, from Ai scribes to kind of the ER EHR automation, I mean things that you mentioned around, you know, also, you know, kind of the patient engagement and and sort of specificity, specificity of what, what they're able to achieve. So we've moved from, you know, kind of promised to actual impact, which is what we like to see around that. And I thought, you know, the new AI pavilion. You know, there were a number of companies in there that I hadn't heard of. So it was great to see new, new companies. And of course, our our friends at art of site were kind of anchored in there, so that that was also great to see another new thing they had, was the eMERGE innovation experience. I didn't get over to it as much as I would have liked, but I heard good things. And then I know the morning started out with Robert horevic. Horevic, right? With Shark Tank. So that was big. Oh my gosh.
Janae Sharp 8:13 The Shark Tank guys being there was kind of fun. Yeah, there was a surprise
Megan Antonelli 8:17 visit, yeah. So that was amazing.
Janae Sharp 8:21 You know, maybe that's one of my good things, is that they're starting to like invite in Shark Tank people, and inviting people who come from a background that's not within technology or not within healthcare, that are taking interest here and making progress in healthcare, like they're seeing the need that we have for healthcare, to to innovate and to meet people's needs more appropriately. And they're coming. They're showing up for that. I kind of love that. Yeah,
Megan Antonelli 8:50 they had, I mean, there they had, like, a Best in Show type solution presentation, where they had, you know, sort of those pitch type competitions, or, you know, feature presentations, demos from, oh, I love it. I think all those guys should be there and they, I'm Ray Lowe, our friend from AltaMed, was doing the evaluation. And no, he did a great job. So, you know that leaning into both education, but then that innovation experience to make sure that you're getting both covered, you know, at depth, which it felt like hims really did this year. More so in the
Janae Sharp 9:23 past, can we talk about one of my, my good things, which was being able to open up the conference. We can, you know, it was before the robots and after the dancers. And the dancers were electric. Yeah, they had these electric dancers, phenomenal. And then six leaders got to come in, three chapter leaders from the US and three of the hymns leaders from abroad, got to come in and talk about the tomorrow's health, and I got to talk about the importance of belief, just how our chapter Utah hymns. Believed that we could build something great and bring people value, that we were able to bring together the right people with the right energy to get things done. And that work that I've been able to do with other people has been fantastic, and being able to share that was super inspiring. And it was an honor to hear about like hims Europe, and you heard the announcement that how, how was able to sign an agreement with the Ministry of Health of Turkey to improve people's health and to advance these digital maturity models, like there are a lot of people who have been coming to hims for years, and who have been invested their lives and invested a lot of their, you know, their career, into making health better. And I think for me, that was one of the good things, realizing that throughout the pandemic, through all these changes and events and all these changes. Even now, people are really struggling with change, but people also are holding on to the belief and into the groups like hims that they've invested a lot of their lives into. And that, for me, was a highlight, just being able to see people who share that belief and to connect with people who share, working together and moving forward. And you're one of them too, like you're, you've been going to him for forever, just kidding. Yeah, that was,
Megan Antonelli 11:32 you know, I think that was important. And I liked how they did that, to bring, you know, to bring the leaders and and they had, you know, the chapter receptions and things that were all happening. Many of them on the hall were great. You know, we got a chance to go to the Utah chapter reception, which is very nice to see. Very great fun.
