[MUSIC] Hello, welcome to today's round table forum. I'm Nicholas Genes. And today's topic is going to be health IT from the hospital perspective, our experiences trying to enable patient interactions with electronic health records, wearable devices, and apps. With me today Sudipto Srivastava, Senior Director of eHealth and IT, Mathew Grob, Senior Director IT Governance, and Dr. Ashish Atreja gastroenterologist and app developer. Ashish, let's start with you. You've had a number of successes and challenges in bringing your vision of how patients can interact with a hospital. Can you tell us a little bit about your work? >> Sure. As a director fo the Sinai AppLab, we started in-house innovation lab at Sinai four years ago. And one of our key platform is remote monitoring platform called Health Promise. We initially started in IBD patients, inflammatory bowel disease, and the goal was we see patients once or twice a year. And that's 0.5% of the time to engage with us. But many things that happen, happens at home or at work when they started to get worse. And the goal was that by providing a connected platform, we can see how they are doing symptom-wise at any given stage. So we can proactively provide their care. I think one of the real success was when we started doing focus groups of the patients we give them a score based on how they evaluate themselves and before that we ask them whether their disease was really controlled or not. When they really found the objective score, which was different than they actually guess, few people had tears in their eyes. >> That they were controlling their symptoms better than the doctor. >> Yeah, and that they had objective score which actually told them how they were. And they thought that was very empowering, it was that gives them an activation and kind of a confidence that they know where they are. Because the number one challenge we found was that they didn't know what is going on with them. Whether they are completely control, not control, and they're in this confusing stat and immediately having one score. And while we were going to multiple features which we talked are very flashy, it's that score thing that really kind of hit the mark out there. So I think part of it is really talking to the patients very early and saying, even if we haven't worked fully the concept or the app, and learning from them, and three of those patients from the focus groups actually helped us design the app for them. And we thought we started walking the journey with them,and learning from them. I think that was very empowering for my programming team, as they were seeing the patients were designing with us and very empowering for patients because therefore they are designing a new kind of health care delivery with us together, as a partner. So I remember that moment, a little teary moment, but it was really kind of an ah-ha moment for us. >> Do you think, you've been head of the AppLab now for many years, the pace of innovation and your efforts to introduce this on an enterprise wide, as they say, throughout the hospital, are things happening at the right pace? Do you think they could be going faster? What do you think? >> You know they can always go faster. I think it's amazing. Our mission is that no patient gets left behind. And while there is an innovation capacity that needs to be built, I think where we and many other health systems are really kind of lacking is innovation delivery. As soon as we prove there is a concept that works in 30, 50, 100 patients, way to build our muscle, our strength in our health systems to be able to disseminate that innovation and think of it when electronic medical records scan, there's a whole army of support people that came to deliver electronic medical records, right. Without that, you cannot just deliver electronic health records in any health system. I think that's what our challenge is. We need to develop a similar kind of army to deliver new technologies, innovation across our health system. And I think that's something we're working on, but we haven't really kind of solved the puzzle. >> You know, Ashish brings up a very important point and in relating this to when electronic health records were first deployed, it was represented massive change. But that change was largely for the providers. And what we're looking at now with digital medicine and eHealth is again massive change. But now it's affecting other areas including our patients. And so the amount of change that is build into that is really needs to be considered and when we think about how we're going to deploy it. As well as when we look at it from a financial perspective because we still need to keep the lights on and doing everything that we're doing today, but care delivery is transforming based on the new technologies that are available to us. And we need to keep pace with it at the same time continuing to keep everything else running along the way. >> That's right. IT isn't always glamorous new technologies, it's as you said, keeping the lights running, the networking, the telephones, lot of basic essentials. >> Yes, Gardner Research categorizes IT spending to three categories. There's run, which you need to run the business on a day-to-day basis. What you need to grow the business from a scale perspective, so if you want to increase volume which we need to do for that. And then transform. And what do you need to transform the business? And typically that run piece of the budget is the biggest, followed by grow and then transform. And our mission as it were, is to see how can we run more efficiently and reduce the cost of run by incorporating other technologies, new technologies. So cloud technologies enable us to shrink that run portion at least in the capital budget so that we can