John R. Dayton, MD is an emergency medicine physician with Intermountain Health in Utah. He was the first Medical Innovation Fellow with Stanford's Department of Emergency Medicine, where he also completed a Biodesign Faculty Fellowship and works as an assistant professor. Dr. Dayton has held local and national leadership positions with the American College of Emergency Physicians and co-founded Utah's chapter of the Society of Physician Entrepreneurs. Dr. Dayton works as a physician advisor for Zus Health and serves on advisory boards for NODE.health and AngelMD.
Dr. Dayton is an expert at bringing his interests in digital health, AI, entrepreneurship, and medical devices to his daily clinical practice. Doximity recently asked Dr. Dayton how physicians can become entrepreneurs and innovators, his views on AI and EMRs, and about recent advancements in emergency medicine.
Doximity: Any interesting stories on how you first began working with Zus Health?
John R. Dayton, MD: Sometimes you need to push yourself outside of your comfort zone. I love my advisory role with Zus Health, but I didn't get that job through a traditional application process. I read Jonathan Bush's “Where Does It Hurt?: An Entrepreneur's Guide to Fixing Health Care” several years ago and was inspired to get more involved with digital health. When I learned that [Bush] left Athena Health and was building a new company focused on health care data interoperability, I reached out to anyone I could find on social media associated with his new venture. I sent messages making the case for including an emergency physician on their team because no one understands the pain point of having a sick patient without any available medical history like we do. I offered to do some pro bono research and work with their product team to create an ideal physician user experience. Eventually, I was offered a part-time gig as Zus Health's physician advisor. This has been a great position because their team is dedicated and interesting, and I've been able to work on something that will make shifts easier for our colleagues. I also believe that innovation prevents burnout because we mentally shift from seeing health care companies controlling us to identifying opportunities to improve medicine.
Dox: What advice would you give to physicians who want to become physician entrepreneurs and health care innovators?
JD: I recommend joining health care innovation communities, connecting with people who have similar interests, and obtaining education on topics that interest you. Most of the best resources on these topics are outside of specialty society events and traditional CME. If you want to advise startups, connect with local incubators and university technology transfer offices. If you are interested in angel investing, reach out to your local angel group(s) and ask to attend their next pitch meeting as a guest.
Some of the best physician innovation communities include InnovatorMD, StartUp Health, the AMA's Physician Innovation Network, and the Society of Physician Entrepreneurs. These groups host live and online events featuring talks, founder stories, and pitch events. LinkedIn groups like Digital Health and Slack communities like Health Tech Nerds offer a great way to connect with other professionals who have similar interests, learn about new ideas, and find mentors.
In addition to finding new communities and curricula, I recommend attending health care conferences focused on your area(s) of interest. If you want to learn more about health care innovation and technology, check out a HIMSS event. If you are interested in emerging medical products and want to connect with startup teams, you should check out HLTH and ViVE. These events are great for education, networking, and providing context for how our specialty contributes to a patient's overall health.
Dox: If you could use AI to take over any daily task in your EM practice, which one would you choose and why?
JD: I don't see AI "taking over" any part of my practice, but I would love to use this emerging resource to save time with administrative tasks, decision support, and charting. I agree with Dr. Jesse Ehrenfeld, AMA President, who said recently that "AI will never replace physicians — but physicians who use AI will replace physicians who don't."
I recently wrote a piece with Drs. Nicholas Ashenburg and Christian Rose about potential uses for large language models, like ChatGPT, in emergency medicine for ACEPNow. Opportunities include customized patient discharge papers, medical education resources, and research assistance.
Dox: What’s your least favorite thing about most EMRs — and how would you go about improving them as a medical innovator?
JD: I need to be diplomatic in how I answer this question. While most EMRs were built more for billing than charting, I also work many overnight shifts and value having access to a patient's old records and EKGs. However, EMRs could move from being a task to becoming a resource if they adopted recent technology. For example, AI could match patient data with practice guidelines to generate treatment recommendations and decision-support tools. Similarly, the addition of health data interoperability could save time, improve chart accuracy, and improve patient outcomes.
Although most major EMR companies talk about data interoperability, their business models are still based on siloing information. Rather than providing access to a health information exchange, or amassing a collection of data from other facilities, I'd love to see an EMR use multiple sources to create one graphic that trends a patient's lab work. I want to see technology that combines patient records from various sources, integrates that data, and displays all of a patient's ICD-10 diagnostic codes on one screen. Ideally, we'd have an accurate list of which medical problems are acute or chronic and which of our colleagues most recently treated each concern. Finally, I'd love to see an EMR utilize multiple sources to provide one updated list of prescriptions, and indicate which meds were prescribed versus which were actually filled.
Dox: What new discoveries or advancements are you most excited about in emergency medicine?
JD: As health care continues to evolve, I'm interested in how our specialty can improve the integration of acute care with prehospital systems and post-ED care. Because EDs manage 140 million visits a year, we need to lead the hospital-at-home movement. Dr. Jared Conley's team did an amazing job making the case for this in NEJM and discussed what this would look like in terms of equipment, treatment teams, and logistics. We don't need another pandemic to show us that hospitals quickly reach maximum capacity. We should leverage telehealth and innovative treatment delivery models to address our patients’ needs.
In addition to exciting new technology, I'm also interested in how EDs can promote product development and innovation. I was lucky enough to co-lead an incubator for Stanford's emergency department with Dr. Ryan Ribeira. We set up a process that hospital departments can use to set quality improvement priorities, evaluate companies addressing those needs, pilot their products, and help speed market adoption through usability studies. Health care startups need to connect with physicians to gain high-level feedback and pilot opportunities for their innovations, and because hospital departments have teams dedicated to improving the quality of care and equipment procurement, our goal was to build a program that met both needs. The innovation team leads an annual conference and pitch event to connect with health tech companies and partner with ACEP and the Emergency Medicine Innovation Collaborative to share best practices and host an annual hackathon that addresses pain points we face in emergency medicine.
Because emergency physicians treat all patients, I'm also interested in finding ways to customize that care to individuals. With this in mind, I'm interested in how AI models can be developed to ensure that all patient demographics are represented. Additionally, I'm interested in making sure that social determinants of health are addressed during patient care. I'm a fan of companies that partner with health care systems to utilize EMR data in order to identify health care disparities. Also, because I don't know how to code, I'm interested in companies that help physicians build no-code solutions that integrate evidence-based guidelines into their patients’ treatment plans.
Dox: If you had an extra hour in the day, how would you like to spend it?
JD: I'd like to spend more time with my family. They were amazing about moving for two years so I could complete my fellowship, and they've been supportive while I worked out of town with the Navajo Nation. Now that we are back in Utah and I'm working locally with Intermountain Health, I look forward to more athletic events, movie nights, and outdoor adventures.
Illustration by Jennifer Bogartz