Janae Sharp 11:52 And notable, had those cute little guys. Another good thing, the cute little dudes, I brought my kids out, that was the number one swag item for my kids a little puzzle, man, right? And
Megan Antonelli 12:02 speaking of community, I think the other good, you know, sort of growth and expansion that I saw was the nursing informatics forum and more for nurses, and more nursing education as part of the hims curriculum. And so I thought that the forum there, you know, was really, really high quality, you know, the topics covered everywhere from, you know, again, you know, administrative burden, but also data literacy and obviously, of course, works, workforce challenges, growth and leadership development and all that. So yeah, they had some really excellent speakers and really high quality, you know, work to showcase the work that's being done at all the organizations across the
Janae Sharp 12:48 you know, it's funny. I talked to I talked to people about their favorite thing. And Sherry, Hess came, she's HCA healthcare, and she said her her favorite thing was, like networking with other nursing and clinical leaders and collaborating with current and future vendors. I love to see how much the nursing community within hims has been strengthened, and how much nurses have been empowered to innovate, to change their workforce for the better. And, you know, we got to sit down with contact.io people talking about, you know, patient talking about nurses and healthcare worker safety, and how important that is, and that community that you just mentioned, like the nurses they're they're really doing good work in that community, and with making it strong and sharing the work that everyone's doing. So I agree,
Megan Antonelli 13:41 yeah. No, it's amazing. I mean, I think that's a lot more than five good things. Can you think of anything else? Janae,
Janae Sharp 13:46 I got to sit down with Nick iannoni from Intermountain Healthcare, and he talked a little bit about how they're using AI and they're using systems to improve approvals for insurance, you know, for claims denials and stuff. I kind of thought that was a good thing, like, because I love it when things get paid for, you know, and just to see what they say actually
Megan Antonelli 14:13 happening, you know, there we go. Well, it's certainly one of the biggest problems that that patients face in in the whole healthcare,
Janae Sharp 14:20 yeah, like when you, when you think about it, you know leaders who are looking out for for patients looking out for your bottom line, that's a good thing for sure. Well,
Megan Antonelli 14:31 again, I want to thank the amazing team over at hams for having us there this week. Really are great. I really like those guys. They are, there will be, you know, we have a number of interviews, a number of stories coming out, covering all the folks that we had a chance to spend time with. And you know, these, it's, it's good to see, as you said, the innovations are not just theoretical. They are being implemented today. And. You know, improving access and improving payment, payment operations and patient experience, which you know is, is, is what we're here to do. So I appreciate our listeners, and stay tuned for our next segment with Dr ya Kuma crystal. Hi. We are here at vive 25 this is Megan Antonelli with digital health talks, and we are excited to talk to Dr ya Kuma crystal today. She is the associate professor of biomedical informatics and pediatric endocrinology at Vanderbilt. Hi, Dr Kuma crystal, how are you? I'm
Dr. Yaa Kumah-Crystal 15:36 wonderful. Thank you so much for having me. Lots of exciting things going on at vive today.
Megan Antonelli 15:40 Yeah, it's great. It's great to be back in Nashville, your hometown. Must be nice to have such a big, big conference right in your backyard. Absolutely,
Dr. Yaa Kumah-Crystal 15:47 the weather has been a little variable, but otherwise, it's great to have everyone here to see all the great things national has to offer.
Megan Antonelli 15:54 Yeah, absolutely. Well, Vanderbilt such an amazing organization. And you know, what an incredible Hospital and Health System, and obviously, university it is. So tell us a little bit about what you do there.
Dr. Yaa Kumah-Crystal 16:04 Gosh. So on the clinical side of things, I'm a pediatric endocrinologist, so I see kids with all sorts of endocrinopathies, a lot of diabetes, growth problems. And my other hat, I get to work as a clinical director in health. It to help think through innovative ways to deliver care using the EHR and other technologies that's
Megan Antonelli 16:21 amazing, and there's so much going on in that space right now. Absolutely. Yeah, when we talked, we had a chance to talk a little bit about it, but tell me a little bit more about you know, how you guys are using AI to help patients navigate the system. Some
Dr. Yaa Kumah-Crystal 16:34 of the fun things that we're going to explore are ways to leverage some of the emerging large language models to help patients communicate better with their doctors. One of the really cool projects that our clinical director Adam Wright is leading is a patient portal interface where a patient will be able to interact with an agent to help them draft a better clinical message. Think of it like this. A patient has a message that they want to send to a provider, but sometimes that message doesn't have all the information the doctor will need to help them solve their problems, so the doctor has to reply back ask them additional questions. Patient might reply back with some things. There's a lot of back and forth. In fact, we did an analysis, and over 30% of messages had three or more threads back and forth. So in this scenario, when a patient drafts their message, when they hit, send, an agent will say, this looks like a great message. Definitely want to help you out here. The doctor might want to know these three additional things. Can you answer these questions for us and help them reshape their message and say, Does this look good? Send that off to the doctor. And then the first time the doctor gets a message, it's going to be more complete. And can help them address their questions and get things solved the first time.
Megan Antonelli 17:39 Oh, wow. And what it, you know, what a great area to automate in terms of, you know, when you think about all the different spots where we can use and apply AI, you know that it is something that can be automated there and really help the patients,
Dr. Yaa Kumah-Crystal 17:54 I think so. I think there are a lot of great, interesting use cases. But at the end of the day, the things that help patients feel like they're being heard the way they can help them communicate more and just help them connect better with healthcare system, I think will be really impactful,
Megan Antonelli 18:08 both with engagement and with experience, in terms of, you know, how they're interacting with their providers. Are you seeing any kind of resistance? What's the patient input feedback from it?