focus more on the grow and the transform. >> I see, I see. So in answer to our earlier discussion, I mean when patients are getting frustrated that change is not happening fast enough though, at least that's one high-level way we can kind of explain it to them that there's just maintaining the current operations is still a huge factor. >> Well, we have, I'm used to explaining this to people and I think this is what patients go through, and this has come up in many, many discussions. When patients go from one, they go to see one provider, and they provide all their information, and then they're referred to a specialist and they have to provide all the information again. And then they're referred for a procedure and they have to give the information again. At the same time, I can take the card that's in my wallet and go to the other side of this planet, put it in the machine, put in four digits, and get local currency instantly debited to my account within seconds. And we can't say yes, we know that you're allergic to penicillin along the care chain efficiently. >> Well we're getting there. >> We are. >> This is a great conversation. I guess over the last several years, we've had the opportunity on the eHealth team to try to roll out any of these digital health and eHealth initiatives. And if somebody were to wake me up at 3 AM in the morning and say what were the biggest challenges? There are a few words that really resonate with me. One is the word pilot. In many times we launch these efforts as that pilot. And that by definition makes it small scale, limited, and there's always the opportunity at the end of it, you can stop it. The second word is workflow, and I want to link them together. Because any time a pilot impacts your environment, if it doesn't address some of the workflow challenges that exist in the healthcare system on a daily basis, those pilots have a higher tendency to fail. So we're trying to sort of, pick, see more in terms of how can we take digital health solutions and bring them in a workflow environment that is absorbed, that is understood and also where change can be easy, both from a physician's perspective and also from the perspective of patients and so many other people that are involved, the administrators, the nurse practitioners and so on. So the other, so besides pilot and workflow the other words that again would come up at 3 AM in the morning would be risk and reimbursement. Because we are a very highly regulated risk-based industry in terms of making sure that nothing goes wrong. And that somehow forces us to be a little hesitant to new tools and technologies that may impact patient care slightly different. And those are the barriers that we're continually pounding against both along with our practitioners as well as with our consumers or the patients. >> You bring up a great point, and I sometimes think when we're talking about innovation and new cutting-edge electronics and devices, I think of Silicon Valley, and Facebook, and Apple and these companies. Mark Zuckerberg had said, one of the mantras that Facebook is going to be, move fast and break things. Is that something that can work in health IT? Is that something we can adapt, or learn from? Or should we try to stay away from that? Ashish, what do you think? >> So I think our mantra is move fast but don't break things, right? >> [LAUGH] >> So I think it has to be considered, as within the perspective of what risk you can take, right? So there's a concept that's coming in healthcare innovation centers that you, like we used to have clinical trial research officers, or CRC, clinical research coordinator to centers to set up an isolated kind of habitual medicine pilot space, which is away from patients, but you can have dummy patients or fake patients. Or you can have employees who can be like patients, especially for FitBit challenges and all, where you may not break, for example, many things per se. But I think, that's where the pilot concept started, where you want to have a little bit isolated pilot. Which, even if the workflow is not perfect and thing break, it doesn't impact the mainstream care delivery. And fortunately, I feel the pilot has gone where it is become so much secluded that it generalize ability of those pilots really become questionable. So I think from healthcare we need to loan that we don't need to move fast and we cannot just slow because innovation is happening so fast. But we probably have to make it healthcare specific and share a loan from other health care centers, whoever is doing a better way of doing it. >> That's right. Even when you have a successful pilot, it remains siloed. And other institutions might not benefit from it. >> That is correct. >> I think that the Facebook example highlights the differences in the environments. Facebook or other company, any company like that, they are technology company and their mission is to innovate. And as an academic health system, we have a tripartite mission. Patient care, education, and research. And those are two completely different things, except for the innovation part, but we're not set up, typically health care providers, health systems, are not set up to innovate at the speed of a technology company. It's not in our DNA pardoned upon, and so it's a new muscle that we've had to first build and then exercise. And we'll never be able to do it at the speed or with the resources that a technology company like Facebook has, but it's important that we learn from what they do and be able to apply that to our environment. >> But when we talk about disruptive technologies like maybe wearables or apps and sharing data between patients and providers. The word disruptive implies that workflows are going to have to change, that doctors, nurses, support staff