240: Lee Health's Jon Witenko: Why Ambient AI Stalls the Moment It Leaves the Ambulatory Clinic, Why He Stopped Waiting for the Perfect Smart Room, and 60-Second Pitches to Get Your Project Funded

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On this episode of The Digital Patient, Joshua Liu, MD, Co-founder & CEO of SeamlessMD, and colleague, Alan Sardana, chat with Jonathan Witenko, System Director, Digital Transformation at Lee Health, about "Why Ambient AI Stalls the Moment It Leaves the Ambulatory Clinic, Why He Stopped Waiting for the Perfect Smart Room, 60-Second Pitches to Get Your Project Funded, 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):

• Jonathan Witenko, System Director, Digital Transformation at Lee Health
• Joshua Liu, MD (@joshuapliu), Co-founder & CEO at SeamlessMD

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‍Episode 240 - Show Notes:

[00:00:07] Episode preview

[00:03:57] How the Room of the Future grew from a TV project into a full program — it started years ago as someone else's initiative to engage patients on the in-room TV, and Jon watched it from afar. Once the team got into it, the operational elements surfaced: it wasn't just technology. "Sure, we can throw on a application onto the TV and put movies on there. Yay, thumbs up. But it really had the power to do much, much more." Adding Epic integration, surfacing clinical information about what's happening in the room, and then telehealth — virtual nursing, observation — turned a small, palatable project into a giant program, with the complexities of money and time that come with it.

[00:05:12] Why they stopped designing for the future and built a core they could layer onto — if you're ripping down walls to mount a TV, you don't want to do construction three times, so it all had to happen at once. That pushed the team into paralysis by analysis: "Well, okay, in 20 years we'll have holograms." Eventually they called it — enough's enough, the foundational components are known. Infrastructure, camera, TV, microphone, speaker. Ambient dictation wasn't a thought four years ago when they started, and it layered onto that same infrastructure. So does screencasting, voice assist, and an incontinence sensor that connects by USB or Bluetooth without damaging the room or displacing a patient.

[00:07:13] What makes ambient documentation harder inpatient and in the ED than in ambulatory — Lee Health started ambient dictation in ambulatory two years ago as an early adopter with Abridge, client number three, after running virtual scribes and human scribes before that. Ambulatory is cut and dry: a single encounter, a closed loop. Inpatient and the ED are not. Consent is the hardest part — Florida is a two-party recording state, and Jon spent an hour that morning with lawyers on where consent gets captured and whether it's required every single time. The answer today is yes. If an ED provider leaves to get lab results and returns ten minutes later, do they re-consent? What if EMS or family walks in? "We've suddenly found ourselves in a paradigm of, are we gonna have to get consent 45 times a day." About 100 providers are live across inpatient, ED, hospitalists, and specialists while they learn.

[00:10:32] Why the informed patient is a better patient, not a harder one — physicians initially resented "Dr. Google," but Jon frames it as a trade: a patient who did the research is proactive, and the clinician can balance what they read against scientific fact and have a collaborative conversation. He recalls an ENT who dictated in front of him and said, "Hey, will you fact check me? I'm gonna say some stuff. If you disagree, stop me." It's rare, because it leaves the provider a little vulnerable, but it makes the encounter collaborative.

[00:11:49] The digital whiteboard that puts estimated date of discharge in front of everyone — Lee Health is replacing the old paper huddle whiteboard with a digital one showing the estimated discharge date. "This is not a threat that we're gonna kick you out in three days. It's a goal." If the patient, the nurse, the dietician, and lactation all walk in and see it, you start thinking about discharge at admission. The same logic extends to surfacing numbers patients never used to hear: "What's my IO? What does that actually mean? Is that good? Is that bad? Should I be trying for more?"

[00:16:01] Why medical jargon is a health equity problem, not just a communication one — Jon is an engineer by trade who grew up in healthcare and says he still only understands about 70% of what's said on *The Pitt*, while his family Googles terms beside him. He tells staff they'll hear things they don't understand and shouldn't be embarrassed to ask. The opportunity he sees in ambient: keep the medical record in clinical language, then render the same content at an eighth-grade reading level, in the patient's own vernacular if they speak another language, and into a flow sheet for nursing. "Read it to me like the snowflake, you know, the unique role base that I am."

[00:18:34] Why they took on the NICU first instead of saving it for later — the NICU is the most precarious and most unique environment, and the bet was that proving it there made everything else downhill. It forced real edge cases: twins in one room meant deciding whether to put two screens up or split the screen so you don't end up with 17 TVs, and multiples are increasing. An early proposal to wheel in a rolling cart TV got rejected outright — "We're going back to my elementary school." NICU also defied the standard content model: pain score is meaningless for a newborn, so feeding times and IO calculations get surfaced instead. Adult rooms, by comparison, are now easy and standard across the board. Jon's caveat: "Sometimes we're smart, sometimes it's just fortuitous and we get lucky." He can name projects where starting with the hardest thing burned the team out and failed.

[00:23:48] How you sustain a decade-long project through hurricanes and a pandemic — the honest answer is understanding the mission. Jon describes onboarding a fully remote team member from outside healthcare and telling him to take the afternoon off, drive to any Lee Health hospital, walk in the front door, sit in the coffee shop for 20 minutes and watch — and to listen for "Twinkle Twinkle Little Star" over the overhead, which plays every time a baby is born. "There's something different about healthcare, and you have to see it to understand it, to appreciate it." People are having their best days and their absolute worst days.

