How Clinician‑Led Informatics Improves Patient Outcomes with Danny E. Lee, MD

Melanie: What does it mean for technology to “work” in healthcare? And what does it mean in the exam room with a real patient in real time? Today on “There’s a Better Way,” we’re kicking off our first episode of Season 5 with a guest who lives each day where healthcare and technology meet. Dr. Danny Lee is a practicing internal medicine physician and chief medical information officer at Johns Hopkins Community Physicians. 

He sees patients, and he builds the systems these patients depend on. So today, we’ll talk about friction, the delays, the gaps, the invisible processes that sometimes come between the doctor and the patient. We’ll dig into prior authorizations, the inbox problem no one talks about at the executive level, ambient AI, and what it looks like when technology gets out of the way and lets people do what people do best. 

And we’ll close with a question that I think sits at the heart of everything we’ll be exploring this season: What should patients never have to think about again when it comes to their care? This is a conversation about what’s broken, what’s working, and what comes next. I’m Melanie Marcus, and this is “There’s a Better Way: Smart Talk on Healthcare and Technology.” 

A warm welcome to the show, Dr. Lee. Thanks for joining us on our first episode.  

Danny: Thank you, Melanie. It’s great to be here.  

Melanie: Let’s start with our signature question, one that draws directly from what you experience as a physician. What’s your better way in healthcare, and how does it show up for your patients when you walk into the exam room? 

Danny: For me, the better way is reducing any friction in the care of our patients so that we can act on the care plan that we agree upon together while we’re in the room. I feel like technology should be felt as something that provides better access to care and not a barrier that you have to navigate around. 

Melanie: You still see patients regularly, right, while you’re serving as the CMIO at Johns Hopkins Community Physicians?  

Danny: That is correct. It’s the only way for me to really understand the technology that we’re implementing and how it impacts the care of our patients. It also gives me some gravitas with our other providers so that I’m in the trenches with them, seeing patients, and I understand the frustrations that they feel. 

And when things are working well, I can see that in action, and when things are not working well, I can bring that to our IT leadership and figure out solutions that make that better.  

Melanie: Can you walk us through a little bit about how you got started and what brought you to combine medical practice and technology? 

Danny: It probably started with frustration. We were slowed down by the tools that weren’t really designed for us in mind, and then I became a certified physician builder and realized that I could address some of the hang-ups and the issues that clinicians were facing by working within the EMR and building tools to help take better care of our patients. 

Melanie: That leads straight to another question. How does being accountable for patients face to face in the exam room shape how you think about technology?  

Danny: It keeps you honest. If things don’t work the way they’re supposed to and you’re feeling that frustration, the patients can also express their frustration when things aren’t working well. We want to make sure that we’re building decision support and systems that help us take better care of our patients and not get in the way of that.  

Melanie: In contrast to that question, how does your role as CMIO inform your approach to patient care?  

Danny: I think it helps me be a better CMIO by being involved in patient care as well, so I can understand what the problems are at the ground level that we’re all facing, and then also understand where our systems are failing, if there are system-wide patterns that are creating obstacles for our providers … as well as being able to collect feedback from many of our providers and then make our teams aware of the fixes that we need to implement. 

I do a lot of listening, so my in-basket is always filled with messages from providers who are frustrated by various things, and I try to read through the lines. Because people hear about my in-basket and say, “How do you do that? How do you take all this negative energy coming at you?” But I don’t look at it as negative energy. They’re telling me something, and I need to understand what they’re telling me.  

Melanie: Do patients give you feedback on technology?  

Danny: Absolutely. We have patient committees, and we try to include patients in as many of our committees as possible. We have a patient representative. We also have a patient-facing committee for each of our sites, so patients can give direct feedback about how things are working, whether it’s the phone room, or the MyChart messages, or their visits with their providers. We collect all of it and we listen to our patients to help us evolve our practices to make it more patient-friendly. 

Melanie: What reminds you that healthcare is still deeply human, even with the promise of technology all around us?  

Danny: I go into an exam room with a patient. It is not about the technology. It’s about the patient, and what problem they’re coming to me with, and how do we solve that problem? It’s all about human-to-human interaction. The technology has to be in service of that—not the other way around.  

Melanie: I love that. It makes so much sense. So, you talked about friction in healthcare, and one thing that seems clear to me is that technology can either nurture trust and protect the doctor-patient relationship, or sometimes quietly erode it. Let’s explore a little bit more deeply by looking at the current friction points in healthcare and the impact it has on patients.  

