229: Inova Health's CHIO Dr. Andrew Miner: 50x IT Adoption Through Physician Bonuses, The Reason Ambient's Biggest Win Isn't Time Savings, and Why Your EHR Will Soon Know Your Patients Better Than You

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On this episode of The Digital Patient, Dr. Joshua Liu, Co-founder & CEO of SeamlessMD, and colleague, Alan Sardana, chat with Andrew Miner, MD, Chief Health Information Officer at Inova Health, about "50x'ing IT Adoption Through Physician Bonuses, The Reason Ambient's Biggest Win Isn't Time Savings, Why Your EHR Will Soon Know Your Patients Better Than You, and more..." Click the play button to listen or read the show notes below.
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Audio:

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Guest(s):

• Andrew Miner, MD, Chief Health Information Officer at Inova Health
• Joshua Liu, MD (@joshuapliu), Co-founder & CEO at SeamlessMD

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‍Episode 229 - Show Notes:

[00:00:07] Episode preview

[00:05:14] How moving from emergency medicine to health IT requires relearning risk — clinical culture demands near-zero tolerance for failure, but effective health IT leadership requires willingness to fail fast and learn by doing. Dr. Miner notes the tension directly: "when you're a patient, you want your doctor to be careful, conscientious, thorough, maybe even a little bit of a control freak" — the same instincts that work at the bedside can hold you back at the system level.

[00:06:25] How society's expectations of AI accuracy have shifted in the last two years — early assumptions held that clinical AI would need to be perfect before deployment. Dr. Miner has observed a change: patients and clinicians now come with the expectation that AI isn't always right and that checking its outputs is simply part of the deal.

[00:07:51] Why a bonus-linked EHR training model produced a 50x increase in smart user course completions — Inova's incentive-based training program ties physician bonuses to completed EHR training, providing what Dr. Miner describes as the priority bump needed to turn "eating your vegetables" training into action. Modeled after a program first developed at OhioHealth by Mike Kramer, it offers multiple formats — on-demand videos, one-on-one sessions, and credit for applying learned tools — to accommodate different practice styles.

[00:09:38] Why ambient AI was added to Inova's EHR training incentive program — even when colleagues describe significant time savings, adoption still requires crossing a productivity dip. Inova now rewards ambient AI training completion and even first-time use through its incentive metrics, recognizing that the activation energy to try something new is real, even when the case for it is strong.

[00:12:02] What ambient AI is actually doing to the clinical encounter — Inova found that clinicians consistently overestimate how much time ambient documentation saves them relative to what Epic data shows. More meaningfully, the team saw improvement in Press Ganey scores on the "physician took the time to listen" question — suggesting that patients are experiencing a different quality of interaction, not just a faster one.

[00:13:10] How ambient AI shifts documentation from authoring to editing — the cognitive shift from composing a note to reviewing and refining a draft makes documentation feel lighter, even when total time invested is similar. Dr. Miner describes the relief of no longer mentally tracking small details — like whether a laceration was a centimeter or a centimeter and a half — through an entire shift.

[00:14:10] Why unintended consequences of ambient AI require active monitoring — risks include over-reliance on AI outputs without adequate review, and patient consent concerns when clinical encounters are recorded without full disclosure. Dr. Miner points to cases observed nationally where patients were not properly informed that the interaction was being recorded, calling it a tough and avoidable consequence that requires explicit attention during rollout.

[00:17:25] How governance protects organizations in ways that often go unappreciated — governance functions as a resource allocation mechanism, ensuring limited capacity goes to the highest-value initiatives rather than being distributed arbitrarily. Dr. Miner describes a cultural shift he has seen: from clinicians feeling that decisions are "done to them" to feeling genuinely empowered to select what moves forward.

[00:21:32] How Inova frames capacity gains from technology as empowerment rather than intensification — the key distinction is ensuring clinicians feel they are moving as fast as they choose to, not being pushed faster from the outside. Dr. Miner's role is making technology work as a genuine asset: "as long as we're continuing to make it easier to do the job you did yesterday with another great tool, I think we're contributing well to that."

[00:23:24] Why the benefit of ambient AI looks different for every clinician — for some, the value is reduced cognitive burden and better wellbeing; for others, it translates to seeing more patients. Dr. Miner's approach is to provide the tools and allow each clinician to pursue the benefit that fits their situation — not to prescribe what the productivity gain looks like.

[00:24:49] Why removing friction from clinical systems has limits — medication warning alerts are a clear example: when 90–95% of alerts are overridden, they become background noise and clinicians stop attending to the important ones. Dr. Miner is focused on reducing low-value warnings so meaningful alerts are actually noticed, and acknowledges that AI-driven improvements to medication warning logic have been slower to arrive than expected.

[00:26:09] What AI still cannot replace in clinical medicine — the human relationship remains central. As patients gain access to AI-powered information tools, Dr. Miner argues that the value of the physician becomes more concentrated in the human elements: understanding priorities, building rapport, and earning trust. "Maybe they don't need the actual practical information from us quite so much anymore. They're really there for what we bring as humans."

[00:28:09] How clinicians have always used reference tools — and why AI is a continuation, not a rupture — from pocket reference books to UpToDate to AI, consulting external sources during care is not new. What changes is scale and accessibility, not the fundamental dynamic: the clinician still orchestrates, interprets, and decides what information is actionable and appropriate for the patient.

[00:29:44] How Inova manages shadow AI tool adoption and PHI risk — the health system has explicitly educated clinicians that a vendor's HIPAA marketing claim does not equal an enterprise BAA. Inova's parallel response is to accelerate vetting and provision of safe alternatives, ensuring clinicians do not need to go outside the system to access tools they want.

[00:33:12] What Dr. Miner expects will be as obvious in 10 years as ambient documentation is today — the inversion of clinical authority over patient data. Today, clinicians assume they know the patient better than the EHR. As data accumulates and systems mature, the EHR will become the more reliable source for many aspects of the patient's story. Dr. Miner sees this as both an opportunity and a "humbling change" in how clinicians understand their role.

[00:34:54] Why Dr. Miner is skeptical that AI can substitute for human connection — AI companionship and therapy tools may offer temporary comfort, but he argues they cannot replace genuine human relationships. His analogy: "If AI relationship is like drinking glucose water... it could sustain you for a little while, but it's not like a full diet." He expects this limitation to make authentic human connection more valued, not less.

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‍Fast 5 Lightning Round:

1. What is your favorite book or book you’ve gifted the most?
   "The books I've gifted the most have all been sort of children's literature books... The Winnie the Pooh series, the original A.A. Milne, is just brilliant. Robert McCloskey's books are gorgeous. Recently, Mo Willems and the Knuffle Bunny series... anything by Mo Willems is just brilliant."
2. If you could instantly master any skill, what would it be?
   "Languages are probably not that for me. So if I could be fluent in every language, snap of the fingers, I would definitely do that."
3. Would you rather have Super strength, super speed, or the ability to read people’s minds?
   "Definitely super speed. Time is our greatest asset. If I could make more of that, that would be fantastic."
4. What is something in healthcare you believe others might find insane?
   "The expectation that we never make mistakes... We're human and we've gotta build systems that make us safe. I wish all of us had a little more appreciation for the fact that it's a job performed by humans and you need those safety checks and those backups and it's really not all on the person when something goes wrong."
5. What is the last movie or TV show you saw, and what did you think of it?
   "The L Word by Dr. Gita Pensa, who's an emergency physician who... chronicled her experience going through a lawsuit... It's gotta be a must listen for anyone who's working clinically and has any discomfort about the idea of making a mistake or ending up in a legal situation for it."

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