Dr. Yaa Kumah-Crystal 18:19 Oh, that's a wonderful question. So one of the fun things we have at Vanderbilt is actually Council, an AI Council, that is commit, we have providers and patients and other folks that work in AI, in the space to give feedback on these technologies. So we're going to be presenting this information and the workload to patients, and they're going to give us feedback on how things appear, the messages that you back from the artificial intelligence, and really help us to shape the tool together. Because I think the CO development aspect of this is going to be what really makes a difference. Most of the time, we build tools for providers that are provider facing, and we're providers. We understand what we want. In some degree, most of us are patients, but it's really good to get input from people who are completely outside of the medical domain to let us know what makes sense for them. I think everyone's had kind of a chat bot experience, and everyone's had a IVR experience where you're not too psyched to be chatting with us, but the hope is this is targeted at helping the patient get their message through and helping them be heard. So by having patients really understand what it takes for them to be heard, hopefully we can craft something that really makes a difference and impacts them. Yeah,
Megan Antonelli 19:31 and that's so important. And, you know, I think that as we hear about even the physician burnout, physician frustration, what more do you think what's the next sort of avenue for this in terms of what you can really automate and how you can use these tools,
Dr. Yaa Kumah-Crystal 19:47 I think, a full end to end experience for the patient and the provider? So another aspect that we have that we're piloting out in our EHR is the ability for when a patient sends a message to their provider, having. Large language model helps do the analysis to pull out some of the relevant components to help the provider draft a message that they can use to send back to the patient. What we don't want is a future where we just have a bunch of AI drafted messages speaking to each other. So we really need to think of the bigger picture. Is the patient has a concern, they have a problem. So what is it that the provider can uniquely offer to help answer their question? And I think some of the ways that the AI can be really beneficial is helping to format things so it's more understandable, helping them pull together information from their problem list, allergies and things like that, to check things against each other, to make sure that they're no concerns, nothing overlooked, nothing missed, so the patient can get all the answers they need. Also making information just more visible to patients. There's a lot of stuff people can google and find, but if there are ways for us to kind of curate content that the patients can interact with from a tested source, so instead of just going to maybe chat GBT to have their questions answered. If they're specific engines that we're able to use that we say these are trusted sources, and you can still have a chat with this, but you can understand the information you get back has been vetted. I think that'll be a much better experience for patients.
Megan Antonelli 21:13 Yeah, absolutely. And, I mean, you mentioned in terms of the sort of reliable and the safety talk a little bit about kind of, you know, some of the guardrails that you guys are putting in, where are some of those considerations being made across the organization?
Dr. Yaa Kumah-Crystal 21:25 Oh, yeah. Ai, safety and trust is a huge component. There are lots of risks with some of these tools, by virtue of how they work, where they can be very creative with some of the responses that they give. We don't have a really big margin for error and creativity when it comes to diagnosis and treating patients. So we have a lot of rigor in evaluating the responses they get back. We have physicians that will review the information, looking for accuracy, looking to see if it solves the question. And what's neat about medicine is a lot of things we do are protocolized. There is a source of truth, there's an answer, there's a certain way to answer questions, and there's a certain way to manage certain conditions. So we have, we are able to benchmark essentially what the AI is producing as results against what the model gives to really identify what the gaps are. So we can say, wow, it's pretty good about handling these certain scenarios, but not so good about these ones. We really need to steer away from these ones are really to figure out how to better train it, to address these ones before this is something safe, and at this point, we're not ready for the AI to be doing any kind of medical diagnosis or medical management. I think we're still a ways away from that, even though some of these tools are benchmarking really well right now, it's really just about, how can we help to shape messages that we're getting. How can we help to configure things so that they're more readable, more understandable, and can deliver the information that we'd like to so a patient the way that they can find it really useful?