Danny: Friction is anything that inserts delay or uncertainty between the decision and the action plan that you have with the patient. For patients, that friction often means silence. In other words, they don’t know what’s going on behind the processes after you’ve created a bunch of orders. And that silence really can erode trust, both from the clinician and patient standpoints.  

Melanie: Are there examples of where you see friction being addressed that are going well?  

Danny: We’ve had a lot of success with our ambient AI documentation. That really reduces friction in the exam room. It makes the provider much more present during the visit with the patient. You’re no longer focused on the computer. Instead, you’re focused on the patient. When I do look at something on the screen, I will do it with the patient, so the patient is always involved in their care, and everything is transparent to them.  

Melanie: Given that example, what lessons does it hold for us as an industry regarding how we solve the other points of friction in the service of patient care? 

Danny: I think it will require all of us to work together to have these discussions, to understand each other’s point of view, and then work collectively to solve these issues. It’s fascinating that we’re all getting there by different means, but having a collective conversation will allow us to figure out a path forward.  

Melanie: Is there a friction point that you bump into as a clinician that never quite shows up at the executive strategy meeting? 

Danny: Absolutely. We’re all dealing with the patient portals and messages that come at the clinicians, and the number of things that are coming into the in-basket aren’t really something that is measured … but we all understand that this can be 50% or more of your job, just managing your in-basket, and that will never show up on a balance sheet on any executive’s summary. 

We have triage nurses that will help triage the patient, and then that layer helps us then decipher, okay, when they’re pulling me out of a room, when the nurse is pulling me out of a room, it’s because they’ve reached the top of what they can do, and they’re asking me to take over at that point. But those are very few. 

So, this stuff requires teamwork and collaboration for us to get through our days.  

Melanie: Let’s take the friction a little deeper into the medication area. We’ve talked about how friction is when a patient is delayed in some way from getting their care. What do you see as the most common reasons medication doesn’t move forward after a visit?  

Danny: There are so many. Probably the most common are incomplete documentation, incorrect diagnoses, and missed clinical content. Prior authorizations are extraordinarily complex because the rules centered around them are complex, too, and that whole process to get these medications approved for our patients is completely invisible to them. Yet there’s so much work that happens behind the scenes each time we sign off on an order. And when there’s missing clinical documentation, it triggers manual review to fill in the gaps. 

Melanie: I’m sure this happens a lot. The patient calls to say, “I can’t get my medication.” What’s happening behind the scenes when you get that call?  

Danny: We begin a manual process review: Did we miss a fax? Did we miss a notification? We want to understand why they didn’t get it, and if they were denied, then start the manual process of appealing that decision. In my experience, most patients won’t call us to say they never got their medication. They just won’t take it. They’ll suffer in silence. This leads me to my next point, which is when I know I am facing a prior authorization, like on a GLP-1, I will look the patient in the face and say, “If you do not get this medicine in 48 or 72 hours, you need to let us know.” I don’t know if they were turned down or approved unless the patient tells us, right? And I don't find out until the next time I see the patient.   

Melanie: Let’s dig a little deeper into the data. It strikes me that trust is incredibly important around the accuracy and timeliness of data. Does that resonate with you?  

Danny: Absolutely. We’ve all been on electronic health records now for decades. Let’s face it, this is not new stuff. We capture diagnoses, lab values and medication histories as discrete values. We know in the patient’s chart what they’ve done, what they have, what their current problem list is, what their current therapies are, and what they’ve tried in the past. We have this discrete data, but we don’t send it anywhere, right? At the time of prescribing, we should package everything we’ve been capturing, package it together and send it out. And then from the pharmacy benefit side of things, they have a process where a person must review it. What if we could just check all the boxes, and then the pharmacy benefit side sees that all the boxes are checked and approves the medication.   

Melanie: Let’s talk about AI. We can’t have a conversation about technology and healthcare without talking about AI, right? So, from your perspective, where is AI genuinely helping healthcare right now?  

Danny: Ambient notes has been a huge burden reduction for our providers. I hear from them regularly about how much this technology has impacted their day, to go home on time, and not have to log in on the weekend to complete notes. The mental fatigue of carrying information in your head until you finally write the note has been alleviated. It’s tailored and curated to the conversation you’re having with the patient, and that has been a huge boon for our providers. Ambient AI allows you to have more human contact with your patient, maintain eye contact, make sure the patient is listening, and you give feedback as they’re talking.  