[00:26:00] What eight hours shadowing case management taught him — Jon spent a full day at an older campus with the case management team, Undercover Boss style; they told staff he was a prospective nursing student. He watched them work with a patient who was homeless, had been kicked out of a halfway house, was estranged from family, and had medical complications — coordinating not just physical care with the physician and translator, but emotional, spiritual, and holistic care, down to a free Lyft pass and a meal ticket. "I just wanna understand your role. Help me understand, because then maybe, who knows, maybe I can help you."

[00:27:35] Why he goes back to the hospital when motivation runs out — sitting in a patient's journey is the reset. He points to the 12 pieces of paper taped on the wall, half hanging off, some contradicting each other, and the whiteboard that doesn't tell you the nurse's name, so you have to walk out to the desk. "Oh my goodness, this system is broken. We have a solution that could fix it." Is it perfect? No. Do we have a solution? Yes. "All right, get motivated again."

[00:29:40] What two texts in one week told him about the gap between vision and reality — one was from someone thanking him for an on-demand telehealth visit she took from her bed while her husband paid twice as much at a walk-in clinic. The other asked why she was wearing an armband a week and a half before surgery. The cause: the hospital doesn't stock the paper armbands, only the lab does. "I'll buy the paper. Is it really that hard?" He was told to walk away, that it wasn't worth the fight and wasn't his area. He hasn't fixed it.

[00:31:56] Why health systems should be asking "should we," not "can we" — Jon notes he's seen a lot of organizations discover that "the cost of AI is really high, and it's actually more expensive than the labor that we got rid of." Lee Health went live with an agentic voice agent the day before, and the first question on everyone's mind was "Am I gonna lose my job? Am I next?" His answer: the agent is making the calls nobody makes today — like checking in with a patient three days after discharge to ask how they're doing and whether they understand the meds they went home with.

[00:32:52] How his own colonoscopy scheduling became the case for redesigning workflows instead of digitizing them — a nurse called with ten screening questions, then couldn't move his appointment because she didn't do scheduling; a customer service rep had to call back; they played phone tag for two days; and the next day a new nurse ran the same questions again because he was now a new patient. He asked the nurse if she liked the work: "No, I'd like to be in the OR. I like to help patients. This doesn't fill my bucket." That's the should-we test — take away the work people don't want to do. And before automating anything, ask whether the task is needed at all. "Could we get AI to make the bracelets red? Sure. Do we need red bracelets?" Sometimes the answer is to build a field in the chart rather than spend $100,000 on AI.

[00:37:32] The ethical line he isn't ready to cross — the practical questions are the easy ones; the harder question is how much of the human experience to digitize. His chief of foundation framed it for him: if I'm asking you for a $50,000 donation, do you want me to look you in the eye or send you an email? The same logic applies to care. "Some of those positions are sacred, or those relationships are real." Jon has five kids and still knows Shannon, the nurse who was there for his first and third. "I don't know the name of the AI agent at Comcast when I call." Some of these conversations, he says, are about whether to open Pandora's box at all.

[00:41:07] Why storytelling is most of the job — Jon says a lot of his role is sales, even though he isn't a salesperson: he has to sell a vision. He teaches a healthcare IT MBA class where the assignment is a 60-second elevator pitch, on any idea at all. "If you can't explain your concept in 60 seconds, I'll never get it." A chief with a couple hundred emails doesn't need every detail — they need the mechanics, the value, and a rough napkin sketch, enough to say "I trust John enough" to give you the time, the money, and the rope to try. He cites the Cleveland Clinic "walk a mile in a patient's shoes" video shown at every new hire orientation, which he's watched roughly 50 times and cries at every time, and Maya Angelou: "They'll remember 20% of what you said, but they'll remember forever how they felt when you said it."

[00:45:17] The personal story behind the work — Jon's daughter fell and cracked her skull. He isn't clinical, so he texted a friend who's an ED physician, who asked whether she was leaking CSF out of her ear. "I don't even know what you just said. She's screaming, there's blood, and it hurts." At the hospital, with no pediatric neurosurgeon on site, the plan was a helicopter to Miami — complicated by five kids at home, including newborn twins. Then the doctor came back holding a piece of paper: "Some IT wizards just figured out how to connect us with the pediatric neurosurgeon." Jon had been one of three people who built that connection and had trained that physician. His daughter was the first patient to use it. She stayed local in the ICU for four days with remote neuro checks and CT review.

[00:50:22] Why that moment turned an employee into an agent of change — when Jon came back to work asking how to do more of it, he was told it was a one-and-done and to move to the next project. "No. I'm in. I bought into the mission now." He'd been there seven years and had never really experienced the system from the inside. He raised his hand for the next opportunity, pitched a tele-stroke program he'd seen on TV, bought the algorithm, and built the carts in his garage because he was personally invested. "I can be an agent of change rather than just, here's another I checked off a box and I did another task."

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‍Fast 5 Lightning Round:

1. What is your favorite book or book you’ve gifted the most?
   Simon Sinek's Start With Why
2. If you could instantly master any skill, what would it be?
   "Ability to speak any language."
3. Would you rather have Super strength, super speed, or the ability to read people’s minds?
   "Honestly, none of them. If I could read people's emotions a little bit better, I would love that."
4. What is something in healthcare you believe others might find insane?
   "I think the predictive and personalized medicine of tomorrow. Will be able to ingest a nano pill and get real-time insights of what's going on in my body."
5. What is the last movie or TV show you saw, and what did you think of it?
   "The Pitt... it's just phenomenal!"

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