Megan Antonelli 22:53 Yeah, that's so important. When you think about kind of the partners that you're using, the tools that you guys are using, I know you're developing a fair amount in house, and also, you know, how are you evaluating them? How are you making sure that they kind of follow and adopt the same guidelines and guardrails that you guys
Dr. Yaa Kumah-Crystal 23:09 are doing? We have whole AI committee for governance to ensure that any tools that were going to be implemented meet very high standards. With regards to data validity, data security and privacy, making sure all the phi is managed with diligence that it needs to for a healthcare system. And overall, once things get through the governance and architecture review, our providers can trust that it gone through all the steps needed to make sure that by the time it's ready for someone to use it, it's more than just experimental. We have a lot of really fun experiments that we're doing, non patient facing side of things, but at the time that we're ready to put something in front of a patient, there needs to be a really high threshold. It's more than just a fun thing that we're playing around with. It's actually something that's gonna be managing care, right?
Megan Antonelli 23:59 And it is. It's all moving so fast, you know, so keeping up with it, keeping those guardrails, making sure your partners are doing it, and also the patients and physicians are understanding all of it. What do you look I mean, as you look, is almost hard to imagine now, but three to five years ahead, you know, where do you think it's going to be? I mean, do you think that we're going to get to that space where the clinical documentation is, or diagnosis is or better. What do you think it's going to bring, in terms of the changes to physician practice?
Dr. Yaa Kumah-Crystal 24:27 I'm so excited about what the prospects look like in the next few years out. I would envision an EHR that is a lot easier to navigate. And one of the things that we're doing right now is Ambien, scribe, documentation for the provider the patient are just talking to each other, and that conversation is captured in the background and helps to generate a note. If we are able to scale that out to every interaction we're having in the hospital, including nurse documentation, including some of the things that we're doing, if we can get video recordings in there and then be able to just simply query what the history. Of the patient has been and what's been going on. And instead of relying on individual notes and individual encounters to piece together, because that every time you in the chart, you're putting together all the little pieces to try to understand what's going on. But you have an entire summary, and you have a powerful LM engine able to synthesize all this information, you can get these summaries that can tell you a broad picture, and moving even beyond that, thinking about something like a learning health system. If you have these patients that have these conditions going on, and you have millions of patients in your EHR and across different health systems that have similar conditions and similar outcomes, you can actually make predictions about how someone's course will be, and you can intuit like what medications might make sense for this patient based on the fact that their characteristics, their presentations, their lab, look exactly like these 20 other patients that are out there. And that's what really kind of brings, the promise of the EHR and all this data that we're capturing, all this work we're doing feeding the EHR, because all this data can actually build out these profiles of these patients that can help us diagnose them by understanding how other patients evolve,
Megan Antonelli 26:03 right? I mean, it goes back to sort of what you said about the fact that healthcare is protocolized. And so there is, you know, there's a science to it. And when you get, when you, you know, are able to kind of get that into this, it's going to be amazing, what, what's possible. So, you know, with our last couple of minutes, you know, in terms of looking at the folks, you know, healthcare leaders and other innovators our listeners, what are some of the you know, sort of best practices, or any advice you would give to kind of clinical operations leaders around, you know, implementing and bringing their organization forward. You know, as quickly as you have it there at Vanderbilt,
Dr. Yaa Kumah-Crystal 26:43 the best advice I would give is for folks to just play with these tools, not even in the clinical space or when you're trying to actually manage patients, but on your own, understand what they do and what the limitations are. And I think the more familiar people get with how to interact, how to prompt, how to ask it questions, it makes it really clear what's ready and what's not, so that you're making really informed decisions. But you can also reveal to yourself, like, wow, this could save a lot of time here, and because everybody's workflow and the problems they're trying to solve are so different, they can come up with really creative solutions that we might not be thinking about because we don't work in that space. So I would encourage everyone to just hammer out there's time on these tools try to solve creative things, and then comes the table with great ideas, and we can think through what the safest ways to try to implement them in an actual operational workflow would be.
Megan Antonelli 27:32 That's great advice. It's, you know, something I practice too, and I tell all my friends like, just, you know, just use it. Get figured out what it is. I mean, if it's nothing, it's accessible, right? So Well, thank you so much. I don't want to take more of your time here at vive. There's such a great show going on, lots of amazing sessions, and I appreciate you taking the time with us here today at Digital Health talks, and I look forward to seeing you again soon.
Dr. Yaa Kumah-Crystal 27:55 Thank you so much, and I love your creativity and all the great things that you guys are doing out here. So thanks for having me.
Megan Antonelli 28:01 Oh, thanks so much. Well, we'll see you soon.
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