Melanie: We’ve talked a lot about the potential impact of technology on patients and those who care for them. We’ve brought the patient straight into the discussion, but let’s bring the patient back in even more closely. When technology is working as intended, it helps keep patient care on track, but when care doesn't stay on track, patients feel it right away. So, after a visit ends, where do you see patients struggling right now to follow through on their care plan most?  

Danny: Oh, that’s a variety of things. I can start with access to specialists. That’s often a delay in care. We all work as hard as we can, and I'm not pointing fingers or blaming, but there aren’t enough specialists for some areas of the country, and it could be long waits to see somebody. That can be a struggle. 

We talked earlier about prior authorizations, and patients not understanding where they are in the prior authorization process can be really frustrating. I’ve said this in a number of venues: You place an online order, and it tells you how far along your order is, and when it’s ready for pickup, right? You’re never in the dark about where your order is for your latte. We need to do something like that with the prior authorization process. We need to say, “Okay, your medication was filled. The PBMs have it. Here’s the decision that they made. And now the pharmacy has it, and it’s being dispensed.” There are all these stages, and none of us know what the other is doing. It’s completely opaque to the patient and the provider.   

Melanie: I completely agree. We call it the “pizza tracker.” I think the “latte tracker” is much better, but we call it a pizza tracker. 

Danny: A pizza tracker, exactly. But we have this interface right now in a variety of things that we do. We order things online. We order an Uber ride. It tells you when the driver’s coming. You know the status of all the stuff that you do.  

Melanie: Right. So, where do the handoffs between clinicians, pharmacies, and payers create the most friction for patients trying to move forward? 

Danny: Oh, there are a variety of places on that. I think we can all share a level of blame on that part of it, and to what I said earlier, the ongoing dialogue between all parties involved is an important process to help knock those down as much as possible. But I don’t have a simple answer because it’s complicated. 

Melanie: If you did, we would’ve fixed it by now.  

Danny: Exactly. If it was easy, it would’ve been fixed.  

Melanie: Looking back, what’s one thing the system could do better to help patients actually complete the care plan you agree on together? 

Danny: Being more transparent about the process with our patients, having patients get a better idea of an order or medication or referral that we’ve placed, where it is in the process. Also, after an appeal, letting patients know that we hear them, we’re appealing, and this is where we are in that process. 

Melanie: Right. I love how you’ve de-centered technology, because that’s the magic of your role and your work—you put the patient in front, and you did that from the very beginning of the conversation. Usually in these kinds of conversations, technology takes the front stage, but it’s really about the patient. It’s all in service of the patient. So, let’s end our conversation today with a little more of that. When you imagine the patient experience in the years to come, what’s the one thing you hope patients never have to think about again … because technology got it right? 

Danny: I love to be able to look a patient in the face, as you go through the electronic prior authorization process, and get an answer back before the patient leaves the clinic or hospital. It’s the best feeling to let them know it was approved.  

Melanie: Well, thank you, Dr. Lee, for grounding us in what really matters—the patient and the clinicians who care for them—and for building what comes next, so that we can keep patient care on track. It was really a pleasure to have you on the show. 

Danny: Well, thank you. 

Melanie: That was Dr. Danny Lee, a physician and chief medical information officer, and one of the most grounded voices I’ve heard who lives and works at the intersection of healthcare and technology. What struck me most is how consistently Dr. Lee came back to the exam room.  

For Dr. Lee, smart talk about healthcare and technology doesn’t focus on the strategy meeting, or the conference keynote, or the slick sales pitch. It’s focused on the actual exam room with the actual patient, and he called this his truth. And in this time of great enthusiasm around the potential of AI, it’s good to hear a voice remind us that technology is only as good as what happens in the exam room.  

A few things really landed for me in this episode. 

First, his idea of friction, not as a technical glitch, but as silence. When a patient doesn’t know what’s happening with their prior authorization, their medication, their referral, the silence that results is a sign of system failure, and it’s invisible to everyone except the patient. Often, as Dr. Lee told us, what ends up happening is that the patients just don’t take their medication. 

They suffer in silence. That’s the human cost of friction. Second, we talked about AI. There’s a notion that ambient AI is just another productivity tool, but it’s more than that. When the doctor doesn’t have to type, when they can look the patient in the eye, when they can listen to understand without worrying about charting later … that’s putting the human back in healthcare, as Dr. Lee put it so well. So, I’ll leave our listeners with this: The best technology is the technology patients never have to think about. That’s the better way.