and patients might have to get used to doing things differently. Because it's patient centric, we understand that it will hopefully be beneficial to the patients but getting the organization to realign itself and change it's perspective is not something that can happen overnight and not something that can happen over and over. >> Well and you have to remember that something that effects both us and the technology innovators are the regulatory environment in which we operate. So a few years ago, at the consumer electronics show in Las Vegas, the first time they had a digital health or e-health component to it, the vendors and the tools that were there were not really terribly exciting. They were not doing anything new or innovative and when asked, the vendors said, we can do all these incredibly cool stuff but it requires FDA regulation. And we're not there yet. We're not at the point where we're ready to support that. Now that has evolved, and we're starting to see more eHealth and digital health tools that are FDA approved or follow the guidelines. But it's a much more difficult, much more rigorous, much more expensive way to do things. >> Yeah. >> And it's an interesting trend that we're starting to observe, particularly as you empower the patients or the consumers who are to take action. So you give them all this data and what will they do with this data? So all the data that they're cracking, all the glucometers that they have implanted in themselves and we were already starting to see how there is a trend line that you can draw. And almost predict that, when a patient has all that information handy with themselves, they'll have better conversations with their physicians. They'll have a better conversation with their friends and neighbors about health, about keeping themselves healthy and hopefully even keeping them outside of the hospital system. But is slow incremental change that takes in the healthcare setting, we wish we were like Facebook and move that fast. The other advantage that Facebook and other organizations have is that they're dealing with the spectrum of the population that tends to be somewhat younger. And I think with healthcare, we often deal with patients who are at sometimes at age spectrum or a social economic spectrum that does not lend them immediately to you embrace digital health and technology. But that's a bandwagon we've gotta join because some of the younger people are eventually going to get older and we will have to evolve at that point. >> As I say, Sadipto raises a very interesting point because the impact of the age of users on, as the industry evolves. So the people who utilize healthcare the most, today are the people who have at least degree of comfort with technology. Older people today, my mother who's in her 80's, who's never used a computer and doesn't even use an ATM, yet she's a very high consumer of healthcare versus people for whom technology has been with them since the womb, but they're not necessarily high utilizer of health care. They may be interested in some eHealth applications for fitness and for wellness, but there's not a lot out there for them right now in terms of their specific healthcare. But we're seeing that shift, so as the population that is comfortable with technology gets older, starts becoming higher utilizers of healthcare, we'll see that start to shift, and I think that will speed, the acceleration. Speed that will accelerate the adoption, thank you, of these tools and technologies. >> If I may add, just one thing that we all can not be better to the speed of Facebook but we can be better innovation adopter, right? So instead of we becoming like Facebook, all our technology company, we can partner with them and a lot of the stuff which we are doing and eHealthdo a market scan on what is coming out outside. And we can assimilate that technology. So, if we are not developing we sometimes under-recognize the value of taking great innovation developed outside, adapting it and making a difference within our health systems. And I think that's where health systems really can get the bang out of their buck, in terms of innovation delivery capacity. So, we cannot just take the technology because we are under HIPAA laws. As soon as any technology touches our patients, which Facebook is not, but think of how we are doing Facebook chats. Or we partner with independent organization who are not health systems. And we give talks in the Facebook and patients come in the Facebook chats, right. So we are able to reach out and deliver the same kind of care we want to or the knowledge using those technologies right. Yeah. >> And Ashish brings up a great point, and the part that comes to my mind immediately, is it's almost like a business decision, as well. Because, we're thinking sometimes, sitting in our ivory towers looking at healthcare systems that, this is where patients will come. And when you talk about areas like wellness, and fitness, and so on, they don't need to go to a hospital. They don't need to see, patients don't need to see doctors. And maybe a whole industry evolves around that. And who knows, five, seven, ten years from now, that's the source. I mean, they can match up the data and that can be the source of projecting their and predicting their healthcare outcomes. And hospitals may not be hospitals. I mean, it could be, when you think of enterprise scale, you think of Walmart or CVS as places where people tend to go for majority of their health kit. So, it becomes both a business and paradox, we have to make sure that you know, these tools find room for growth within our ecosystem. >> All right interesting stuff. Thank you so much. Thank you to our panelist, Dr. Shi Shatrasia, Matthew Grove, I'm Nicholas Genes, thank you for watching. [MUSIC]
